术中磁共振联合运动功能神经导航在颅内病变切除术中的临床应用

摘要

Aim:To investigate the clinical value of intraoperative magnetic resonance imaging ( iMRI) combined with motor functional neuronavigation in resection of intracranial lesions .Methods: A total of 138 cases ( 75 males and 63 fe-males, aged from 5 to 83 years with mean of 43.2 years) underwent surgical operation with the assistance of 3.0T iMRI combined with motor functional neuronavigation .All cases were adjacent to or involved motor area or corticospinal tract . Blood oxygen level dependent functional MRI and diffusion tensor imaging data analysis could be analyzed in real -time using the software directly installed on the MR , and the result visualization was possible during scanning .Results:3D brain sur-face visualization was considered useful for precise localization of 41 cases situated at the brain convexity .Eventually , out of 138 cases, 81(58.7%) benefited from further resection after iMRI scans;104 achieved gross total resection (GRT) and the GRT rate improved from 29.7%to 75.4%.All 138 cases accomplished more than 6 months follow-up postoperatively. No new permanent postoperative motor deficit was observed in 127 cases(92.0%),among which, improved motor function was observed in 34 cases,unchanged neurological findings in 83 cases,and transient motor deficit in 10 cases.New perma-nent motor deficit was present in 11 cases(8.0%) until 6 months after surgery.Conclusion:iMRI combined with function-al neuronavigation can help to maximize tumor removal and minimize neurological deficit , which has great value in impro-ving operation efficiency and prognosis of patients with intracranial lesions .%目的：探讨术中磁共振（ iMRI）联合运动功能神经导航在颅内病变切除术中的临床应用。方法：2012年12月至2014年10月，138例患者接受3．0T iMRI联合运动功能神经导航引导下颅内病变切除术；男75例，女63例；年龄5～83岁，平均43．2岁。全部病变邻近或累及运动功能皮质或皮质脊髓束。术中应用MR工作站携带的后处理软件进行实时BOLD-fMRI和DTI数据分析。结果：41例病变位于大脑皮质表面，根据运动功能神经导航3D脑表面脑回及脑沟的显示可明确判断病变部位。最终81例（58．7％）因iMRI扫描后进一步扩大切除而获益。104例病变全切，全切率从297．％提高到75．4％。138例获长期（6个月以上）随访，其中127例（92．0％）患者无术后新发永久性运动障碍，127例中好转34例，无变化83例，暂时性10例（出院时）；11例（8．0％）患者术后6个月仍遗留不同程度的新发运动障碍。结论：iMRI联合运动功能神经导航有助于最大程度切除病变，同时最小限度地损伤神经功能，对提高手术效率和改善患者预后具有重要的应用价值。