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目的探讨切除脑功能区胶质瘤手术新技术与方法。方法48例脑功能区胶质瘤经术前常规MRI、弥散张力成像(DTI)和fMRI定位大脑皮层功能区及功能投射纤维束,以神经导航为前导,在术中全麻唤醒状态下,通过术中B超定位脑内病灶,皮层体感诱发电位(Co-SEP)及皮层直接电刺激术(Co-ST)脑功能区定位,并在清醒状态下切除病变。术后随访时间3-42个月。结果16例Co-SEP确定中央沟,42例Co-ST明确运动区,16例Co-ST确定语言运动区;肿瘤全切35例,次全切除9例,部分切除4例。术后1个月神经症状好转44例,术后出现暂时性局部神经症状36例;长期局部神经症状加重4例,无手术死亡。全部患者无手术痛苦回忆。结论术中全麻唤醒、皮层-皮层下电刺激术和脑超声技术是切除功能区胶质瘤必备的三项基本技术;术前fMRI与DTI为脑功能区手术提供十分重要信息,神经功能导航为术中功能区定位提供重要前导,综合使用这些现代技术能够在术中明确脑功能区与肿瘤切除范围的关系,做到最大限度地切除脑功能区病变和保护脑功能。
Objective To investigate the new technique and method of resection of glioma in brain functional area. Methods 48 cases of brain functional gliomas were treated with routine preoperative MRI, diffusion tensor imaging (DTI) and fMRI to locate the functional areas of the cerebral cortex and functional projection fiber bundles. With neural navigation as the guide, Intraoperative focal B-localization of brain lesions, cortical somatosensory evoked potentials (Co-SEP) and cortical direct electrical stimulation (Co-ST) brain functional areas were located, and the lesion was removed under awake condition. Postoperative follow-up time of 3-42 months. Results 16 cases of Co-SEP identified central groove, 42 cases of Co-ST clear motor area, 16 cases of Co-ST to determine the language movement area; tumor resection 35 cases, subtotal resection in 9 cases, partial resection in 4 cases. One month after operation, the neurological symptoms improved in 44 cases. There were 36 cases of temporary local neurological symptoms after operation. Long-term local neurological symptoms were aggravated in 4 cases without surgical death. All patients without painful memories. Conclusion Intraoperative awakening of the general anesthesia, cortical-subcortical stimulation and brain ultrasound are the three essential technologies for resection of functional area gliomas. Preoperative fMRI and DTI provide very important information for the operation of brain functional areas. Neurological function Navigation provides an important guide for the positioning of intraoperative functional areas. The comprehensive use of these modern technologies can clear the relationship between the brain function area and tumor resection scope during operation, and maximize the excision of brain function areas and the protection of brain function.