脑干mapping技术在脑干病灶切除术中的应用-外科学(神经外科)专业论文.docx

摘 要目的：探讨如何通过脑干 mapping 技术确定脑干神经核团和传导束的位置并持续 监测其功能。在脑干病灶切除手术中应用该技术选择合适的手术入路、调整手术操作以尽量避开重要神经核团和传导束，最大可能的降低脑干病灶切除术造 成的副损伤。方法：通过功能磁共振 DTI 检查定位脑干传导束位置并据此选择合适的手术入路， 通过神经电生理监测 SSEP、BAEP、MEP、EMG 和脑干 EEG 技术定位脑干的运动核团、感觉核团以及传导束的位置并持续监测其功能，设计合适的脑干表面切口，调整术中手术操作，实现最大限度的切除病灶，最大程度的保护脑功 能。结果：通过脑干 mapping 技术共进行脑干病灶切除术 13 例，海绵状血管瘤 8 例， 胶质瘤 4 例，蛛网膜囊肿 1 例，均取得良好疗效，术后无一例出现重要功能障碍。通过全面检索数据库，比较在脑干病灶切除术中行脑干 mapping 技术与未行脑干 mapping 技术的死亡率及致残率，发现前者的死亡率及致残率明显低于 后者。 应用 SPSS19.0 软件进行统计学分析，采用卡方检验。P0.05，差异有统计学意义。结论：脑干 mapping 技术可有效降低脑干病灶切除术的副损伤，代表着脑干病灶 手术治疗的发展方向。关键词：脑干病灶；mapping；手术治疗；神经电生理；fMRIIIAbstractObject：To investigate how to use the brainstem mapping technology to determine the position of the brainstem motion nucleus and sensory nucleus and nerve fiber, and monitor its function Continuously. Apply this technology to choose the proper operation approach, adjust the operation to try to avoid the important nucleus andnerve fiber in the brainstem lesion resection. The maximum possible reduce the injury caused by brainstem lesion resection.Method：Mapping the brainstem nerve fiber by functional MRI and select proper operation approach with the result of the mapping. Mapping the brainstem motion nucleus and sensory nucleus and nerve fiber by EMG, SSEP, BAEP, MEP andbrainstem EEG, and monitor its function Continuously ， designing the incision ofbrainstem surface and adjusting the operation in the surgery according to the result of the mapping and monitoring, so as to achieve the maximum resection of the lesion, the greatest degree of protection of brain function.Result：We have done 13 cases of brainstem lesion resection by brainstem mapping technology, 8 cases of cavernous hemangioma, 4 cases of glioma, 1 case of arachnoid cyst. the therapeutic effect is good, no patient occur distinguished deficit of neuro-function.Through a comprehensive searching in database, compare the mortality and disability rate of the brainstem lesion resection which use brai