Clinical use of diffusion tensor imaging combined with neuronavigation for brain tumor surgeries
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摘要: 目的 探讨磁共振扩散张量成像重建结合神经导航对功能区脑肿瘤手术的指导意义。 方法 对15例胶质瘤患者和6例脑膜瘤患者手术前后分别行磁共振常规扫描、增强扫描及磁共振扩散张量成像检查,并在扩散张量成像的基础上利用白质纤维束示踪成像技术行神经纤维束三维重建,根据重建图像制定手术方案,确定手术入路和手术切除范围,术中结合神经导航,显微镜下切除肿瘤。 结果 本研究21例病例术前的DTI三维纤维成像图中15例胶质瘤患者中肿瘤对瘤周白质纤维的影响有6例表现为单纯破坏、9例表现为移位伴破坏;6例脑膜瘤患者肿瘤对瘤周白质纤维的影响中有4例表现为单纯移位、2例表现为移位伴少量破坏。15例胶质瘤患者镜下全切13例,次全切2例;4例术后与术前对比有少量神经纤维损伤,其余病例神经纤维均未见手术损伤。6例脑膜瘤患者均镜下全切,手术前后对比均未见神经纤维损伤。12例原有神经功能缺失患者术后神经功能缺失症状无明显加重,随访6个月症状明显好转;术后新发部分运动性失语2例,经治疗后随访6个月基本恢复;新发肢体偏瘫2例,经治疗后随访6个月1例完全恢复,1例无明显好转。 结论 扩散张量成像重建结合神经导航可在保护神经功能的同时最大程度切除肿瘤,对手术方案的制定具有重要的指导意义。Abstract: Objective To investigate the guiding significance of Diffusion Tensor Imaging (DTI)combined with neuronavigation for brain tumor surgeries. Methods Fifteen cases of glioma and 6 cases of meningioma underwent conventional MRI scan,contrast-enhanced MRI and DTI before the operations.Three-dimensional trajectories were reconstructed from diffusion tensor imaging(DTI) data by using white matter fiber tract mapping.The surgical planning,approach and resection range were determined according to the reconstructed images.The brain tumor tumorectomy was performed under a microscope combined with neuronavigation. Results Among 15 cases of glioma,6 cases showed simple displacement,9 cases showed both displacement and disruption;among 6 cases of meningioma,4 cases showed simple displacement,2 cases showed displacement and a small amount of disruption.The total resection(13 cases) and subtotal resection(2 cases) were performed for 15 cases of glioma,and few nerve fiber damage by surgical injury occurred.The total resection was performed in all 6 cases of meningioma,and there was no nerve fiber damage.12 patients with preoperative symptoms of neurologic function loss displayed obvious improvement in 6 months.2 cases suffered from new-onset partial motor aphemia that recovered in 6 months,2 cases suffered from new-set hemiplegia,1 case recovered in 6 months,1 case didn't improved. Conclusion DTI combined with neuronavigation can guide the brain tumor surgery at maximum extent on the basis of protecting of nerve function.
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Key words:
- Brain Tumor /
- Diffusion tensor imaging /
- Neuronavigation /
- Surgery
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