开颅手术中锥体束移位的探讨及应对策略.pdfVIP

开颅手术中锥体束移位的探讨及应对策略 王宇博，马晓东，许百男，余新光，孙国臣，赵　岩，王　飞，宋志军，赵　溪，梁永平 解放军总医院 神经外科，北京　100853 摘要 ：目的 探索神经外科手术中锥体束的移位情况及应对策略。方法 选择 74 例术前影像学诊断为额、颞及岛叶占位病 变的病人，术前及术中应用 MRI 弥散张量成像 (DTI) 技术进行扫描，传入神经导航工作站进行锥体束的追踪描计，并对比 术前及术中锥体束的位置。结果 锥体束在前后方向上 25 例发生向前移位，45 例发生向后移位，4 例无移位 ；锥体束在左 右方向上 32 例发生向外移位，38 例发生负向移位，4 例无移位。结论 在颅脑病变切除术中，锥体束的移位是普遍存在的， 而且移位的方向及距离不具有可预测性，只有通过术中磁共振实时更新导航才能予以保护。 关键词 ：锥体束 ；术中磁共振 ；功能神经导航 ；脑移位 中图分类号 ：R 651.1　　文献标识码 ：A　　文章编号 ：110032　　DOI: CNKI:11-3275/R1446.001 2011-02-25 14:46 /kcms/detail/11.3275.R1446.001.html 网络出版时间：　　　　　　　　　　　　　 网络出版地址 ： Shift of pyramidal tract during craniotomy and its countermeasures WANGYu-bo, MA Xiao-dong, XU Bai-nan, YU Xin-guang, SUN Guo-chen,ZHAO Yan,WANGFei,SONG Zhi-jun,ZHAOXi, LIANG Yong-ping Department of Neurosurgery, Chinese PLA General Hospital, Beij ing 100853, China Corresponding author: MA Xiao-dong. Email: xiaodongm @ Abstract: Objective To study the pyramidal tract shift craniotomy and its countermeasures. Methods Seventy-four patients with frontal, temporal or insular lobe mass lesions were enrolled in the study. Preoperative and intra-operative diffusion tensor images(DTI) were obtained. The iPlan 2.6(Brain Laboratory, Feldkirchen, Germany) was used for reconstruction of the pyramidal tract and assessment of its shifting. Results Forward shifting, backward shifting, and no shifting of the pyramidal tract were found in 25, 45 and 4 patients, respectively, while outward shifting, inward shifting, and no shifting of the pyramidal tract were found in 32, 38 and 4 patients, respectively. Conclusion Pyramidal tract shift is common during craniotomy with its direction and distance unpredictable. Only by intra-operative updated real-time MRI navigation, can the shifting be prevented. Key words: Pyramidal Tracts; Intraoperative MRI; Functional Neuronavigation; Brain Shift 神经系统的解剖结构较为精细，在狭小的空 瘤的移位，对于锥体束的移位研究较少。锥体束 间