摘要
目的:探讨功能磁共振成像(fMRI)结合术中神经电生理技术在药物难治性癫痫患者运动区定位中的应用价值。方法:回顾性分析2018年6月至2019年4月清华大学玉泉医院癫痫中心行癫痫灶切除术治疗的9例难治性癫痫患者的临床资料。患者的中位年龄为15岁(2~31岁)。所有患者术前行头颅MRI、弥散张量成像(DTI)及血氧水平依赖(BOLD)成像-fMRI检查,初步定位病灶和运动功能区。术中应用神经电生理监测运动诱发电位(MEP)确认运动功能区,同时应用手术神经导航系统定位病灶区域及功能区。手术切除病灶的同时行神经电生理监测,以避开功能区、最大程度地切除病灶。术后复查头颅CT,观察有无水肿、出血。比较手术前后及随访3个月时患者的肌力情况,作为保护运动区效果的评估指标。结果:9例患者DTI结果均清晰地显示病灶、病灶周围与大脑脚之间的运动纤维联系。9例患者中,4例术前BOLD-fMRI结果与术中神经电生理监测的MEP定位的功能区一致,1例为部分一致,4例不一致。9例患者的致痫灶完全切除。术后5例患者出现不同程度的肌力下降,此5例患者头颅CT出现轻微脑水肿,1周后缓解。无一例颅内出血。术后3个月随访时,8例患者未见癫痫发作,仅1例患者仍有癫痫发作,发作频率下降;8例患者的肌力水平同术前,1例患者的肌力较术前改善。结论:术前BOLD-fMRI、DTI结合术中神经电生理技术可定位药物难治性癫痫患者的运动区,对其运动功能有较好的保护作用。
Objective To explore the application value of functional magnetic resonance imaging(fMRI)combined with intraoperative neuroelectrophysiological technique in the localization of motor area of intractable epilepsy patients.Methods The clinical data of 9 patients with intractable epilepsy who underwent epileptogenic zonectomy at Epilepsy Center of Yuquan Hospital,Tsinghua University from June 2018 to April 2019 were retrospectively analyzed.The median age was 15 years old(range:2-31 years old).All patients underwent head MRI,diffusion tensor imaging(DTI)and blood oxygen level depend(BOLD)-fMRI before operation,and the lesion and motor functional area were initially located.During the operation,neuroelectrophysiological monitoring of motor evoked potential(MEP)was used to confirm the motor functional area,and surgical navigation system was employed to identify the lesion area and functional area.Neuroelectrophysiological monitoring should be performed during the same time period when the lesion is removed to preserve the functional area and remove the lesion to the greatest extent.CT examination was performed after operation to detect the edema and hemorrhage.We compared the muscle strength of the patients before operation,after operation and at 3 months of follow-up,which served as an evaluation index of the outcome of motor area preservation.Results The DTI results of 9 patients clearly showed the lesion,the motor fiber connection between the lesion and the cerebral peduncles.Among the 9 patients,4 had preoperative BOLD-fMRI results which were consistent with the functional area identified by intraoperative neuroelectrophysiological monitoring of MEP,1 patient had partially consistent results,and 4 had inconsistent results.The epileptogenic zones in 9 patients were completely removed.Five patients had varying degrees of muscle strength reduction after operation.Those 5 patients had slight brain edema on head CT imaging,which was relieved after 1 week.There was no case of intracranial hemorrhage.At 3-month follow-up,8 patients had no seizures,only 1 patient still had seizures,and the frequency of seizures was decreased.The muscle strength of 8 patients was the same as before surgery,and the muscle strength of 1 patient was improved compared with preoperative conditions.Conclusion Preoperative BOLD-fMRI and DTI combined with intraoperative neuroelectrophysiological technique for motor area identification seem to have a relatively good outcome in terms of motor function preservation in patients with intractable epilepsy.
作者
贺晶
周文静
林久銮
宋宪成
阮静
李佳
He Jing;Zhou Wenjing;Lin Jiuluan;Song Xiancheng;Ruan Jing;Li Jia(Epilepsy Center,Yuquan Hospital,Tsinghua University,Beijing 100040,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第7期677-681,共5页
Chinese Journal of Neurosurgery
关键词
癫痫
运动皮质
磁共振成像
弥散张量成像
诱发电位
运动
Epilepsy
Motor cortex
Magnetic resonance imaging
Diffusion tensor imaging
Evoked potentials,motor
