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

目的研究多模态影像联合电生理监测技术在脑功能区胶质瘤手术中的保护脑功能的应用价值。方法回顾性分析5例语言区和55例运动区胶质瘤患者的临床资料。术前行功能磁共振定位功能区,弥散张量成像显示重要传导束,融合多模态影像构建功能神经导航,术中采用皮层体感诱发电位定位中央沟,并运用皮层-皮层下电刺激技术监测语言区、运动区和皮层下重要神经传导束,在保护功能前提下尽可能切除病灶。术后评价肿瘤切除程度和神经功能。结果 5例语言区胶质瘤和30例病变毗邻运动皮层胶质瘤患者术前功能磁共振成功定位功能区,通过弥散张量成像3例语言区胶质瘤和42例运动区胶质瘤患者分别重建出弓状束和锥体束。术中电刺激语言区和运动区检出率分比为100%和92.7%;92.7%的运动区肿瘤患者可通过皮层体感诱发电位技术定位中央沟。术中神经导航对手术具有指导作用。肿瘤影像全切率86.7%,术后功能保留率91.7%。结论运用多模态影像技术有助于术前定位脑功能区,功能神经导航有助于术前规划、术中引导病灶切除,但需注意影像漂移。术中电生理监测技术是定位和保护脑功能结构的主要手段。

Application of multimodal neurological imaging and neurophysiological monitoring in ;surgical resection for eloquently located cerebral gliomas

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.