中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2011年
8期
693-698
,共6页
路俊锋%章捷%吴劲松%姚成军%庄冬晓%邱天明%龚秀%许耿%毛颖%周良辅
路俊鋒%章捷%吳勁鬆%姚成軍%莊鼕曉%邱天明%龔秀%許耿%毛穎%週良輔
로준봉%장첩%오경송%요성군%장동효%구천명%공수%허경%모영%주량보
神经导航%电刺激%术中磁共振%语言皮质定位%唤醒麻醉
神經導航%電刺激%術中磁共振%語言皮質定位%喚醒痳醉
신경도항%전자격%술중자공진%어언피질정위%환성마취
Neuronavigation%Electric stimulation%Intraoperative magnetic resonance imaging%Language mapping%Awake anesthesia
目的 评价3.0 T术中磁共振成像(iMRI)下采用唤醒麻醉联合术中语言皮质定位技术辅助语言区脑胶质瘤切除的临床有效性.方法 2010年12月至2011年4月以集成3.0 TiMRI数字一体化神经外科手术中心为平台,采用唤醒麻醉、改良手术铺巾技术、联合直接电刺激语言皮质定位和iMRI实时影像神经导航,对11例右利手患者实施左侧语言区脑胶质瘤切除.术中采用简易语言任务模式,包括语言流利度、图片命名和文字测读,评估患者语言功能状况.围手术期采用汉语失语检查法,评估新技术的临床有效性.结果 通过iMRI实时影像导航,6/11的患者可以定量提升胶质瘤切除范围,其中影像学全切除率提高3/11,最终肿瘤全切除7例,次全切除4例.语言皮质定位阳性率为8/11.患者术后1周内出现一过性失语率为4/11,随访至术后1个月,所有患者语言功能均恢复到术前水平或以上;围手术期患者无肢体运动功能障碍.结论 应用3.0 T超高场强iMRI实时影像导航可在术前设计脑胶质瘤个体化手术方案,术中精确定位病灶,等体积定量切除肿瘤,提高肿瘤切除率;在唤醒麻醉下实施术中皮质电刺激定位语言区,能最大程度保护患者语言皮质,避免出现不可逆的语言功能损伤,提高术后社会生活质量.
目的 評價3.0 T術中磁共振成像(iMRI)下採用喚醒痳醉聯閤術中語言皮質定位技術輔助語言區腦膠質瘤切除的臨床有效性.方法 2010年12月至2011年4月以集成3.0 TiMRI數字一體化神經外科手術中心為平檯,採用喚醒痳醉、改良手術鋪巾技術、聯閤直接電刺激語言皮質定位和iMRI實時影像神經導航,對11例右利手患者實施左側語言區腦膠質瘤切除.術中採用簡易語言任務模式,包括語言流利度、圖片命名和文字測讀,評估患者語言功能狀況.圍手術期採用漢語失語檢查法,評估新技術的臨床有效性.結果 通過iMRI實時影像導航,6/11的患者可以定量提升膠質瘤切除範圍,其中影像學全切除率提高3/11,最終腫瘤全切除7例,次全切除4例.語言皮質定位暘性率為8/11.患者術後1週內齣現一過性失語率為4/11,隨訪至術後1箇月,所有患者語言功能均恢複到術前水平或以上;圍手術期患者無肢體運動功能障礙.結論 應用3.0 T超高場彊iMRI實時影像導航可在術前設計腦膠質瘤箇體化手術方案,術中精確定位病竈,等體積定量切除腫瘤,提高腫瘤切除率;在喚醒痳醉下實施術中皮質電刺激定位語言區,能最大程度保護患者語言皮質,避免齣現不可逆的語言功能損傷,提高術後社會生活質量.
목적 평개3.0 T술중자공진성상(iMRI)하채용환성마취연합술중어언피질정위기술보조어언구뇌효질류절제적림상유효성.방법 2010년12월지2011년4월이집성3.0 TiMRI수자일체화신경외과수술중심위평태,채용환성마취、개량수술포건기술、연합직접전자격어언피질정위화iMRI실시영상신경도항,대11례우리수환자실시좌측어언구뇌효질류절제.술중채용간역어언임무모식,포괄어언류리도、도편명명화문자측독,평고환자어언공능상황.위수술기채용한어실어검사법,평고신기술적림상유효성.결과 통과iMRI실시영상도항,6/11적환자가이정량제승효질류절제범위,기중영상학전절제솔제고3/11,최종종류전절제7례,차전절제4례.어언피질정위양성솔위8/11.환자술후1주내출현일과성실어솔위4/11,수방지술후1개월,소유환자어언공능균회복도술전수평혹이상;위수술기환자무지체운동공능장애.결론 응용3.0 T초고장강iMRI실시영상도항가재술전설계뇌효질류개체화수술방안,술중정학정위병조,등체적정량절제종류,제고종류절제솔;재환성마취하실시술중피질전자격정위어언구,능최대정도보호환자어언피질,피면출현불가역적어언공능손상,제고술후사회생활질량.
Objectives To evaluate preliminary clinical experience for combining awake craniotomy and intraoperative language brain mapping within the integrated 3.0 T intraoperative maguetic resonance imaging (iMRI) suite.Methods From December 2010 to April 2011,11 right hand-dominant patients with left glioma were involved in, or adjacent to, eloquent cortex was carried out awake craniotomies with cortical stimulation within an integrated 3.0 T iMRI suite.Aphasia battery of Chinese was used to test the language function before the operation.During the procedure, after the occipital, temporal, and supraorbital nerves were blocked by the anesthesiologists, the head was fixed with a custom high-field MRI-compatible head holder.The skull and dura was opened as usual and language brain mapping was then performed.Language testing followed a set protocol:counting numbers from 1 to 50, naming objects, reading single words.Resection of the tumor was guided by neuronavigation system and continued until eloquent areas were encountered or the margin of assessment was reached.An interdissection MRI was aquired to evaluate the glioma removal in a movable MRI scanner after minimal draping. Meanwhile, adverse effects caused by electrical stimulation and iMRI were recorded.The follow-up speech tests were assessed on 7th day and 1 month at least after the operation.Results The combined use of 3.0 T iMRI and awake craniotomy was performed safely in all patients.No adverse effects were reported.The duration of surgery was prolonged by 2 to 4 h.The patients' perception of iMRI during surgery was favorable.First-look MRI studies led to further resection attempts in 6/11 cases as well as a 3/11 increase in the number of gross-total resections.One week after surgery, baseline language function worsened in 4 cases. However, no patients had a persistent language deficit one month after surgery. Conclusions Awake craniotomy and direct cortical electrical stimulation can be performed safely and effectively within a 3.0 T iMRI suite.The combination of high-field iMRI and awake craniotomy may facilitate safe removal of eloquent glioma.
