多模态神经导航联合皮层电刺激技术在脑功能区胶质瘤的临床应用研究

Clinical application of multimodal neuronavigation combined with cortical electrical stimulation in cerebral functional area glioma

目的探讨多模态神经导航联合皮层电刺激技术在脑功能区胶质瘤的临床应用价值。方法选择2016年4月至2018年4月本院收治的脑功能区胶质瘤患者64例作为研究对象,包含语言区胶质瘤患者6例,运动区胶质瘤患者58例,术前行多模态神经导航,术中利用皮层电刺激技术监测重要神经传导束,利于手术切除治疗的开展,实现脑结构的保护。结果肿瘤全切除55例,肿瘤次全切除术8例肿瘤部分切除1例。6例语言区胶质瘤患者经治疗后语言功能改善2例,3例患者语言功能无明显变化,而1例患者语言功能出现恶化。31例患者术前肢体肌力正常,术后8例运动功能受到影响,经康复指导后恢复正常,另外27例患者术前肌力下降,经手术治疗及康复指导后,20例肌力得到改善,但7例患者肌力恶化,康复指导改善后仍弱于术前。结论在脑功能区胶质瘤诊治中利用多模态神经导航可实现脑功能区的定位,利于为制定手术计划提供可靠的依据,确保病灶完全切除,同时术中应用皮层电刺激技术可进行脑功能结构的定位和保护,避免损害神经功能,应用价值较高。

Objective To investigate the clinical value of multimodal neuronavigation combined with cortical electrical stimulation in cerebral functional area glioma.Methods 64 patients with brain gliomas admitted to our hospital from April 2016 to April 2018 were enrolled as data,including 6 patients with linguistic glioma and 58 patients with glioma in the motor area.Multimodal neural navigation,intraoperative cortical electrical stimulation technology to monitor important nerve mission bundles,facilitate the development of surgical resection and achieve brain structure protection.Results Total tumor resection was performed in 55 patients,and subtotal tumor resection was performed in 8 patients with partial tumor resection.In 6 patients with glioma,the language function improved after treatment in 2 cases.The language function of 3 patients did not change significantly,and the language function of one patient deteriorated.Thirty-one patients had normal muscle strength before operation.Eight patients had motor function after operation,and returned to normal after rehabilitation.Another 27 patients had decreased muscle strength before surgery.After surgery and rehabilitation,20 muscle strengths were improved.However,in 7 patients,the muscle strength deteriorated,and the rehabilitation guidance was still weaker than the preoperative.Conclusion The use of multimodal neural navigation in the diagnosis and treatment of cerebral glioma can realize the location of brain functional area,which is helpful for providing a reliable basis for the development of surgical planning,ensuring complete resection of the lesion,and intraoperative application of cortical electrical stimulation technology.The positioning and protection of the functional structure avoids damage to nerve function and has a high application value.