导航经颅磁刺激在脑肿瘤术中精准定位脑功能区的应用进展

Progress in the application of navigated transcranial magnetic stimulation on brain functional areas accurate mapping in brain tumor surgery

脑肿瘤手术的困难在于最大程度切除肿瘤与最大程度保留神经功能之间取得平衡以求达到最佳治疗效果,因此,对皮质及皮质下重要神经功能的定位是手术操作的重要步骤。经颅磁刺激作为一种新型神经刺激方法,显示出良好的临床应用价值。近年随着与神经导航技术的联合应用,这种无创性精准神经功能定位方法逐渐显示出在脑肿瘤术中的应用价值。将导航经颅磁刺激与神经解剖和功能影像进行多模态影像学融合,可以完成术前对运动功能区和语言功能区的定位,并基于此分析皮质下纤维联系,为手术提供可靠信息,同时也可以用于术后监测神经功能康复和重塑趋势,在脑肿瘤术中具有较好的应用价值,有助于提高患者术后生活质量,对改善重要脑区的手术疗效、减少术后并发症具有重要意义。

Maximize the extent of tumor removal while maximize the preservation of neurological function is the goal of brain tumor surgery.Therefore,brain eloquent functional area mapping of both cortical and subcortical level is the most important procedure during operation.As a new method of noninvasive brain stimulation,transcranial magnetic stimulation(TMS)shows its value in neuroscience.Combining with neuronavigation,navigated transcranial magnetic stimulation(nTMS)can localize functional cortices in both brain tumor patients and healthy volunteers noninvasively and accurately.With the help of neuroanatomical structure and brain functional imaging information fusion,nTMS can localize motor cortex and language related cortex preoperatively and provide reliable connection information of subcortical fiber tracts during surgery.nTMS can also monitor and evaluate function recovery level and brain plasticity patterns post⁃operation,while further improve patients'outcome and quality of life and reduce postoperative complications as well.nTMS shows its significant value applied in brain tumor surgery.