术中磁共振联合功能神经导航在中央区胶质瘤手术的应用张家墅*、陈晓雷*、侯远征*、孙国臣*、李方晔*、郑刚*、李晋江*、许百男**中国人民解放军总医院神经外科(北京100853)通讯作者(E-mail:shujiazhang@126.com)【摘要】目的探索术中磁共振联合功能神经导航在中央区胶质瘤手术中的应用价值。方法回顾性研究22例中央区胶质瘤患者，均接受1.5T高场强术中磁共振联合功能神经导航下显微手术。分别分析导航系统准确性、肿瘤切除程度、手术前后神经功能变化及其影响因素。结果术中肿瘤切除程度的误判率达到27.28%，而术中扫描使54.54%患者受益。手术后15例（68.18%）患者神经功能改善或同术前，7例（31.82%）神经功能下降，功能下降者KarnofskyPerformanceScale评分（KarnofskyPerformanceScale，KPS）均大于60，生活能够自理。手术前后神经功能变化值ΔK与肿瘤切除残腔与术中重建锥体束的距离D中呈正直线相关（r=1,P=0.003）。手术前后神经功能变化情况与胶质瘤病理级别（P=0.032,OR=68.713），术前KPS评分（P=0.012,OR=1.314）及肿瘤切除残腔与术中重建锥体束的距离D中是否大于5mm（P=0.006,OR=0.008）有关。结论该研究充分验证了术中磁共振联合功能神经导航的准确性、稳定性与可靠性。实现了最大限度保护神经功能与最大程度切除肿瘤的目的，体现了精准神经外科的理念。[关键词]术中磁共振;功能神经导航;中央区;胶质瘤中图分类号：ImplementationofintraoperativeMagneticResonanceImagingcombinedwithfibertractnavigationincentralareagliomasZhangJiashu,Chenxiaolei,Houyuanzheng,Sunguochen,Lifangye,Zhenggang,Lijinjiang,XubainanDepartmentofNeurosurgery,ChinesePLAGeneralHospital,门牌路名Beijing100853,China科室电话[Abstract]ObjectiveToevaluatethefeasibilityandefficacyofintraoperativeMagneticResonanceImaging(IMRI)combinedwithfibertractnavigationincentralareagliomas.MethodRetrospectivelycollected22centralareagliomacases,whounderwentmicrosurgeryunderIMRIcombinedwithfibertractnavigationsystem.Measuredtheaccuracyofthenavigationsystem,recordedtheextentsoftumorresection,evaluatethedifferencesbetweenpre-andpostoperativeneurologicalfunctionsandfurtheranalyzetheinfluencingfactors.ResultAccordingtotheIMRIresults,27.28%casesweremisestimatedbysurgeonsconcerningtheextentsofresection,and54.54%benefitfromintraoperativescanning.Afteroperations,theneurologicalfunctionsof15caseswereimprovedorunchanged,whilethefunctionsof7casesworsened.However,the7casescouldcareforthemselvswithKPSscoringmorethan60.ΔKdenotingthedifferencesbetweenpreandpostoperativeneurologicfunctionshadpositivelinearcorrelationwithD中denotingthedistancesbetweenresectioncavitiesandpyramidaltracts(r=1,P=0.003).Thelogisticregressionrevealedthatneurologicalfunctionscorrelatedwithpathologicalgrades(P=0.032,OR=68.713),preoperativeKPSscores(P=0.012,OR=1.314)andwhethertheD中morethan5mmornot.ConclusionThisstudyconfirmedtheaccuracy,stabilityandreliabilityoftheIMRIcombinedwithfunctionalneuronavigationsystem,realizedmaximumtumorresectionandminimumneurologicalpreservation,consistentwiththeconceptoftheaccurateandpreciseneurosurgery.[Keyword]Intraoperativemagneticresonance;functionalneuronavigation;centralarea;glioma术中超声、磁共振及血管造影等一系列术中影像技术，已经越来越广泛的应用于神经外科手术。功能磁共振、弥散张量成像及纤维束示踪技术的进步，也促进了功能神经导航的发展。正是这两项技术，使得神经外科手术由凭借经验判断肿瘤切除程度及重要功能结构位置的传统神经外科时代，发展到根据术中影像客观判断肿瘤切除程度，功能神经导航实时显示重要功能结构位置的精准神经外科时代[1]。本中心自2009年安装高场强术中磁共振系统以来，积累了一些经验。胶质瘤是颅内最常见的原发性肿瘤，手...
