功能神经导航及术中磁共振对语言区病变语言保护作用研究

Protective Effect of Multimodal Navigation and Intraoperative Magnetic Resonance Imaging on Language Function in Cerebral Lesions Involving Language Area

目的探讨功能神经导航及术中磁共振在邻近弓形束病变手术中提高切除程度、全切率和保护患者语言功能的作用。方法收集65例病变累及优势半球皮层下语言传导束即弓形束的患者。评价功能神经导航和术中磁共振对手术策略、病变切除程度、全切率及语言功能的影响。结果 65例患者在功能神经导航和术中磁共振引导下行病变切除术,与第一次i MRI结果比较,术者对12例患者切除程度判断不准确,误判率为18.5%。非胶质瘤病变首次i MRI确认全切除。54例胶质瘤中,第一次i MRI证实,21例全切除,33例有肿瘤残留。25例根据术中影像更新手术计划后切除残余肿瘤的平均切除程度从87.3%提高到97.4%,所有胶质瘤患者的平均切除程度从92.1%提高到96.8%。术后2周有15例(23.1%)原有症状加重或新发失语。6个月随访时,2例患者(3.2%)存在长期语言功能障碍。结论功能神经导航和术中磁共振有助于在最大化切除病变的同时,最小程度损伤患者的语言功能,提高患者术后健康相关生活质量。

Objective To evaluate the impact of multimodal navigation and intraoperative magnetic resonance imaging(iMRI)on extent of resection,gross total resection and preservation of language function.Methods A total of65patients with cerebral lesions involving arcuate fasciculus(AF)were enrolled.Impact of multimodal navigation and iMRI on surgical strategies,extent of resection,rate of gross total resection(GTR)and language function were analyzed.Results Extent of resection was overestimated in12cases(18.5%)by the neurosurgeons,compared with the first iMRI.The first iMRI confirmed total resection of non-glioma lesions.First iMRI demonstrated gross total resection in21patients and incomplete resection in33cases.Further resection was continued with updated imaging in25patients.Additional tumor resection in25cases increased extent of resection from87.3%to97.4%,resulting in improvement of mean resection degree in glioma cases from92.1%to96.8%.Compared with preoperative language function status,15cases(23.1%)got new or worsened language dysfunction2weeks after surgery.At6-month followup,only2patients had a permanent postoperative language deficit.Conclusion Multimodal navigation and iMRI help maximal resection of cerebral lesions while minimum injury to language function,which can improve health related quality of life.