中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2010年
4期
314-316
,共3页
侯远征%许百男%陈晓雷%余光宏%肖炳祥%王东
侯遠徵%許百男%陳曉雷%餘光宏%肖炳祥%王東
후원정%허백남%진효뢰%여광굉%초병상%왕동
锥体束%术中磁共振成像%弥散张量成像%纤维束追踪
錐體束%術中磁共振成像%瀰散張量成像%纖維束追蹤
추체속%술중자공진성상%미산장량성상%섬유속추종
Pyramidal tracts%Intraoperative magnetic resonance imaging%Diffusion tensor imaging%Fibet tracking
目的 总结74例锥体束导航辅助手术的初步经验.方法 术前及术中重建椎体束,总结该技术对手术策略的影响,术前及术中锥体束变化情况、手术效果、影响锥体束保护的因素.结果 36例锥体束到肿瘤的距离<5 mm,其中27例(75%)术前有肢体功能障碍;距离5～10 mm之间12例,2例(16%)有功能障碍;两组差异有统计学意义(x~2检验,P<0.05);>10 mm有26例,均无肌力异常.术后症状改善7例(9%),无变化48例(65%),轻度加重14例(19%),偏瘫5例(7%).锥体柬术中移位在(-16.2 mm,+17.2 mm)间.结论 锥体束导航可帮助术者制定手术入路,评估手术风险及决定切除程度,减低严重运动功能障碍的发生率.术中锥体束移位无规律,术中磁共振扫描十分必要.
目的 總結74例錐體束導航輔助手術的初步經驗.方法 術前及術中重建椎體束,總結該技術對手術策略的影響,術前及術中錐體束變化情況、手術效果、影響錐體束保護的因素.結果 36例錐體束到腫瘤的距離<5 mm,其中27例(75%)術前有肢體功能障礙;距離5～10 mm之間12例,2例(16%)有功能障礙;兩組差異有統計學意義(x~2檢驗,P<0.05);>10 mm有26例,均無肌力異常.術後癥狀改善7例(9%),無變化48例(65%),輕度加重14例(19%),偏癱5例(7%).錐體柬術中移位在(-16.2 mm,+17.2 mm)間.結論 錐體束導航可幫助術者製定手術入路,評估手術風險及決定切除程度,減低嚴重運動功能障礙的髮生率.術中錐體束移位無規律,術中磁共振掃描十分必要.
목적 총결74례추체속도항보조수술적초보경험.방법 술전급술중중건추체속,총결해기술대수술책략적영향,술전급술중추체속변화정황、수술효과、영향추체속보호적인소.결과 36례추체속도종류적거리<5 mm,기중27례(75%)술전유지체공능장애;거리5～10 mm지간12례,2례(16%)유공능장애;량조차이유통계학의의(x~2검험,P<0.05);>10 mm유26례,균무기력이상.술후증상개선7례(9%),무변화48례(65%),경도가중14례(19%),편탄5례(7%).추체간술중이위재(-16.2 mm,+17.2 mm)간.결론 추체속도항가방조술자제정수술입로,평고수술풍험급결정절제정도,감저엄중운동공능장애적발생솔.술중추체속이위무규률,술중자공진소묘십분필요.
Objective To summarize the experience of 74 patients with brain tumors whose pyramidal tracts were visualized by diffusion tensor imaging(DTI)based fiber tracking(FT)during perioperative period.Methods All the patients received MRI scans preoperatively and intraoperatively.Pyramidal tracts were constructed and integrated into neuronavigation system to implement fiber tracts navigation.The outcome,modification for strategy of surgery and factors influencing the protection for pyramidal tract were summarized.Results Before operation,the distance between pyramidal tract and tumor was ranged from 0 nun to 5 mm in 36 cases.27 among the 36 cases had motor deficits.The distance in 12 cases was ranged from 5 mm to 10 mm and two had motor deficits among them.The distance was greater than 10 mm in 26 cases and none of them had motor deficits.After operation,motor deficits were improved in 7 cases.no change in 48,14 developed new postoperative deficits and paresis was observed in 5 cases.The paresis was resolved partially in the prolonged postoperative course in 3 eases.The maximal pyramidal tract shifting Was ranged from-16.2 mm to+17.2 mm.Conclutions Pyramidal tract navigation can help surgeon to choose right snrgical approach,to lower the risk of surgery and determine the extent of resection.Thus,the rate of severe motor deficits could be decreased.The shifting of pyramidal tract during operation is irregular.Intraoperative MRI scan is necessary for detection of the shifting.
