多模态MRI技术结合神经导航术中超声在枕叶视觉功能区胶质瘤手术中的应用

目的 探讨多模态MRI技术结合神经导航及术中超声在大脑枕叶视觉功能区胶质瘤手术中的应用价值。方法 回顾性分析2012年1月—2014年11月安徽医科大学附属省立医院神经外科收治的20例大脑枕叶视觉功能区胶质瘤患者手术相关资料,其中男9例、女11例,年龄27~72岁,均行神经显微手术治疗。术前利用灌注加权成像、弥散张量成像及血氧水平依赖功能MRI多模态MRI技术结合神经导航进行图像融合,重建病灶与视皮层及视辐射的3D图像位置,设计合适的手术入路、界定病灶切除范围;术中超声实时判断肿瘤切除程度,合理保护功能区和视辐射。结果 根据术后复查MRI结果,影像学全切除85.0%(17/20),大部分切除15.0%(3/20)。术后随访1~30个月,肿瘤大部分切除3例分别于术后7、13、15个月复发;与术前相比,视力视野改善与术前相比,视力视野改善60%(12/20),无明显变化40%(8/20)。结论 多模态MRI技术结合神经导航及术中超声,能够准确定位枕叶视觉功能区和视辐射的走行,制定个体化手术方案,提高了枕叶视觉功能区胶质瘤外科治疗的安全性和有效性,实现最大程度保护脑功能的同时最大范围切除肿瘤组织,提高患者术后生存质量。

Application of multi-modal magnetic resonance imaging,neuronavigation and intraoperative ultrasound in the microsurgery for gliomas near occipital visual function area

Objective To evaluate the application value of multi-modal magnetic resonance imaging, neuronavigation and intraoperative ultrasound in the microsurgery for gliomas near occipital visual function area.Methods The clinical data of 20 patients with gliomas in the occipital visual function area from January 2012 to November 2014 were retrospectively analyzed. All multi-modal magnetic resonance imaging were transferred to the neuronavigation system, reconstructed the three-dimensional location of lesions, visual cortex and optic radiation. Surgical approach was designed and excision scope was defined before the surgery. The level of tumor resection was real-time judged by intraoperative ultrasound. Visual cortex and optic radiation were reasonably protected.Results Total lesion resection of the MRI was achieved in 17 cases (85.0%, 17/20), subtotal resection in 3 cases (15.0%, 3/20). At 1-30 months follow up, 3 patients with subtotal lesion resection were found recurrence at 7, 13 and 15 months after operation,respectively.Visual functions were improved in 12 cases(60%, 12/20), unchanged in 8 cases(40%, 8/20).Conclusions The combination of multi-modal magnetic resonance imaging, neuronavigation and intraoperative ultrasound is helpful for accurately locating the visual cortex and optic radiation, making individual operation plan, improving the effectiveness and safety of surgical treatment for gliomas near occipital visual function area, achieving the greatest degree to protect brain function and maximize lesion resection, and is useful to improve the postoperative quality of life.