3D重建脑表面中央前回辨识及初级皮层运动功能分布研究

目的研究利用三维重建脑表面成像辨识中央前回的方法及其可靠性。方法难治性癫痫经术前评估需要进行颅内电极植入的病例12例,术前行3T磁共振结构像扫描及运动功能磁共振测试,颅内电极植入后行头颅CT扫描。利用磁共振数据,用Brainvoige软件进行脑表面三维重建,并与硬膜下电极CT融合。根据中央前回的形状走行特点,在重建的脑表面上标记中央前回,进而辨识标记术区中央前回。用皮层电刺激和功能磁共振验证所标记中央前回的可靠性。结果 12例均进行了脑表面三维重建,并标记出了中央前回,硬膜下电极CT电极点与三维脑表面融合。统计中央前回上电极点101个,电刺激运动响应73个,响应率72%;对照组中央前回前1cm（统计中央前沟前2个电极范围）,130个电极,17个电极有运动响应,响应率13%,p值小于0.05;功能磁共振手的运动100%中央前回有激活,中央前回前无明显激活。电刺激及功能核磁均验证了本研究方法确定中央前回准确可靠。结论脑表面成像辨识中央前回准确可行,可以利用各初级运动皮层分布的距离进行详细的初级运动皮层的绘制定位。

A method to identify the precentral gyrus and its detailed functional distribution in teal brain surfaces using reconstructed 3D brain surface imaging

Objective To study the use of reconstructed 3D brain surface image（RBSI short for reconstructed 3Dbrain surface image following）to identify the precentral gyrus and its detail functional distribution.Methods There are a total of 12 refractory epilepsy cases which need intracranial electrode implantation.In these patients,magnetic resonance imaging（MRI）and functional MRI（fMRI）were conducted pre-operation,and a cranial computed tomography（CT）scan was performed after electrode implantation.And the RBSI were accomplished with BrainVoyager software by using MRI data,and then the 3Dbrain surface was integrated with the subdural electrode CT.The precentral gyrus was found in the reconstructed brain surface image acording their own shape,and then were identified in the surgical field by comparing the exposed gyrus in the RBSI with that in the intraoperative photographs.Results The 12 cases of precentral gyrus was found and marked in the RBSI.There were 101 electrodes covering the precentral gyrus and 73（72%）of them had motor response to electrical stimulation.In the contrast team,（the area which is 1cm ahead of the precentral gyrus）,the motor response rate was 13%（17/130）（P〈0.05）.During fMRI,100% of the precentral gyrus and 58%（7/12）of postcentral gyrus was activated during hand movement,with no activation of the areas ahead of precentral gyrus,so there was also significant difference between precentral gyrus and gyrus ahead.Conclusion It is simple and feasible to identify the precentral gyrus by using the RBSI.And its detail functional distribution is also identified according the electrical cortical stimulation.