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目的探讨术前功能磁共振成像(fMRI)和术中皮质脑电图(ECoG)在伴继发性癫疒间脑肿瘤手术中的应用价值。方法回顾性分析13例脑运动皮质区附近肿瘤病人的临床资料。术前通过fMRI了解相应脑功能区皮质和白质纤维束的形态和分布;术中在切除肿瘤前后行ECoG检测,确定致疒间灶的位置,指导肿瘤及致疒间灶的切除。结果手运动功能区受肿瘤推挤而出现功能转移或重组9例,行肿瘤全切除;功能区局部重叠2例,行肿瘤次全切除;大部分重叠2例,行肿瘤部分切除。ECoG确定的致疒间灶距肿瘤2 cm以内9例,3～5 cm 2例,与肿瘤重叠2例。术后出现短暂性失语1例,一过性偏瘫2例。结论fMRI能准确显示运动皮质中枢位置,对脑肿瘤术前手术方案制定和手术时减少重要功能区损伤具有重要意义。ECoG确定致疒间灶大多距肿瘤2 cm以内。
Objective To investigate the value of preoperative fMRI and intraoperative cortical electroencephalogram (ECoG) in the surgical treatment of patients with secondary epileptic brain tumors. Methods Retrospective analysis of 13 cases of brain tumor patients with cortical area of clinical data. Before operation, fMRI was used to understand the morphology and distribution of the cortical and white matter fiber bundles in the corresponding brain functional areas. ECoG was performed before and after resection of the tumor to determine the location of the foci and guide the tumor and the resection of the fissure. Results The hand motor function area was implanted by tumor. There were 9 cases with functional metastasis or reorganization. The tumors were excised completely. The functional area was partially overlapped in 2 cases. The tumors were subtotally resected. Most of the tumors were overlapped in 2 cases. The tumor was partially resected. In ECoG, there were 9 cases within 2 cm, 2 cases between 3 and 5 cm, and 2 cases overlap with the tumor. A case of transient aphasia occurred after surgery and transient hemiplegia occurred in 2 cases. Conclusion fMRI can accurately display the central location of motor cortex, which is of great significance for the development of surgical planning of brain tumors and the reduction of important functional area injuries during operation. ECoG determined that most of the lesions are within 2 cm of the tumor.