MRI与DSA影像融合联合电生理监测对脑动静脉畸形伴癫痫手术的价值

Value of MRI and 3D-DSA images fusion combined with intraoperative neuro-electrophysiological technique to surgery for intracranial arteriovenous malformation associated with epilepsy

目的探讨MRI与3D-DSA三维影像融合联合电生理监测在脑动静脉畸形伴癫痫显微手术中的应用价值。方法将1例脑动静脉畸形合并癫痫患者的MRI与3D-DSA影像数据输入神经导航进行影像融合,对病灶进行精准定位,联合术中电生理监测,完成脑动静脉畸形及致痫灶显微切除术。结果本例通过MRI与3D-DSA影像融合,精确定位显示病灶范围,术中实时导航找到主要供血动脉及引流静脉,成功切断主要供血动脉,完整切除畸形血管团,同时结合术中神经电生理技术定位脑功能区及致痫灶,术后患者无神经功能缺损,复查DSA示畸形无残留,脑电监测颅内未见异常放电。结论 MRI与3D-DSA影像融合结合术中电生理监测联合应用,可以既能完全切除脑动静脉畸形病灶,又能同时清除致痫灶,保护脑重要功能区,为重要功能区脑动静脉畸形继发癫痫的治疗提供了一种安全有效的新方法。

Objective To investigate the value of MRI and 3D-DSA images fusion combined with intraoperative neuro-electrophysiological technique to the surgery for intracranial arteriovenous malformation （AVM） associated with epilepsy. Methods MRI and 3D-DSA images fusion was performed in 1 patient with epilepsy induced by AVM, in whom, AVM and epileptogenic zone were resected by neuronavigator-assisted surgery under eletroophysiological monitoring. Results The lesion was exactly located by MRI and 3D-DSA images fusion. The main arteries supplying blood to AVM and veins dainaging from AVM were found by the real-time navigation and then were ligated and cut off. AVM was totally resected. The epileptogenie zone and the functional cortex were accurately located by intraoperative eletrophysiological technique. The epileptogenic zone were successfully resected without neurological functional deficits. Conclusions MRI and 3D- DSA images fusion technology, which can clearly show anatomical structure and vascularity on the same image, combined with electrophysiological technique, which can locate epileptogenic zone and functional areas, is of the great value to the surgery for the epilepsy secondary to the intracranial AVM.