脑干海绵状血管瘤术中扩散张量成像联合电生理学监测研究

Study on diffusion tensor imaging combined with electrophysiological monitoring in brain stem cavernous hemangioma resection

目的探讨术中扩散张量成像(DTI)联合电生理学监测在脑干海绵状血管瘤切除术中的应用价值。方法共39例脑干海绵状血管瘤患者术中采用DTI和扩散张量纤维束示踪成像(DTT)追踪并重建锥体束,电生理学监测体感诱发电位、运动诱发电位和脑干听觉诱发电位变化。结果 39例患者均顺利完成脑干海绵状血管瘤切除术,术中体感诱发电位异常5例(12.82%);运动诱发电位异常6例(15.38%),2例(5.13%)经DTI证实锥体束体积减少;脑干听觉诱发电位无明显变化。术中MRI显示病变全切除36例(92.31%),次全切除3例(7.69%),术后临床症状改善29例(74.36%)、无明显变化4例(10.26%)、新发面瘫3例(7.69%)、运动障碍加重2例(5.13%),意识障碍合并肺部感染致死亡1例(2.56%)。术后平均随访30个月,Glasgow预后分级5分27例(69.23%)、4分7例(17.95%)、3分4例(10.26%)、1分1例(2.56%)。结论术中联合应用DTI和电生理学监测有助于安全、有效地切除脑干海绵状血管瘤。

Objective To evaluate the clinical application value of diffusion tensor imaging （DTI） combined with electrophysiological monitoring in the resection of brain stem cavernous hemangioma （CM）. Methods There were 39 patients with brain stem cavernous hemangioma. DTI was performed before and during the operation. Diffusion tensor tractography （DTT） was used to track fiber and reconstruct pyramidal tract, lntraoperative neurobehavioral monitoring was used to detect the changes of somatosensory-evoked potentials （SEP）, motor- evoked potentials （MEP） and brain stem auditory- evoked potentials （BAEP）. Results Of all the 39 patients, there was no significant change of BAEP during the operation, 5 patients （12.82%） had abnormal SEP, 6 cases （15.38%） had abnormalities in MEP monitoring, 2 cases （5.13%） had reduced volumes of pyramidal tract proved by DTI. Intraoperative MRI confirmed 36 cases （92.31%） had complete removal of lesions, and 3 cases （7.69%） had subtotal resection. There were improvement of clinical symptoms in 29 cases （74.36%）, no obvious changes in 4 cases （10.26%）, postoperative facial paralysis in 3 cases （7.69%）, worsened movement disorder in 2 cases （5.13%）, death due to disorder of consciousness and pulmonary infection in one case （2.56%）. Postoperative follow-up was 30 months in average. Glasgow Outcome Scale （GOS） showed 27 cases （69.23%） of Grade 5, 7 cases （17.95%） of Grade 4, 4 eases （10.26%） of Grade 3, and one case （2.56%） of Grade 1. Conclusions Combined use of intraoperative DTI and electrophysiological monitoring can safely and effectively remove brain stem cavernous hemangioma.