fMRI辅助神经导航技术结合术中脑电监测在癫痫外科中的应用

Application of fMRI assist with neuronavigation combined with intraoperative ECoG monitoring in epilepsy surger

目的探讨功能磁共振成像(fMRI)辅助神经导航技术结合术中脑电监测对脑功能区癫痫患者术中功能区定位的意义及手术效果的评估。方法对18例头皮脑电异常放电部位位于功能区的难治性癫痫患者(12例位于感觉运动区,6例位于语言区)术前进行fMRI扫描后,将导航序列的fMRI影像传输至神经导航仪,术中应用导航系统定位感觉运动区及语言区,应用术中脑电监测,对癫痫起源部位进一步精确定位,术中最大限度的切除致痫灶,对波及功能区的病灶实行皮层电灼术或多处软膜下横切(MST),术后常规应用抗癫痫药。结果全部患者在预定的癫痫灶局部均可记录到癫痫波,术后出现感觉运动区功能障碍者2例,言语障碍者1例,除1例出现永久感觉障碍外,其余患者均在术后1周内症状缓解。按照Engel分级评价为:I级7例,Ⅱ级5例,Ⅲ级4例,Ⅳ级2例;总有效者16例,有效率达88.9%。结论fMRI结合术中皮层脑电监测可实现个体化、实时、精确地定位病灶及毗邻的脑皮质功能区,达到在保护重要脑功能的前提下最大限度的切除致痫灶的目的。

Objective To investigate the significance of the functional area location and the evaluation of operation effect in epilepsy patients,whose paradoxical discharge located in functional area,using fMRI assist with neuronavigation combined with intraoperative ECoG monitoring in epilepsy surgery.Methods fMRI scanning was used on 18 patients with refractory epilepsy in preoperative,whose scalp ECoG monitoring demonstrated that paradoxical discharge located in functional area,including 12 patients in sensorimotor area and 6 patients in language area.Then transmit BOLD image to neuronavigator to localize sensorimotor area and language area in operation.Intraoperative ECoG monitoring was also used to pinpoint the origin part of epilepsy.We resected epileptogenic focus maximatily in operation,cortical electrocautery or multiple subpial transaction was also used for functional area focus.Antiepileptic drugs were used after operation.Results Epileptic discharge was obtained from predicated location of epileptogenic zone in all patients by ECoG.After operation sensorimotor area dysfunction existed in 2 cases,language disorders existed in 1 case.All symptoms were released within a week,except a patient has permanent sensation disorders.According to curative effect assessment of Engel,the clinical outcome showed that 7 patients were seizure free after surgery,9 patients were improved,and 2 patients were not improved.The effective rate was 88.9%（16/18）.Conclusion Using fMRI assist with neuronavigation combined with intraoperative ECoG monitoring can supply more precise,individualization and real-time information about the relationship between lesions and neighboring cortical functional area,to achieve the purpose of resecting epileptogenic focus maximatily in condition of protecting brain function.