磁共振血管成像和功能定位在脑皮层运动功能区脑膜瘤显微手术中的应用

The application of MRA and fMRI in microsurgery of meningiomas in the region of motor cortex

目的 探讨磁共振脑血管成像(MRA)和功能定位(fMRI)在皮层运动功能区脑膜瘤显微手术中的应用价值。方法 32例皮层运动功能区脑膜瘤均行CT和(或)MRI检查及fMRI和静脉相MRA检查。术中肿瘤予以瘤内分块切除,然后在显微镜下分离肿瘤包膜。结果 肿瘤切除程度:Simpson Ⅰ级12例,Ⅱ级18例,Ⅲ级2例。其中7例同时行去骨瓣减压术。术后肌力好转6例,肌力无改变23例,肌力下降或加重3例,功能保护率91％。结论 术前行MRA和fMRI检查有助于选择合适的手术入路和避免损伤矢状窦、中央沟静脉和脑功能区皮质,对预防术后脑水肿、保护脑功能有重要价值。

Objective To evaluate the applied value of MRA and fMRI in microsurgery of meningiomas in the region of motor cortex. Method 32 cases of meningiomas were examined with MRA and fMRI. All tumors were resected microsurgically. Result The excised extent of tumors were graded with Simpson grade: 12 cases in grade Ⅰ , 18 cases in grade Ⅱ , 2 cases in grade D1. 7 cases were decompressed by removing bone flap simultaneously. The patient's myodynamia after operation improved in 6 cases, unchanged in 23 cases, descended or worsened in 3 cases. Conclusion The examination of MRA and fMRI contribute to selecting appropriate surgerical approach and avoiding damage of upper saggital sinus, cerebral central veins and motor cortex. It is very useful in preventing brain edema and protecting brain function.