功能性磁共振和皮质脑电图在伴继发性癫脑肿瘤手术中的应用(附13例分析)

Application of fMRI and ECoG in surgery for the tumor in the eloquent brain areas with associated epilepsy: analysis of 13 cases

目的探讨术前功能磁共振成像(fMRI)和术中皮质脑电图(ECoG)在伴继发性癫疒间脑肿瘤手术中的应用价值。方法回顾性分析13例脑运动皮质区附近肿瘤病人的临床资料。术前通过fMRI了解相应脑功能区皮质和白质纤维束的形态和分布;术中在切除肿瘤前后行ECoG检测,确定致疒间灶的位置,指导肿瘤及致疒间灶的切除。结果手运动功能区受肿瘤推挤而出现功能转移或重组9例,行肿瘤全切除;功能区局部重叠2例,行肿瘤次全切除;大部分重叠2例,行肿瘤部分切除。ECoG确定的致疒间灶距肿瘤2 cm以内9例,3～5 cm 2例,与肿瘤重叠2例。术后出现短暂性失语1例,一过性偏瘫2例。结论fMRI能准确显示运动皮质中枢位置,对脑肿瘤术前手术方案制定和手术时减少重要功能区损伤具有重要意义。ECoG确定致疒间灶大多距肿瘤2 cm以内。

Objective To investigate the applied value of function magnetic resonance imaging （tMRI） and electrocorticogram （ECoG） in surgery for the tumor in the eloquent brain areas with associated epilepsy. Methods Clinical data from 13 cases of eloquent tumor was retrospectively analyzed, The morphology and distribution of the eloquent cortex and white matter were evaluated by fiVIRI before the operation, and the epilepsy focus was localized to guide resections of the tumor and epileptogenic focus by ECoG records during the operation. Results Hand motor cortex was jostled, the eloquent cortex transferred or recombined and the tumor was totally resected in 9 cases. The tumor partially overlapped with the eloquent cortex and the tumor was sub-totally resected in 2, and totally overlapped with partially resected in 2. ECoG showed that the distance between epileptogenic focus and brain tumor was less than 2 cm in 9 patients, 3-5 cm in 2, and overlapped in 2. Postoperative transient aphasia occurred in 1 case, and transient hemiplegia in 2. Conclusion fiVIRI can exactly display the position of the motor cortex, and is very important for making pre-operative plan and reducing damage from the tumor in the eloquent brain area. ECoG shows that most of the epileptogenic foci are less than 2 cm in distance to the tumor.