功能区胶质瘤术中应用DTI-FT导航定位和保护锥体束(附13例报告)

目的研究功能区胶质瘤术中完善而有效的锥体束空间定位和功能保护方法。方法对13例功能区胶质瘤应用1.5T磁共振系统采集弥散张量成像(DTI)数据,在功能神经导航中进行纤维束示踪(FT),在导航中确定肿瘤与锥体束界面的标记点,应用自制导航穿刺针、着色明胶海绵对白质内锥体束走行进行空间定位。在空间定位锥体束基础上,应用皮质、皮质下直接电刺激或唤醒麻醉技术在肿瘤切除中对锥体束功能进行评估监测,保证其正常功能。结果本组锥体束与肿瘤交界区在神经导航中均得到确定,术中在DTI-FT导航下空间定位满意;锥体束功能判定明确者10例。均全切肿瘤,运动功能保持术前正常水平或得到改善。结论联合应用DTI-FT导航、神经电生理或唤醒麻醉技术可确保锥体束功能不出现手术损伤,同时为明确胶质瘤在脑白质内功能性边界提供有效方法。

Localization and function protection of pyramidal tract using DTI-FT in resection of glioma in eloquent brain areas: report of 13 cases

Objective To establish an optimized method for localizing and protecting the pyramidal tract in resection of glioma in eloquent brain areas. Methods Functional magnetic resonance image (DTI) data were obtained with a 1.5T Siemens scanner and fused in a neuronavigation system in 13 cases of glioma in eloquent brain area. After pyramidal tract visualization by fiber tractography (FT) technique, the interface between the tumor and pyramidal tract was identified and marked in the neuronavigation. A self-made puncture needle for navigation and methylene blue-stained gelatin sponge were used to localize the pyramidal tract after the dura was opened. The cortical and subcortical direct electrical stimulation or "awake anesthesia" were used to protect pyramidal tract function during tumor resection. Results The pyramidal tracts were visualized and marked in the neuronavigation in all the patients. The interface between tumor and pyramidal tract were successfully localized before tumor resection. Pyramidal function was inspected and identified definitely during tumor resection in 10 patients. Tumor was totally resected in all the patients without operation-related motor function disorder, even with some improvement of motor function. Conclusion Combination of DTI-FT neuronavigation, direct simulation and (or) "awake anesthesia" is an optimal method for protecting functional against injury to the pyramidal tract, which also could let us identify the functional boundary of glioma in the brain white matter.