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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。
Objective To study the application value of multimodal imaging combined with electrophysiological monitoring technique in brain function in patients with brain glioma. Methods The clinical data of 5 gliomas and 55 gliomas in motor area were retrospectively analyzed. Preoperative functional magnetic resonance functional areas, diffusion tensor imaging showed important conduction beam fusion multi-modal imaging to build functional nerve navigation, intraoperative use of cortical somatosensory evoked potentials to locate the central groove, and the use of cortical-subcortical electrical stimulation monitoring Language area, exercise area and subcortical nerve conduction bundle, in the protection of function as much as possible removal of lesions. Postoperative evaluation of tumor resection and neurological function. Results Five cases of glioma in gliomas and 30 cases of glioma adjacent to motor glomeruli were successfully located in functional regions. Three cases of gliomas in gliomas and 42 cases of gliomas in motor region were detected by diffusion tensor imaging Rebuild the arcuate beam and cone beam respectively. The detection rate of language area and motor area during operation was 100% and 92.7% respectively. 92.7% of the patients in motor area could locate the central sulcus through cortical somatosensory evoked potentials. Intraoperative neural navigation has a guiding role in surgery. Tumor imaging full rate of 86.7%, functional retention rate of 91.7%. Conclusions The multimodal imaging technique can be used to locate the brain functional areas preoperatively. Functional neuro-navigation is helpful for the preoperative planning and intraoperative guidance of the lesions. However, attention should be paid to the image drift. Intraoperative electrophysiological monitoring technology is to locate and protect the main means of brain function structure.