术前脑磁源成像脑皮质功能区定位提高功能区脑肿瘤手术的准确性

背景:脑磁图作为一种无创性生物磁学技术,通过记录神经细胞在不同功能状态下产生的磁场变化,以磁源成像反映脑功能的即时信息。目的:应用脑磁图定位神经导航下手术治疗脑皮质运动区或附近肿瘤患者36例,评估脑磁成像在脑功能区肿瘤手术过程中的应用价值。设计:观察性实验。单位:广东省中医院神经外科。对象:选择2003-01/2006-04在广东三九脑科医院神经外科采用脑磁图定位神经导航手术治疗脑功能区肿瘤患者36例,其中男17例,女19例;年龄13～70岁。脑膜瘤19例,神经上皮肿瘤14例,转移性腺癌2例,海绵状血管瘤1例。所有患者及家属同意此治疗方案,并经医院伦理委员会批准。方法:应用采用美国4-D Neuroimaging公司的148导脑磁图系统确定运动和/或感觉皮质,采样频率为678.17 Hz,高通滤波为1.0 Hz,带宽200 Hz;脑磁图信息叠加到飞利浦公司的Philips Gyroscan Intera 1.5T超导型磁共振成像系统图像上;然后图像传递到神经导航系统,在神经导航下手术治疗脑肿瘤。于术后2～26个月通过复诊、电话的形式对患者预后情况进行随访。主要观察指标:手术效果及预后。结果:脑磁图定位显示36例脑肿瘤患者患侧功能区均发生不同程度的移位和变形,34例患者肿瘤被全切除。术后2～26个月影像学显示36例患者功能区保存良好,神经功能障碍完全恢复正常19例,无变化15例,加重2例。结论:脑磁图可无创性功能定位,为制定脑功能区保护方案提供重要的指导价值。

Preoperative localization of brain cortex by using magnetic source imaging can increase the veracity of brain neoplasm operation in functional region

BACKGROUND: As a kind of unwounded biomagnetism technique, magnetoencephalography (MEG) relfects immediate information of cerebral function by using magnetic source imaging through recording changes of magnetic field of neurocytes under different functional status.OBJECTIVE: To investigate the practicability of magnetoencephalography (MEG) imaging in localizing sensory-motor cortex for brain tumour surgery in 36 patients.DESIGN: Observational study.SETTING: Department of Neurosurgery, Guangdong Provincial Hospital of Traditional Chinese Medicine.PARTICTPANTS: From Janury 2003 to April 2006, 36 patients (17 male and 19 female) with brain tumors selected from Deparment of Neurosurgery, Guangdong 999 Brain Hospital underwent surgery with MEG-guided neuronavigation in the region of the sensory and motor cortex. Ages of the patients ranged from 13 to 70 years. Among the 36 patients, 14 with gliomas (including 5 highly malignant gliomas), 19 with meningomas, 1 with spongy angioma and 2 with adenocarcinoma (due to the metastasis of brain tumor). All patients and relatives provided the confirmed consent and the experiment provided by the local ethics committee.METHODS: A 148-channel biomagnetometer (4-D Neuroimaging, USA) was used to determine motor and/or senory cortex with sampling rate 678.17 Hz, high-pass filter 1.0 Hz and bandwith 200 Hz. MRI images were acquired using a Philips Gyroscan Intera 1.5T MR tomography. And then, the functional maps were transfered to the neuronavigation system for the treatment of brain tumor. All patietns followed up by further consultation and telephone call in 2-26 months after operation.MAIN OUTCOME MEASURES : Operative outcome and prognosis.RESULTS: MEG demonstrated that the tumor lesion changed the sensory-motor cortex in various degrees for the 36 patients. Brain tumors were resected completely in 34 cases. At 2-26 months after surgery, neurological deficits fully recovered in 19 cases, unchanged in 15 cases and deteriorated in 2 cases.CONCLUSION: MEG was found to be practical and useful in localizing sensory-motor cortex and brain tumor. It is a valuable non-invasive method for presurgical planning in the treatment of brain tumors.