术前功能磁共振在脑功能区肿瘤切除中的应用

Presurgical Functional Magnetic Resonance Imaging for Resection of the Cerebral Tumors Involving Functional Areas

目的探讨术前功能磁共振(fMRI)在功能区肿瘤切除中的临床应用价值。方法10例肿瘤邻近脑运动功能区患者,平均51.3岁,7例肢体无力,2例抽搐,1例口角偏斜,术前Karnofsky评分平均82分。常规行头颅核磁增强扫描,证实肿瘤位于功能区,再行fMRI检查。依据fMRI中活化区与肿瘤的位置关系决定全切或者次全切除肿瘤,术中避免活化区的损伤。术后观察肢体肌力恢复情况、进行术后Karnofsky评分并复查核磁了解术后肿瘤切除情况,与术前进行对比。结果10例fMRI活化区显示清晰,8例活化区被肿瘤挤压移位,拉伸变形。肿瘤边缘与活化区的最近距离0～26 mm,平均13.6mm。本组肿瘤全切7例,次全切除3例。术后肌力好转7例,2例抽搐患者术后未再出现抽搐;1例口角歪斜患者术后面神经功能分级减轻。术后1个月Karnofsky评分平均93分。术后1周复查MRI显示:肿瘤消失7例,余3例肿瘤缩小95%～99%。结论fMRI对邻近脑运动功能区肿瘤患者的术前评价有重要临床意义,对手术切除脑功能区周围肿瘤并保留运动功能有重要的指导作用。

Objective To investigate the value of presurgical functional magnetic resonance imaging （fMRI） in identifying the eloquent brain areas and guiding the resection of cerebral tumors located in these areas. Methods A total of 10 patients （aged 51.3 years on average） with tumors near to the brain functional areas were enrolled in this study, among which 7 had weakness in the limbs, 2 had convulsion, and 1 suffered from facial palsy. The preoperative Karnofsky scale of the patients was 82 on average. Before the fMRI, the patients have been confirmed as having tumors involving functional areas. They were treated by total or subtotal resection according to the anatomical relationship between activated areas and the tumor. Injuries to the activated areas should be avoided during the operation. After the treatment, the muscular strength, Karnofsky scales of the patients were tested. Postoperative MRI was carried out in all of the patients, and the results were compared with that before the operation. Results As shown by fMRI, the activated areas were compressed and dislocated by the tumor in 8 of the 10 patients. The minimal distance between the edge of the tumor and the activated spots was 0 - 26 mm（ mean, 13.6）. Seven of the patients received total resection of the tumor, while the other 3 underwent subtotal resection. After the surgery, the muscular strength was improved in 7 cases; the convulsion disappeared in the 2 patients who had symptom before the treatment; and the one who had facial palsy was improved. One month after the surgery, the mean Karnofsky scale of the patients was 93. Re-examination by MRI performed one week after the operation showed that the tumor was disappeared in 7 patients, and reduced by 95% to 99% in the other three. Conclusions fMRI is valuable in the preoperative evaluation of the brain functional area near to a cerebral tumor. It can be used to guide the tumor resection while preserving the motor areas.