CAJ | 학술논문

目的：探讨多模态 MRI 技术结合神经导航及术中超声在大脑枕叶视觉功能区胶质瘤手术中的应用价值。方法回顾性分析2012年1月—2014年11月安徽医科大学附属省立医院神经外科收治的20例大脑枕叶视觉功能区胶质瘤患者手术相关资料，其中男9例、女11例，年龄27~72岁，均行神经显微手术治疗。术前利用灌注加权成像、弥散张量成像及血氧水平依赖功能 MRI 多模态 MRI 技术结合神经导航进行图像融合，重建病灶与视皮层及视辐射的3D 图像位置，设计合适的手术入路、界定病灶切除范围；术中超声实时判断肿瘤切除程度，合理保护功能区和视辐射。结果根据术后复查 MRI 结果，影像学全切除85.0%(17/20)，大部分切除15.0%(3/20)。术后随访1~30个月，肿瘤大部分切除3例分别于术后7、13、15个月复发；与术前相比，视力视野改善与术前相比，视力视野改善60%(12/20)，无明显变化40%(8/20)。结论多模态 MRI 技术结合神经导航及术中超声，能够准确定位枕叶视觉功能区和视辐射的走行，制定个体化手术方案，提高了枕叶视觉功能区胶质瘤外科治疗的安全性和有效性，实现最大程度保护脑功能的同时最大范围切除肿瘤组织，提高患者术后生存质量。
목적：탐토다모태 MRI 기술결합신경도항급술중초성재대뇌침협시각공능구효질류수술중적응용개치。방법회고성분석2012년1월—2014년11월안휘의과대학부속성립의원신경외과수치적20례대뇌침협시각공능구효질류환자수술상관자료，기중남9례、녀11례，년령27~72세，균행신경현미수술치료。술전이용관주가권성상、미산장량성상급혈양수평의뢰공능 MRI 다모태 MRI 기술결합신경도항진행도상융합，중건병조여시피층급시복사적3D 도상위치，설계합괄적수술입로、계정병조절제범위；술중초성실시판단종류절제정도，합리보호공능구화시복사。결과근거술후복사 MRI 결과，영상학전절제85.0%(17/20)，대부분절제15.0%(3/20)。술후수방1~30개월，종류대부분절제3례분별우술후7、13、15개월복발；여술전상비，시력시야개선여술전상비，시력시야개선60%(12/20)，무명현변화40%(8/20)。결론다모태 MRI 기술결합신경도항급술중초성，능구준학정위침협시각공능구화시복사적주행，제정개체화수술방안，제고료침협시각공능구효질류외과치료적안전성화유효성，실현최대정도보호뇌공능적동시최대범위절제종류조직，제고환자술후생존질량。
Objective To evaluate the application value of multi-modal magnetic resonance imaging, neuronavigation and intraoperative ultrasound in the microsurgery for gliomas near occipital visual function area. Methods The clinical data of 20 patients with gliomas in the occipital visual function area from January 2012 to November 2014 were retrospectively analyzed. All multi-modal magnetic resonance imaging were transferred to the neuronavigation system, reconstructed the three-dimensional location of lesions, visual cortex and optic radiation. Surgical approach was designed and excision scope was defined before the surgery. The level of tumor resection was real-time judged by intraoperative ultrasound. Visual cortex and optic radiation were reasonably protected. Results Total lesion resection of the MRI was achieved in 17 cases (85. 0% , 17 / 20), subtotal resection in 3 cases (15. 0% , 3 / 20). At 1 - 30 months follow up, 3 patients with subtotal lesion resection were found recurrence at 7, 13 and 15 months after operation,respectively. Visual functions were improved in 12 cases(60% , 12 / 20), unchanged in 8 cases (40% , 8 / 20 ). Conclusions The combination of multi-modal magnetic resonance imaging, neuronavigation and intraoperative ultrasound is helpful for accurately locating the visual cortex and optic radiation, making individual operation plan, improving the effectiveness and safety of surgical treatment for gliomas near occipital visual function area, achieving the greatest degree to protect brain function and maximize lesion resection, and is useful to improve the postoperative quality of life.