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目的:初步探讨磁共振弥散张量成像(DTI)及皮层电刺激在涉及运动通路脑肿瘤手术中的联合应用价值。方法:采用GE1.5T MRI成像系统,对6例临近运动皮质及锥体束的病变(Ⅲ-Ⅳ级胶质瘤1例,Ⅱ-Ⅲ级胶质瘤1例3例,Ⅰ-Ⅱ级胶质瘤1例,炎性假瘤1例)进行磁共振DTI检查,用dTV.Ⅱ软件进行处理,显示部分各向异性图及彩色部分各向异性方向(FA)图;并采用种子方法重建双侧皮质脊髓束的三维纤维束成像图,评估纤维束的移位、连续性及破坏情况。在气管插管静脉复合麻醉下开颅,神经导航解剖及边界定位;经过术中麻醉唤醒,在清醒状态行皮质电刺激确定额叶运动区及可能的皮质与皮层下脑组织切除范围,在保护脑运动功能的前提下切除肿瘤。结果:6例肿瘤FA图显示良好,纤维束重建后4例可见锥体束的消蚀破坏,其中3例伴有变形及移位;2例可见锥体束的单纯变形及受压移位。6例肿瘤均成功获得神经导航定位并确定肿瘤边界及其与运动功能区的关系;显微镜下全切除肿瘤4例,次全切除2例,术后肢体运动功能同术前或较术前好转4例,偏瘫加重2例,经治疗于1周内恢复术前水平。无其它手术并发症。结论:DTI可以清晰地观察瘤体、功能区及白质纤维三者关系,辅助术前手术方案的制定。皮质电刺激可实时定位额叶功能区,最大限度保护运动功能。二者的有效、合理应用有助于更安全准确地切除肿瘤,提高涉及运动通路脑肿瘤病人术后生活质量。
Objective: To investigate the combined application of magnetic resonance diffusion tensor imaging (DTI) and cortical stimulation in brain tumors involving motor pathway. Methods: The lesions of 6 cases of proximal motor cortex and pyramidal tract were examined with GE1.5T MRI system (1 case of grade Ⅲ-Ⅳ glioma, 1 case of grade Ⅱ-Ⅲ glioma, 1 case of grade Ⅰ-Ⅱ gum 1 case of Tumor and 1 case of inflammatory pseudotumor) were examined by magnetic resonance DTI and processed with dTV.II software to show the partial anisotropy and the color part anisotropy (FA) map. The seed method was used to reconstruct the double Three-dimensional fiber bundle imaging of the lateral corticospinal tract to assess the displacement, continuity, and destruction of the fiber bundle. After tracheal intubation and intravenous anesthesia, craniotomy, neuro-navigation anatomy and border localization were performed. After intraoperative anesthesia arousal, cortical electrical stimulation in the awake state was performed to determine the excision range of the frontal lobe motor region and possible cortical and subcortical brain tissue, Removal of tumor under the premise of motor function. Results: The FA showed good results in 6 cases. The destruction and destruction of the pyramidal tract were observed in 4 cases after reconstruction. Three cases were accompanied by deformation and displacement. Two cases showed simple deformation and displacement of the pyramidal tract. 6 cases of tumor were successfully obtained neuro-navigation positioning and to determine the tumor boundary and its relationship with motor function area; under the microscope in 4 cases of total resection of the tumor, subtotal resection in 2 cases, postoperative limb motor function improved compared with preoperative or preoperative 4 Cases, hemiplegia aggravated in 2 cases, after treatment within 1 week to restore the preoperative level. No other surgical complications. Conclusion: DTI can clearly observe the relationship between the tumor, the functional area and the white matter fibers and assist in the development of preoperative surgical plans. Cortical electrical stimulation can be real-time positioning of frontal lobe function, maximum protection of motor function. The effective and reasonable application of both can help to safely and accurately remove the tumor and improve the postoperative quality of life of brain tumor patients involved in motor pathway.