两种感兴趣区选择方法示踪锥体束在中央区病灶 - 第三军医大学学报.doc

两种感兴趣区选择方法示踪锥体束在中央区病变手术中的初步对照研究 张卿云1，姚一2* (1.安徽医科大学解放军174临床学院 361003厦门解放军174医院神经医学中心外科， 361003厦门?采用术中直接皮层下电刺激技术（DsCS），验证并对比以功能磁共振运动激活区为感兴趣区示踪（fMRI 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，并进一步探讨以功能磁共振运动激活区为感兴趣区示踪锥体束的精确性及可靠性。方法?前瞻性研究12例涉及中央区的病灶患者，以fMRI运动激活区、大脑脚为感兴趣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DsCS的符合率，验证其准确性和可靠性。结果?除1例患者因运动功能障碍致fMRI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DsCS的符合率分别为77%和70%，16个DsCS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±2.8mm和5.5±3.4mm，对比差异结果均有统计学意义（P0.05），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3例肢体运动同术前或较术前好转，余2例仍有偏瘫。结论?对于涉及中央区的病灶，以功能磁共振运动激活区为感兴趣区示踪锥体束的方法，可同时保护功能皮层和锥体束，但仍需联合应用皮层及皮层下电刺激，更加有助于妥善处理病灶并有效保护脑功能区，最大程度提高患者的生活质量。 【关键词】弥散张量成像；功能磁共振；中央区；对照研究 Two kinds of region of interest selection methods of pyramidal tract tracking in the surgery of central lesion -a preliminary comparative study [Abstract] objective to adopt direct intraoperative cortical electrical stimulation under the technology (DsCS), validation and comparison with functional magnetic resonance motion activated area as the region of interest tracer (fMRI guided DTI-FT) of the pyramidal tracts and in traditional anatomy of primary motor cortex for region of interest of the pyramidal tract tracing, and further explore the functional magnetic resonance imaging the motor area activation for accuracy and reliability of the interested area trace of pyramidal tract. Methods a prospective study of 12 cases of patients with central lesions involving the motor area activation by fMRI, cerebral peduncle in order to improve the method of interest and in the precentral gyrus, cerebral peduncle to the traditional method of region of interest were tracing pyramidal tract, auxiliary under neuronavigator guided surgery, with a positive point electrical stimulation with two methods cone beam imaging distance were recorded, the coincidence rate comparing two methods of pyramidal tract imaging and DsCS, to verify the accuracy