功能磁共振神经导航在定位和保护语言功能中的应用

目的 拟运用功能磁共振成像(fMRI)方法术前确定语言功能皮层位置及其与病灶的关系,探讨fMRI在保护语言功能方面的应用价值.并通过术后随访论证fMRI融合神经功能导航对术中语言功能保护的作用及术后语言功能缺失恢复的影响.方法 对2006年1月至2010年1月北京天坛医院88例位于或邻近语言功能区的颅内病变患者,在术前接受脑fMRI检查(包括语言功能、视觉功能及肢体运动和舌运动功能检测),将fMRI图像输入神经导航系统,进行图像融合,术前进行注册、校正,在fMRI导航下进行微创神经外科手术.术后3～6个月复查fMRI,对照术前fMRI评价语言功能恢复情况.结果 88例患者术前行fMRI图像与神经导航系统图像融合、注册顺利,术中能明确定位颅内病变与语言功能区.72例病变至功能区最近距离＞ 10 mm,6例病变至功能区最近距离＜5 mm,10例病变至功能区最近距离5～10 mm.术后随访3个月至1年,手术致残率6.8％(6/88),无手术死亡.所有患者在阅读汉字时均出现广泛的激活.表现为:双侧额下回、左侧额中回、双侧或左侧颞上回(BA46区)、视觉系统17 ～19区、双侧小脑等.结论 fMRI融合神经导航术中可定位语言功能区,对术中保护脑语言功能区,实施个体化治疗方案,减少手术并发症及预后判断有重要意义.病变至功能区最近距离＞10 mm时,手术全切除病变是安全的.

The application of functional magnetic resonance imaging integrated neuronavigation in localization and lingual function protection

Objective To evaluate the clinical practicability of integration of functional magnetic resonance imaging (fMRI) data into neuronavigation as a tool to localize the language area and their relationship with the lesion for the preoperative planning,intraoperative guidance and postoperative follow-up study of brain functions during minimally invasive surgeries in or adjacent to functional areas.Methods Eighty eight patients with intracranial lesions located in or adjacent to the functional language area underwent fMRI ( including examinations of lingual and visual function,and motor functions of the limbs and tongue).fMRI data was entered into a neuronavigation system for image fusion and preoperative registration and correction; minimally invasive neurosurgery was performed with fMRI navigation.Results The shortest distance between the lesion and the functional cortex was less than 5 mm in 6 patients and was more than 5 mm but less than 10 mm in another 10 patients,respectively.10 patients were recovered and improved in another 6 between 3 - 6 months after surgery,The follow-up time was between 3 months and 1 year.The morbidity rate was 6.8％ ( 6/88 ).There was no postoperative mortality.Various brain areas were widely activated when the patients were reading and understanding the Chinese words.The unilateral speech functional maps were located in left Brodmann's 9,46,17,18 and 19 areas.Conclusion fMRI-integrated neuronavigation can locate functional language areas and played an important role in intraoperative protection of functional lingual areas,execution of individualized therapeutic regimens,minimization of surgical complications and determination of prognosis.Total surgical resection was safe for lesions ＞ 10 mm from functional lingual areas.