联合BOLD和DECS技术脑功能区定位辅助语言相关区脑肿瘤手术治疗及应用.pdfVIP

联合BOLD和DECS技术脑功能区定位辅助语 言相关区脑肿瘤手术治疗的应用 马辉黄伟孙胜玉夏鹤春孙涛 [摘要] 目的 利用BOLD和DECS技术进行语言功能区定位，实现语言功能区保护下肿瘤的最大程 度切除。方法 对15例语言相关功能区脑肿瘤患者，利用血氧依赖功能磁共振 （BOLD-fMRI）技术和 （或） 术中唤醒麻醉下皮层直接电刺激(DECS)定位技术进行脑语言功能区定位；对所获定位资料进行个体化评 估，术中辅助保护语言功能区，在神经导航指引下切除肿瘤。结果 15例患者成功获取了术前BOLD语言区 图像，评估后其中6例患者实现了术前BOLD和术中DECS技术联合定位语言功能区。全组病例在保护语言 区条件下病变全切除10例，次全切除3例，大部分切除2例。术后语言功能明显改善6例，无变化5例，短暂 性感觉性失语2例，语言功能障碍明显加重2例。结论 术前BOLD-fMRI结合术中唤醒麻醉下皮层电刺激 可客观定位脑语言功能区，导航辅助保护语言功能区条件下切除肿瘤，在保护语言功能的同时最大化切除肿 瘤组织，提高患者术后生活质量。 [关键词] 语言功能区；脑功能定位；脑肿瘤 FunctionalbrainmappingwithBOLDandDECSapplicationinthesurgicaltreatmentof Ma Hui SunSheng-yu NeurosurgeryDepartment, braintumorsinlanguageareas HangWei TheAffiliatedHospitalofNingxiaMedicalUniversity,Yinchuan750001,China Abstract:Objective Tostudythemethodsofcorticalmapping,preoperativelocalizationof languageareaswithBOLD-MRIand(or)intraoperativedirectlyelectricalcorticalstimulation(DECS) oflanguageareaswithawakensurgery,assisttoremovebraintumorsinfunctionalareasoflanguage. Methods corticalmappingdatafromsuchasoxygendependentfunctionalmagneticresonance imaging(BOLD-MRI)technology,usingtheblockdesignandrecitingtasktoactivatebrocaareaand paragraphcomprehensiontasktoactivatewernickearea,calculatedcerebrallateralityindexto determinethedominanthemisphere;usingoftheelectricalcorticalstimulationtolocalizatelanguage areasunderawakeanesthesiainpatientswithsurgery.Thedatacombinedwithneuronavigationassist microscopicremovebraimtomorsinthelanguageareas.Results Functionalcorticalmappingwas usedforlocalizatebrocaorwernickeareaof15cases,imageacquisitionsatisfiedin15cases. Intraoperativeawakeandelectricalstimulationoflanguageareasin6casesofall,.Lesiontotal resectionin10cases,subtotalresectionin3cases,partialresectionin2cases.Languagefunction improvedsignificantlyaftersurgeryin6cases,unchangedin5patients,transientsensoryaphasiain2 case,deteriorationoflanguagefunctiondoesin2case.Conclusion Functionalcorticalmappin