神经导航融合DTI在大脑功能区附近病变手术的临床应用

Clinical application of neuronavigation with diffusion tensor imaging in microsurgery for lesions near cerebral functional area

目的探讨神经导航融合DTI在大脑功能区附近病变手术的应用价值。方法对40例病变位于大脑功能区附近(20例位于额顶叶中央沟附近,13例位于枕叶视觉距状裂附近,7例位于左侧语言中枢附近)的右利手病人,术前行磁共振弥散张量成像(DTI),获得白质纤维束原始资料,经神经导航融合DTI和解剖像并三维重建后,术中在导航辅助下行显微手术。结果病变全切34例,次全切6例。术后神经功能好转或无变化35例,出现一过性加重5例。无遗留永久性功能障碍。结论神经导航融合DTI可以准确定位功能区,操作性强,易推广,术中实时保护周边邻近传导束,减少术后神经功能障碍并发症,安全范围内最大程度切除,具有颇高的临床意义。

Objective To explore the clinical value of neuronavigation in combination with diffusion tensor imaging（DTI） in microsurgery for lesions near cerebral functional area. Methods Forty right-handed patients with lesion near the eloquent brain region, including 20 lesions located near the central sulcus in the frontoparietal lobes, 13 located near the occipital visual calcarine fissure, 7 near the left language center, underwent microsurgical resection of lesions near cerebral functional area with assistance of DTI based on functional neuronavigation. Results The radical resection of the lesions was achieved in 34 patients and subtotal resection in 6. Postoperative neurological dysfunction was improved or unchanged in 35 patients and aggravated in 5. There was no permanent dysfunction.Conclusions Neuronavigation with DTI in microsurgery for lesions near the eloquent brain area is helpful in protecting peripheral neuronal tract, maximizing the resection of lesions, minimizing neural injury and promoting postoperative recovery.