术中磁共振联合显微镜下导航在难治性癫癎脑深部小病变切除术中的应用

目的探讨术中MRI联合显微镜下导航在难治性癫癎病人脑深部小病灶切除中的价值。方法回顾性分析10例脑深部小病灶难治性癫癎病人的临床资料,所有病人行弥散张量纤维束重建,并在术中MRI及显微镜导航下切除病灶,记录骨瓣的大小、手术时间、病灶移位距离、术中MRI扫描次数、术后癫癎发作情况及功能缺失情况。结果本组病人开颅骨窗（44.60±9.19）cm2,手术时间（3.99±0.81）h,病变移位距离（10.50±2.92）mm。病灶移位距离与骨瓣大小、手术时间无明显关系（P〉0.05）。所有病人术中MRI共扫描19次,病灶全部切除。5例病人术后出现肢体偏瘫及视野缺失,术后1年症状改善。术后1年随访癫癎控制疗效：EngelⅠ级5例,Ⅱ级2例,Ⅲ级2例,Ⅳ级1例。结论在伴有癫癎的脑深部小病灶切除术中,应用术中MRI可以及时纠正病灶移位,减少术后神经功能缺失,疗效肯定。

Application of intraoperative MRI and neuronavigation under microscope in the resection of intracranial deep small lesions in intractable epilepsy patients

Objective To explore the clinical value of intraoperative MRIcombined with neuronavigation under microscope in the resection of intracranial deep small lesions in intractable epilepsy patients. Methods Clinical data of 10 intractable epilepsy patients with intracranial deep small lesions were analyzed retrospectively. The fasciculus was reconstructed by diffusion tensor in all the patients, who underwent surgery with the assistance of intraoperative MRI and neuronavigation under microscope. The size of bone flap, operative time, distance of lesion shift, frequency of intraoperative MRI, postoperative seizure outcomes and neurologic deficits were recorded. Results The mean size of bone flap was 44.60 ± 9.19 cm2, mean operative time 3.99 ± 0.81 h, and mean distance of lesion shift 10.50± 2.92 mm. There was no significant relationship between the distance of lesion shift and both the operative time and size of bone flap （P 〉 0.05）. All the patients were examined by 19 times of intraoperative MR/and the lesions were completely removed. The hemiparalysis or vision loss occurred in 5 patients after operation and the symptoms were improved in long follow-up period. All the patients were followed-up for a year, the seizure outcomes were Engel class I in 5 patients, class Ⅱ in 2, class Ⅲ in 2, and class Ⅳ in 1. Conclusion The intraoperative MR/can correct the lesion shift in the resection of intracranial deep small lesions and significantly reduce the postoperative neurologic deficits, thus achieving good outcome in intractable epilepsy patients. Key words： epilepsy, refractory; small lesions, intracranial deep; intraoperative magnetic resonance imaging; microscopy; neuronavigation