脑磁图定位皮质运动区与术中皮质电刺激运动诱发电位的对照研究

目的评价脑磁图（MEG）术前定位初级运动皮质（M1）的准确性。方法选取顺序入院的中央区胶质瘤26例,术前均运用MEG定位皮质运动区,与MRI导航影像融合,在神经导航下定位MEG激活区。术中对MEG成功定位的病例行直接皮质电刺激（DCES）,比较两种技术的吻合度。结果因病人不能配合,MEG定位失败2例,余24例均定位成功,每例激活区1～5个。DCES成功监测24例,所有选择的DCES靶点共41个,阳性靶点24个,1个/例。以所有的41个靶点分析,MEG定位M1区与DCES定位的吻合率为58.5%；而以第1组病灶侧M1区和第2组病灶侧中央区的MEG激活区中27个靶点分析,两者吻合率为88.9%；仅以第1组M1区的MEG激活区中17个靶点分析,两者吻合率为100%。结论 MEG可以灵敏而可靠地定位M1区,可用于中央区胶质瘤病人术前手术规划。

Control study of magnetoencephalography and intraoperative cortical electrical stimulation based motor evoked potential monitoring for mapping motor cortex

Objective To evaluate the accuracy of preoperative primary motor cortex （M1） mapping with magnetoencephalography （MEG）. Methods Twenty-six consecutive patients with glioma in the central region were selected. Motor cortex was located by MEG preoperatively, and its results were overlaid on the MRI, then the activated regions located under neuronavigation. Intraoperative direct cortical electrical stimulation （DCES） was performed in patients located successfully by MEG, and the coincidence rate was calculated between MEG and DCES techniques. Results MEG mapping failed in 2 patients because of the problems of patients, and succeeded in other 24 patients with 1 to 5 activated regions in every patient. DCES was performed in 24 patients with 41 targets, including 24 positive targets, one target in every patient. For the analysis of all the 41 targets, the coincidence rate was 58.5%in mapping M1 between MEG and DCES. For the analysis of 27 targets in MEG activated regions of M1 in group 1 and central region in group 2 at the lesion side, the coincidence rate of the two techniques was 88.9%. For the analysis of 17 targets in MEG activated regions of M1 in group 1 at the lesion side, the coincidence rate of the two techniques was 100%. Conclusion MEG can locate M1 sensitively and reliably, and can be used for the preoperative planning in patients with glioma in the central region.