大脑功能组织可视化及fMRI术中导航在脑肿瘤切除术中的应用

Three-dimensional visualization of functional brain tissue and functional magnetic resonance imaging-integrated neuronavigation in the resection of brain tumor adjacent to motor cortex

目的探讨术前功能组织三维可视化及功能信息引导下无框架立体定向导航技术于脑肿瘤切除术中的应用价值。资料与方法将拟行立体导航的患有中央沟附近脑肿瘤的病人随机分配到功能导航组及普通导航组,各30例。功能导航组所有病人均行术前功能组织定位,并将信息导入神经外科导航仪行术中功能区导航。普通导航组病人术中未加入功能信息。比较两组病人手术疗效、肿瘤切除率、运动功能改善情况以及肿瘤病人术后生存质量。结果功能导航组均于术前完成功能组织可视化,且于术中成功标定肿瘤、中央沟及运动区。术中功能信息在开颅前及开颅后均有明显作用。随访结果显示,在手术方式选取(u=2.646,P=0.008)、肿瘤切除率(χ2=7.200,P<0.01)、病人术后运动功能改善情况(u=2.231,P=0.026)及术后生存质量(KPS评分uc=2.664,P=0.008;Zubrod-ECOG-WHO评分uc=2.135,P=0.033)等方面,功能组均优于普通组。结论应用术前功能组织可视化辅助手术计划,实施术中功能信息引导下的神经导航技术,结合术中超声的准确定位,能够正确判断脑功能区与病变的关系,使手术方案个体化,实现在尽可能保护功能区的情况下最大限度切除肿瘤的目的,提高术后病人的生存质量。

Objective To assess the value of three-dimensional visualization of functional brain tissue and the functional magnetic resonance imaging （fMRI）-integrated neuronavigation in the resection of brain tumor adjacent to motor cortex. Method Sixty patients with tumor located in the central sulcus were enrolled. Thirty patients were randomly assigned to function group and 30 to control group. Patients in function group underwent fMRI to localize the functional brain tissues. Then the function information was transferred to the neurosurgieal navigator. The patients in control group underwent surgery with navigation without function information. The therapeutic effect, excision rate, improvement of motor function, and survival quality during follow-up were analyzed. Result All patients in function group were accomplished visualization of functional brain tissues and fiVIRI-integrated neuronavigation. The locations of tumors, central sulcus and motor cortex were marked during the operation. The fMRI-integrated information played a great role in both pre- and post-operation. Pre-operation： designing the location of the skin flap and window bone, determining the relationship between the tumor and motor cortex, and designing the pathway for the resection. Post- operation： real-time navigation of relationship between the tumor and motor cortex, assisting to localize the motor cortex using interoperation ultra-sound for correcting the displacement by the CSF outflow and collapsing tumor. The patients in the function group had better results than the patients in the control group in therapeutic effect （u=2.646, P=0.008）, excision rate （X2=7.200,P〈0.01）,improvement of motor function （u=2.231, P=0.026）, and survival quality （KPS uc= 2.664, P=O.OO8;Zubrod-ECOG-WHO uc=2.135, P=0.033）. Conclusions Using preoperative three-dimensional visualization of cerebral function tissue and the fMRI-integrated neuronavigation technology, combining intraoperative accurate positioning supplied by ultrasound, we can correctly judge the brain function and pathological tissues and protect brain function in the resection of tumor.