脑功能区病变术前运动功能的评估

Preoperative assessment of motor function in cerebral central lesions

目的探讨功能磁共振成像（Functional Magnetic Resonance Imaging，fMRI）在脑运动区病变患者术前评估和手术设计中的作用。方法20例累及运动区的脑内占位病变患者，术前采用手握拳运动block激发模式，fMRI获取运动激活信号，术前分析病变与运动区的关系及功能重组织类型。结果病变位于中央前回前或后15例，fMRI均表现为病变对侧第一运动区（Primary Motor Area，M1）激活并向后或向前移位，病灶边缘与激活信号之间的最小距离为5～9mm，平均9．6mm。病变位于中央前回5例，表现为瘤周激活3例，运动前区激活并皮层弥散激活2例。结论fMRI有助于神经外科医师在术前对病变与功能区的关系及皮层功能重组织类型有较好的认识，对运动区病变术前评估和手术设计有重要指导价值。

Objective To explore the usefulness of functional MR imaging （fMRI） in preoperative assessment and surgical planning in cerebral central lesions. Methods A total of 20 patients bearing intrinsic massive lesions in or adjacent to the primary motor cortex were included. Motor activation signals were acquired by fMRI with hand clenching block active mode. The relationship between the border of lesion and the motor area activation as well as the types of the function reorganization were analyzed before surgery. Results Fifteen lesions were adjacent to the primary motor area. fMRI showed the activation in primary motor area （M1） and M1 activation shift ahead or backward. The closest distance between the borders of lesion to the activation was from 5 to 19 mm, average of 9.6 mm. Among five lesions involved in the primary motor area three lesions showed peri-tumor activation and two lesions showed pre-motor area activation. Conclusion fMRI can be helpful for the neurasurgeons to realize the relationship between lesion and motor cortex as well as the types of cortex function reorganization. It is of great importance in the preoperative assessment and surgical planning for lesions in or close to the central region.