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目的探索大脑半球胶质瘤切除术中锥体束的移位情况及解决方法。方法 选择术前影像学诊断为额、颞、岛叶胶质瘤的患者63例,手术采用仰卧位下额颞入路,术前及术中应用MR I弥散张量成像技术进行扫描,并进行锥体束的追踪描计,对比术前及术中锥体束的位置。结果 锥体束在前后方向上18例发生向前移位,移位距离从0.9 mm至11.4 mm,42例发生向后移位,移位距离从1.7 mm至10.4 mm,3例无移位;锥体束在左右方向上31例发生向外移位,移位距离从1.5 mm至11.2 mm,30例发生向内,移位距离从1.3 mm至8.1 mm,2例无移位。结论 锥体束的移位的方向和距离具有不可预测性,最佳解决方案是通过术中影像及神经导航的实时更新并予以保护。
Objective To explore the displacement of pyramidal tract during brain hemispherectomy and its solution. Methods Sixty-three patients with frontal, temporal and island gliomas were selected as preoperative imaging. The surgery was performed by frontotemporal frontotemporal approach. MR I diffusion tensor imaging was performed before and during surgery. Cone beam tracking tracing, contrast preoperative and intraoperative cone beam position. Results In the anteroposterior direction, the pyramidal tract was displaced forward from 0.9 mm to 11.4 mm in 18 cases, and 42 cases were displaced posteriorly from 1.7 mm to 10.4 mm in 3 cases. Conical beam in the left and right direction 31 cases of outward displacement, displacement distance from 1.5 mm to 11.2 mm, 30 cases occurred inward, the displacement distance from 1.3 mm to 8.1 mm, 2 cases without displacement. Conclusions The direction and distance of pyramidal tract displacement are unpredictable. The best solution is through real-time update and protection of intraoperative images and neural navigation.