术前脑磁源成像脑皮质功能区定位提高功能区脑肿瘤手术的准确性

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中国组织工程研究与临床康复第77卷第48朋2007—12—02出版 JournalofClinicalRehabilitativeTissueEngineeringResearch December2,2007 Vo1.11.No.48 

麟 锄鳓刍 雾 囊 甏鬻| 曩I茸 0一毫|鬈_| 籀蠢 强臻 - 甏“| Preoperative localization of brain cortex by using magnetic source imaging can increase the veracity of brain neoplasm operation in ● ●i ■ i ^ tUnCt●ona_reg●on w 

Zhang Zhi-qiang ,Huang Tao ,Xie Cai‘jun ,Lin Tao ,Zhang Ping Abstract BACKGROUND:As a kind of unwounded biomagnetism technique,magnetoencephalography(MEG)relfects immediate information of cerebral function by using magnetic source imaging through recording changes of magnetic field of neurocytes under different functional status. 

OB3 EC-FIVE:To investigate the practicability of magnetoencephalography(MEG)imaging in localizing sensory-motor cortex for brain tumour surgery in 36 patients. 

DESIGN:Observational study SETTING:Department of Neurosurgery,Guangdong Provincial Hospital of Traditional Chinese Medicine PARTICIPANTS:Fr0m Janury 2003 to April 2006,36 patients(17 male and 19 female)with brain tumors selected fr0m Deparment of Neurosurgery,Guangdong 999 Brain Hospital underwent surgery with MEG・guided neuronavigation in the region of the sensory and motor cortex.Ages of the patients ranged fr0m 1 3 f0 7O years.Among the 36 patients.1 4 with gliomas(including 5 highly malignant gliomas),1 9 with meningomas,1 with spongy angioma and 2 with adenocarcinoma (due to the metastasis of brain tumor). AIl patients and relatives provided the confirmed consent and the experiment provided by the Joca J ethics committee. 

METHODS:A 148一channel biomagnetometer(4・D Neuroimaging,USA)was used to determine motor and/or senory cortex with sampling rate 678.1 7 Hz.high—pass filter 1.0 Hz and bandwith 200 Hz.MRI images were acquired using a Philips Gyroscan Intera 1.5T MR tomography.And then,the functional maps were transfered to the neuronavigation system for the treatment of brain tumor.All patietns followed up by further consultation and telephone call in 2-26 months after operation. 

MAIN OUTCOME MEASURES:Operative outcome and prognosis RESULTS:MEG demonstrated that the tumor lesion changed the sensory-motor cortex in various degrees for the 36 patients.Brain tumors were resected completely in 34 cases.At 2-26 months after surgery。neurological deficits fully recovered in 1 9 cases,unchanged in 1 5 cases and deteriorated in 2 cases. 

CONCLUSION:MEG was found to be practical and useful in localizing sensory-motor cortex and brain tumor.It is a valuable non—invasive method for presurgical planning in the treatment of brain tumors. 

INTR0DUCT10N Brain tumors invade the normaI brain tissue and cause damage to the brain.Tumor surgery is an important treatment of brain tumors。 but patients are often at the risk of neurologicaI deficits due to aggressive resection which easily causes damage to functionaI cortex. and of shorter survivaJ due to partial tumor resection. Neurosurgens have been puzzled for long by the question: How to accurately localize functionaI cortex and the tumor in order to achieve maximum tumor resection while mi。n‘im‘izi‘ng neurologicaJ deficits? Jn recent years. magnetoencephalography(MEG)has been used for pre・surgical funcational mapping(PSFM)and has played an important role in localizing func6onaI cortex and avoiding intraoperative damage to functionaI cortex.MEG overlaid on magnetic resonance (MR) image fon s magnetic source imaging(MSI),a noninvasive imaging technique that combines functionaI data with structuraJ data to provide a functionaI map on brain structure}1~. 沈阳1200邮政信箱1 10004 kf23385083@sina.corn www.zglckf.corn In this study,we investigated the feasibility of MEG by performing MEG imaging On 36 patients with brain tumors f0r PSFM.integrating MEG—based functional maps into a neuronavigation system for(ntraoperative localization of functional cortex and evaluating the postoperative clinical outcome. SUBJECTS AND METHODS Subiects From Janury 2003 to April 2006,36 patients(1 7 male and 1 9 female1 with brain tumors selected fr0m Deparment of Neurosurgery,Guangdong 999 Brain Hospital underwent surgery with MEG・guided neuronavigation in the region of the sensory and motor cortex.Ages of the patients ranged fr0m 13 f0 70 years,with a mean age of (45+14)years. The course ofdisease ranged fr0m 4 days to 10 years with mean course of(2.79_+1.6)years.There were 1 3 patients th headache and diziness, 12 with epilepsy. 18 with weakness and the rest 4 patients with no significant symptoms. Among the 36 patients, 14 wit h gliomas