弓状束DTI技术结合神经影像导航在癫痫外科术中的应用

Application value of arcuate fasciculus diffusion tensor imaging technology combined withneuronavigation in epilepsy surgery

目的评价弓状束弥散张量成像（DTI）技术结合神经影像导航在癫痫外科术中的应用价值。方法回顾性分析自2011年3月至2014年3月北京军区总医院f现陆军总医院）收治的24例难治性癫痫外科切除手术患者资料，所有患者术前均经影像学明确诊断病灶毗邻语言功能区。术中应用弓状束DTI技术结合术中神经影像导航技术指导手术，术后随访应用Engel分级及语言行为评估量表评估患者的疗效及语言功能。结果癫痫灶毗邻Broca语言区者7例中，术后EngelⅠ级3例，Ⅱ级3例，Ⅲ级1例；毗邻weinicke语言区17例中，术后EngelⅠ级13例，Ⅱ级2例，Ⅲ级2例。所有患者均未出现永久性语言功能障碍。结论弓状束的DTI技术结合术中神经影像导航技术在癫痫外科治疗中有很高的应用价值。

Objective To evaluate the application value of arcuate fasciculus diffusion tensor imaging （DTI） combined with neuronavigation in epilepsy surgery. Methods A retrospective analysis of 24 patients with refractory epilepsy, admitted to our hospital from March 2011 to March 2014, was performed; the epileptic foci of these patients were adjacent to the language functional areas conformed by imaging before operation. Surgical resection was performed with the help of arcuate fasciculus of DTI, diffusion tensor fiber tracking （DT-FT） combined with neuronavigation. The surgical efficacy and language function of the patients were evaluated by Engel classification and Verbal Behavior Assessment Scale （VerBAS） at postoperative follow-up. Results During the follow-up from 12 to 47 months, according to Engel classification, in 7 patients with loci adjacent to Broca area, Engel grade I was achieved in 3, Engel grade II in 3 and Engel grade III in one; and in 17 patients with foci adjacent to Wernicke area, seizure control was as follows： Engel grade Ⅰ was noted in 13, Engel grade Ⅱ in 2 and Engel grade Ⅲ in 2. No perpetual language dysfunction after operation was noted in all the patients. Conclusion Arcuate fasciculus DTI combined with intraoperative neuronavigation has very high application value in the epilepsy surgery.