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目的研究功能区胶质瘤术中完善而有效的锥体束空间定位和功能保护方法。方法对13例功能区胶质瘤应用1.5T磁共振系统采集弥散张量成像(DTI)数据,在功能神经导航中进行纤维束示踪(FT),在导航中确定肿瘤与锥体束界面的标记点,应用自制导航穿刺针、着色明胶海绵对白质内锥体束走行进行空间定位。在空间定位锥体束基础上,应用皮质、皮质下直接电刺激或唤醒麻醉技术在肿瘤切除中对锥体束功能进行评估监测,保证其正常功能。结果本组锥体束与肿瘤交界区在神经导航中均得到确定,术中在DTI-FT导航下空间定位满意;锥体束功能判定明确者10例。均全切肿瘤,运动功能保持术前正常水平或得到改善。结论联合应用DTI-FT导航、神经电生理或唤醒麻醉技术可确保锥体束功能不出现手术损伤,同时为明确胶质瘤在脑白质内功能性边界提供有效方法。
Objective To study the perfect and effective pyramidal tract spatial location and functional protection in functional gliomas. Methods Diffusion tensor imaging (DTI) data were acquired in 13 cases of functional gliomas by using 1.5T magnetic resonance system. Fiber optic tract tracing (FT) was performed in functional neuro-navigation, and the relationship between tumor and cone beam interface Marked points, the use of self-navigation needle, colored gelatin sponge white cone within the space for spatial positioning. On the basis of pyramidal tract located in space, the function of pyramidal tract was evaluated and monitored in cortical and subcortical direct electrical stimulation or awakening anesthesia to ensure its normal function. Results The pyramidal tract and tumor junction in this group were all identified in neuro-navigation. The spatial location was satisfactory under the guidance of DTI-FT during operation. Ten cases with definite cone beam function were identified. All tumor resection, motor function to maintain normal levels before surgery or be improved. Conclusion Combined application of DTI-FT navigation, neuroelectrophysiological or arousal anesthesia technology can ensure the function of pyramidal tract without surgical injury, and provide an effective method to clarify the functional boundary of glioma in the white matter.