CAJ | 학술논문

目的应用神经导航影像融合并结合皮层电刺激功能定位技术,初步实现三维可视化皮层功能拓扑定位,辅助累及皮层功能区致痫灶的手术,提高疗效.方法 1例药物难治性癫痫患者,行双侧皮层电极埋藏覆盖中央区,术后予皮层脑电图监测,并实施皮层电刺激定位功能区.神经导航系统融合头颅MRI和CT影像,三维可视化拓扑定位皮层功能和致痫灶,第二次手术在导航辅助定位保护功能区的前提下,行致痫灶切除术,对累及功能区的病变实施皮层热灼术.结果患者成功埋藏32导、24导及6导皮层电极各一枚覆盖中央区,皮层脑电图监测捕获临床发作4次,定位致痫灶；皮层电刺激确定功能区.神经导航影像融合建立覆盖皮层电极的三维大脑模型,还原电生理资料,实现拓扑定位.手术成功实施病灶切除,术后无发作情况,无并发症.结论应用神经导航影像融合技术,使作为脑-机接口的脑皮层电极技术与影像学技术相结合,将皮层电极的空间位置,精确融合在基于头颅MRI建立的大脑皮层解剖模型上,还原皮层脑电图和皮层电刺激结果,实现三维可视化拓扑定位,对于累及功能区致痫灶的神经外科手术具有重要指导意义.
목적 응용신경도항영상융합병결합피층전자격공능정위기술,초보실현삼유가시화피층공능탁복정위,보조루급피층공능구치간조적수술,제고료효.방법 1례약물난치성전간환자,행쌍측피층전겁매장복개중앙구,술후여피층뇌전도감측,병실시피층전자격정위공능구.신경도항계통융합두로MRI화CT영상,삼유가시화탁복정위피층공능화치간조,제이차수술재도항보조정위보호공능구적전제하,행치간조절제술,대루급공능구적병변실시피층열작술.결과 환자성공매장32도、24도급6도피층전겁각일매복개중앙구,피층뇌전도감측포획림상발작4차,정위치간조；피층전자격학정공능구.신경도항영상융합건립복개피층전겁적삼유대뇌모형,환원전생리자료,실현탁복정위.수술성공실시병조절제,술후무발작정황,무병발증.결론 응용신경도항영상융합기술,사작위뇌-궤접구적뇌피층전겁기술여영상학기술상결합,장피층전겁적공간위치,정학융합재기우두로MRI건립적대뇌피층해부모형상,환원피층뇌전도화피층전자격결과,실현삼유가시화탁복정위,대우루급공능구치간조적신경외과수술구유중요지도의의.
Objective With the help of image fusion,a 3D model of cortex covered with cortical electrodes was established.With that model,the electrophysiological information from the electrodes could be bound with gyri and sulci as point to point for analysis.A preliminary topological trial in clinical brain mapping was demonstrated,in order to improve the accuracy of localization and the outcome of surgery involving the eloquent cortex.Method One case of drug -resistant epilepsy was screened by long term video - EEG,localizing the epileptogenic zones around central areas without iateralization.There was no more valuable information could be supplied by imageology.Three subdural electrodes(4 ×8 grid; 4 ×6 grid; 1 ×6 strip) were then implanted for covering bilateral central cortex for 4 days.The long term video - ECoG and electrocortical stimulation had been applied in this period for more information about the foci and cortical function.Based on the 3D model that established by merging MRI and CT,the relationship between the foci and eloquent cortex could be shown as schemes for analysis and surgical plan.With the iastruction of neuronavigation and the schemes,the foci which was out of the funtional area would be removed and that involving would be thermocoagulated.Results Four clinical seizures were captured with three cortical electrodes and the cortical function of 52 areas were detected.Depending on the colleeted information,the operation was performed without postoperative complication.There was neither seizure nor permanent neurological deficit was shown after the surgery.Conclusions The technique of image fusion realized the visual combination of cortical electrodes and 3D brain model as a brain - computer interface.It demonstrates a preliminary topological trial for millimeter -scale human brain mapping in order to provide more accurate localization for surgery involving eloquent cortex,and would make the clinical topology of brain mapping to be true.