临床神经外科杂志2016，Vol.13Issue(5)：335-339,343,6.DOI:10.3969/j.issn.1672-7770.2016.05.005
多模态影像联合电生理监测在脑功能区胶质瘤手术中的应用研究
Application of multimodal neurological imaging and neurophysiological monitoring in ;surgical resection for eloquently located cerebral gliomas
摘要
Abstract
Object To explore the role of multimodal neurological imaging and intraoperative neurophysiological monitoring( IOM) in eloquent area glioma surgery.Methods The clinical data of 5 patients with language area glioma and 55 with sensorimotor area glioma were analyzed retrospectively. Functional MRI ( fMRI ) , diffusion tensor image ( DTI ) were performed preoperatively and were immerged into neuronavigation system for preoperative planning and intraoperative real-time guiding for the procedure.In cases with perirolandic tumors,cortical somatosensory evoked potential(SEP) was recorded to locate the central sulcus.Tumor resection was alternated with direct electrical stimulation (DES) and functional structures were preserved during the operation.Extent of tumor resection and neurological status were evaluated post-operatively.Results Functional areas were localized by fMRI in 5 language area glioma cases and 30 sensorimotor area glioma cases.By diffusion tensor fiber tractography(DT-FT), arcuate fasciculus was traced in 3 cases with language area glioma, and motor pathways were traced in 42 cases with deeply-seated motor eloquent area glioma.Intraoperatively,language area and motor area were located by DES in 100%language area glioma cases and 92.7%motor area glioma cases respectively.Central sulcus could be located in 92.7%motor area cases using cortical SEP recording.Neuronavigation was appreciative in defining the lesions and functional structures although brain shift existed.Gross total resection was achieved in 86.7% of all cases. Neurological functions were well preserved in 91.7% cases.Conclusions Multimodal imaging is useful in defining the language and motor area in eloquently located gliomas.Functional navigation immerged with structural and functional imaging is valuable in planning and guiding the surgery although accuracy can be compromised by brain shift.IOM plays an important role in mapping eloquent structures and preserving neurological function.关键词
多模态影像/功能区/电生理监测/功能磁共振/弥散张量成像/胶质瘤Key words
multimodal imaging/eloquent area/neurophysiological monitoring/functional MRI/diffusion tensor image/glioma分类
医药卫生引用本文复制引用
张玉海,章文斌,陈永严,杨纶先,黄庆玖,刘翔,陆军,阮义峰,刘宏毅,张锐,胡新华,杨坤,刘永,何升学,钱春发,邹元杰..多模态影像联合电生理监测在脑功能区胶质瘤手术中的应用研究[J].临床神经外科杂志,2016,13(5):335-339,343,6.基金项目
南京市医学科技发展项目（课题）（ YKK13123， YKK12137）；国家卫生与计划生育委员会科研基金（W201308）；江苏省卫计委科技项目（H201540），南京市卫计委和科委联合重点项目 （）
