摘要
目的采用术中直接皮层下电刺激技术(Ds CS),验证并对比以功能磁共振运动激活区为感兴趣区示踪(f MRI guided DTI-FT)的锥体束和以传统解剖初级运动皮层为感兴趣区进行示踪的锥体束。方法前瞻性研究12例涉及中央区的病灶患者,以f MRI运动激活区、大脑脚为感兴趣区的改进方法和以中央前回、大脑脚为感兴趣区的传统方法分别示踪锥体束,神经导航辅助下引导手术,术中记录同一电刺激阳性点与两种方法成像锥体束之间的距离,比较两种方法成像锥体束与Ds CS的符合率。结果除1例患者因运动功能障碍致f MRI激活失败,1例电刺激结果阴性,余患者均成功显示两种方法重建的锥体束,并应用于术中神经导航定位和辅助切除病灶。两种方法成像锥体束与Ds CS的符合率分别为77%和70%,16个Ds CS阳性位点距离两种方法成像的锥体束之间的平均最短距离分别为(4.3±2.8)mm和(5.5±3.4)mm,对比差异结果均有统计学意义(χ2=7.393,t=0.675,P<0.05)。术后5例上肢暂时性偏瘫,1例上下肢暂时性偏瘫,余6例患者手术前后肌力无改变,术后2周4例肢体运动同术前或较术前好转,余2例仍有偏瘫。结论以功能磁共振运动激活区为感兴趣区示踪锥体束的方法在涉及中央区的手术中可同时保护功能皮层和锥体束,有助于妥善处理病灶并有效保护脑功能区。
ObjectiveTo validate and compare the pyramidal tracts traced by functional magnetic resonance motion activated area as the region of interest method（f MRI guided DTI-FT） and by the anatomy of primary motor cortex as region of interest method（traditional DTI-FT）using subcortical electrical stimulation（Ds CS）.MethodsA prospective study was conducted in 12 cases of patients with central lesions involving the motor area. The pyramidal tracts were traced by f MRI guided DTI-FT method and traditional DTI-FT method. The lesions were resected with the assistance of neuronavigation. The distances between same stimulation positive point and pyramidal tracts traced by the f MRI DTI-FT or traditional DTI-FT were recorded. The coincidence rates between pyramidal tract imaging and Ds CS were analyzed in order to verify the accuracy and reliability of these two methods.ResultsTwo cases were excluded： one due to the failuredal tracts were successfully reconstructed in the rest 10 patients using these two methods which were further applied to assist surgery. The coincidence rates between Ds CS and pyramidal tracts were 77% in f MRI DTI-FT and 70% in traditional DTI-FT. The shortest distances were 4.3mm±2.8mm and 5.5mm±3.4mm in f MRI DTI-FT and in traditional DTI-FT in16 Ds CS positive sites and the difference was statistically significant（P0.05）. Five cases had temporary postoperative paralysis. Among them, four cases had upper limb paralysis and one case had hemiplegia. The motor function was improved in four cases and remained unchanged in two cases two weeks after the operation. The motor function in the rest six cases did not have any change before and after operation.ConclusionThe f MRI guided DTI-FT can be helpful to deal with lesions and effectively protect the brain function area in patients with the central area lesions involved motor area.
出处
《中国神经精神疾病杂志》
CAS
CSCD
北大核心
2015年第1期36-41,共6页
Chinese Journal of Nervous and Mental Diseases
基金
南京军区医学科技创新重点课题(编号:ZD26)
关键词
弥散张量成像
功能磁共振
中央区
对照研究
Diffusion tensor imaging Magnetic resonance imaging Central area Control study
