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目的探讨立体定向结合脑血管造影与MRI影像融合在治疗脑动静脉畸形引发癫痫时对脑功能区、脑内病变和致痫灶空间范围的定位作用。方法对17例患者采用Talairach立体定向系统,绘制脑皮质表面血管图,并与三维MRI成像进行融合,标注脑功能区并设计术前深部电极放置部位和手术方案。结果17例患者获得了清晰的立体脑血管造影与MRI图像,涉及手术部位包括额叶8例、顶叶6例、颞叶2例和枕叶1例。手术完整切除动静脉畸形。术后随访1年,8例未见癫痫发作。结论该技术可以保证术前准确定位病灶,有利于术中判断脑沟回和功能区,避免损伤皮质功能区和血管。
OBJECTIVE: To investigate the spatial localization of brain functional areas, intracerebral lesions and epileptic foci when stereotactic combination of cerebral angiography and MRI imaging is used to treat epilepsy induced by cerebral arteriovenous malformations. Methods Talairach stereotactic system was used in 17 patients. The cerebral cortex surface angiogram was drawn and fused with three-dimensional MRI. The brain functional areas were marked and the preoperative deep electrode placement site and operation plan were designed. Results Seventeen patients had clear stereotactic angiography and MRI images, including 8 cases of frontal lobe, 6 cases of parietal lobe, 2 cases of temporal lobe and 1 case of occipital lobe. Surgical complete removal of arteriovenous malformations. One year after follow-up, 8 cases did not have seizure. Conclusion This technique can ensure accurate preoperative localization of lesions, is conducive to intraoperative evaluation of sulci and functional areas, to avoid damage to cortical areas and blood vessels.