联合BOLD和DECS技术脑功能区定位辅助语言相关区脑肿瘤手术的应用

Functional brain mapping with BOLD and DECS in surgical treatment of brain tumors in language areas

目的利用BOLD和DECS技术进行语言功能区定位,实现语言功能区保护下肿瘤的最大程度切除。方法对15例语言相关功能区脑肿瘤患者,利用血氧依赖功能磁共振(BOLD-fMRI)技术和(或)术中唤醒麻醉下皮层直接电刺激(DECS)定位技术进行脑语言功能区定位;对所获定位资料进行个体化评估,术中辅助保护语言功能区,在神经导航指引下切除肿瘤。结果 15例患者成功获取了术前BOLD语言区图像,评估后其中6例患者实现了术前BOLD和术中DECS技术联合定位语言功能区。全组病例在保护语言区条件下病变全切除10例,次全切除3例,大部分切除2例。术后语言功能明显改善6例,无变化5例,短暂性感觉性失语2例,语言功能障碍明显加重2例。结论术前BOLD-fMRI结合术中唤醒麻醉下皮层电刺激的方法可客观定位脑语言功能区,导航辅助保护语言功能区条件下切除肿瘤,在保护语言功能的同时最大化切除肿瘤组织,提高患者术后生活质量。

Objective To study the application pendent-magnetic resonance imaging （BOLD-MRI） for perative direct electrical cortical stimulation （DECS） of of cortical mapping methods of blood preoperative localization of language oxygen level-de- areas and intraolanguage areas in awake anesthesia in assisting to remove brain tumors in language areas. Methods Cortical mapping data of language areas was collected from 15 patients with brain tumors in language areas by BOLD-MRI and/or intraoperative DECS in awake anesthesia, and the data combined with neuronavigation assisted-microscopy were applied for the removal of brain tumors in language areas. Results The images of language areas were successfully obtained from the 15 patients by preoperative BOLD-MRI, and after evaluation the language areas were localized by both preoperative BOLD and intraoperative DECS in 6 patients. There were total resection in 10 patients, subtotal resection in 3 patients and partial resection in 2 patients based on the protection of language areas. After the operation, there were 6 patients with significantly improved language function, 5 patients with unchanged language function, 2 patients with transient sensory aphasia and 2 patients with deteriorated language function. Conclusion Functional cortical mapping including preoperative BOLD-MRI and intraoperative DECS has a good clinical value for the localization of language areas. It can increase the extent of tumor resection without impairing the language area, reduce postoperative morbidity, and improve the life quality of the patients with brain tumor.