脑功能区胶质瘤手术中的新技术

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。

Contemporary techniques during surgery of gliomas in eloquent areas

Objective To study the new techniques and methods during surgery of brain gliomas located in supratentorial eloquent areas. Methods 48 patients with supratentorial gliomas were evaluated with routine MRI and DTI and fMRI to map the eloquent cerebral cortex and white matter fiber. The patients were operated under awake anesthesia with neuro-navigation and ultrasonic wave B for locating the tumor and intra-operative direct electrical stimulation for functional mapping of the eloquent areas. The maximal resection of tumors and minimal damage of the eloquent areas were the surgical goal for all patients. The follow-up periods were 3 to 42 months. Results 16 patients were detected the central sulcus by cortical somatosensory evoked potential. 42 patients were detected the motor areas by intra-operative direct electrical stimulation and 16 patients for language related cortex. Total resection was performed in 35 cases, subtotal resection in 9 cases and partial resection in 4 cases. 44 patients got the better neurological results after surgery, however, 36 patients had the temporary neurological deficits. Four patients had permanent neurological deficits. No patients died and complained of pain during the operation. Conclusion Awake anesthesia, intra-operative direct electrical stimulations and intra-operative ultrasonic wave B are three basic techniques for surgery of brain gliomas located in supratentorial eloquent areas. Pre-operative DTI and fMRI and intra-operative neuro-navigation will provide very useful help for the surgery. Combined using these techniques can ascertain the relationship of eloquent areas and the extent of gliomas, and allows a minimization of post-operative neurological deficit and maximum resection of tumors.