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目的通过研究脑磁图、功能磁共振皮层运动区、神经传导束影像构筑特点,探讨涉及大脑半球运动区胶质瘤病人的微创手术,最大程度的保护运动功能。方法采用脑磁图、功能磁共振完成14例涉及运动区胶质瘤术前评估,评价运动区及锥体束的完整性及与肿瘤的位置关系;在磁源影像(MSI)神经导航指导下,采用穿硬脑膜栅栏定位法分离瘤-运动区的界面后实施肿瘤手术。结果 6例患侧脑功能区移位,8例锥体束走行移位,10例神经纤维束形态完好、4例纤维束弥散。肿瘤全切11例、部分切除3例。术后肌力恢复正常4例、减弱2例,其余病例术前后肌力均正常。结论运动区胶质瘤的手术应综合评价运动区分布和锥体束的影像构筑特点,这对设计和指导手术具有重要意义;功能性神经导航指导下的经硬膜栅栏法肿瘤切除有助于运动功能的保护。
Objective To study the characteristics of brain magnetic resonance imaging (EMG), functional cortex motor area (CMR) and nerve conduction bundle (CT) imaging to explore the minimal invasive surgery of glioma patients involved in hemisphere area motor movement to maximize the motor function. Methods Fourteen cases of glioma involving motor area were evaluated by using magnetoencephalography (FMR) and functional magnetic resonance (MRI). The integrity of the motor area and pyramidal tract and the relationship with the tumor were evaluated. Under the guidance of magnetic nerve imaging (MSI) guidance , The use of dura mater to locate the separation of tumor - motor area interface after the implementation of tumor surgery. Results In 6 cases, the functional areas of the affected side shifted and the pyramidal tract was displaced in 8 cases. The shape of the nerve fiber bundles in 10 cases was intact and the fiber bundles in 4 cases were dispersed. Tumor resection in 11 cases, partial resection in 3 cases. Muscle strength returned to normal in 4 cases, weakening in 2 cases, the remaining cases of normal muscle strength before and after surgery. Conclusions The operation area of glomerulus in motor area should evaluate the distribution of motor area and the imaging features of pyramidal tract comprehensively, which is of great significance for the design and operation of the glioma. Excision of the epidural space under the guidance of functional neurotransmission helps Protection of motor functions.