两种感兴趣区选择方法示踪锥体束在中央区病变手术中的初步对照研究

发布时间：2018-11-26 18:57

【摘要】：目的采用术中直接皮层下电刺激技术(Ds CS),验证并对比以功能磁共振运动激活区为感兴趣区示踪(f MRI guided DTI-FT)的锥体束和以传统解剖初级运动皮层为感兴趣区进行示踪的锥体束。方法前瞻性研究12例涉及中央区的病灶患者,以f MRI运动激活区、大脑脚为感兴趣区的改进方法和以中央前回、大脑脚为感兴趣区的传统方法分别示踪锥体束,神经导航辅助下引导手术,术中记录同一电刺激阳性点与两种方法成像锥体束之间的距离,比较两种方法成像锥体束与Ds CS的符合率。结果除1例患者因运动功能障碍致f MRI激活失败,1例电刺激结果阴性,余患者均成功显示两种方法重建的锥体束,并应用于术中神经导航定位和辅助切除病灶。两种方法成像锥体束与Ds CS的符合率分别为77%和70%,16个Ds CS阳性位点距离两种方法成像的锥体束之间的平均最短距离分别为(4.3±2.8)mm和(5.5±3.4)mm,对比差异结果均有统计学意义(χ2=7.393,t=0.675,P0.05)。术后5例上肢暂时性偏瘫,1例上下肢暂时性偏瘫,余6例患者手术前后肌力无改变,术后2周4例肢体运动同术前或较术前好转,余2例仍有偏瘫。结论以功能磁共振运动激活区为感兴趣区示踪锥体束的方法在涉及中央区的手术中可同时保护功能皮层和锥体束,有助于妥善处理病灶并有效保护脑功能区。
[Abstract]:Objective to adopt intraoperative direct subcortical electrical stimulation (Ds CS),) technique. To verify and compare the pyramidal tracer (f MRI guided DTI-FT with the functional magnetic resonance motor activation region (fMRI) and the pyramidal tracer with the traditional anatomical primary motor cortex as the region of interest. Methods A prospective study was carried out in 12 patients with focal lesions involved in the central region. The improved method of tracing pyramidal tracers using the f MRI motor activation area, the cerebral foot as the region of interest and the precentral gyrus and the cerebral foot as the region of interest were used to trace the pyramidal tract, respectively. The distance between the positive spot of the same electric stimulation and the two methods for imaging the pyramidal tract was recorded during the operation guided by neuronavigation, and the coincidence rate between the two methods was compared between the two methods of imaging the pyramidal tract and Ds CS. Results except for one patient who failed to activate f MRI due to motor dysfunction and 1 patient with negative electrical stimulation, the other patients were successfully shown the pyramidal tract reconstructed by two methods, and were used in neuronavigation localization and assisted resection of lesions during operation. The coincidence rates between the two imaging methods and Ds CS were 77% and 70, respectively. The average shortest distances between the 16 Ds CS positive sites and the pyramidal tracts were (4.3 卤2.8) mm and (5.5 卤3.4) mm, respectively. There was significant difference between the two groups (蠂 2, 7.393, P < 0.05). There were 5 cases of temporary hemiplegia of upper and lower limbs and 1 case of temporary hemiplegia of upper and lower extremities after operation. The muscle strength of the other 6 cases had no change before and after operation. 2 weeks after operation, 4 cases of limb movement were improved before or after operation, and 2 cases still had hemiplegia. Conclusion the method of tracing the pyramidal tract in the area of interest can protect both the functional cortex and the pyramidal tract in the operation involving the central area, which is helpful for the proper management of the lesion and the protection of the functional area of the brain.
【作者单位】：安徽医科大学解放军第174临床学院神经医学中心外科;解放军第174医院神经医学中心外科;
【基金】：南京军区医学科技创新重点课题(编号:ZD26)
【分类号】：R445.2

【相似文献】