功能神经导航和术中核磁共振引导下症状性枕叶癫痫的精准外科治疗

Precise resection of symptomatic occipital lobe epilepsy guided by functional neuronavigation combined with intra-operative magnetic resonance imaging

目的 评估功能神经导航和术中核磁共振（MRI）引导对症状性枕叶癫痫切除术的协助效果. 方法 回顾性分析北京军区总医院附属八一脑科医院自2011年1月至2012年4月收治的16例枕叶癫痫患者临床资料.所有患者术前均采取MRI扫描,并行影像融合,设计病变切除范围及入路后将三维计划输入导航系统并投射至手术显微镜辅助手术,其中5例还采用了术中MRI对残余病变重新定位,实施手术切除.术后定期对所有患者进行随访及疗效评定. 结果 所有患者均成功实施了功能神经导航,致痫病变、中央后回皮层和锥体束投射在手术显微镜下,精确切除病变,同时中央后回皮层和锥体束获得有效保护.术中MRI末次扫描提示致痫灶病变的切除范围达到术前计划.术后随访12～24个月,癫痫发作控制达Engel Ⅰ级11例、EngelⅡ级5例.出现偏侧视野缺损或扩大者9例,未出现偏瘫和偏身感觉障碍. 结论 对于症状性枕叶癫痫的致痫病变,通过功能神经导航和术中MRI精准定位病灶和功能区,可以达到精准切除病变并尽量减少神经功能障碍的目的.

Objective To evaluate the clinical effect of functional neuronavigation combined with intra-operative magnetic resonance imaging （iMRI） in resection of symptomatic occipital lobe epilepsy.Methods Sixteen patients with symptomatic occipital lobe epilepsy,admitted to our hospital from January 2011 to April 2012,were involved in present study.All patients underwent surgical operation assisted by functional neuronavigation.Before the operation,MRI scanning,imaging fusing,scope of lesion excision describing,and operative approach designing were performed successively.Three-D reconstructed navigation plan was integrated into neuronavigation system and used by combining with functional neuronavigation under microscope during the surgical procedure.And,the iMRI was performed in five of them; the operative plan of the residuary lesion was redesigned accordingly.After the operation,the regular clinical and iconography follow-up were in progress.Results The functional neuronavigation was successfully completed.The lesions,posterior central gyrus and pyramidal tracts were projected into operation microscope.The lesions were precisely excised,and the posterior central gyrus and pyramidal tracts were protected effectively.The last iMRI indicated that the range of resection was coincided with the pro-operative plan.During the follow-up of 12-24 months,11 patients were found to be completely seizure-free or with only aura （Engel I）,and 5 patients had only rare seizure （Engel Ⅱ,fewer than three seizures per year）.Nine patients appeared visual field defect without hemiparalysis or hemianesthesia.Conclusion Functional neuronavigation combined with iMRI is a safe and reliable technique for perfect resection of symptomatic occipital lobe epilepsy and reduction of normal brain functions by precisely locating lesions and important functional structures.