中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2013, Vol. 8 ›› Issue (15): 1400-1409.doi: 10.3969/j.issn.1673-5374.2013.15.007

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

术中弥散张量成像可预测岛叶病变患者术后运动功能的恢复？

  

  • 收稿日期:2013-02-11 修回日期:2013-04-02 出版日期:2013-05-25 发布日期:2013-05-25

Intraoperative diffusion tensor imaging predicts the recovery of motor dysfunction after insular lesions

Jinjiang Li, Xiaolei Chen, Jiashu Zhang, Gang Zheng, Xueming Lv, Fangye Li, Shen Hu, Ting Zhang, Bainan Xu   

  1. Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2013-02-11 Revised:2013-04-02 Online:2013-05-25 Published:2013-05-25
  • Contact: Bainan Xu, M.D., Ph.D., Professor, Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China, neurox7@gmail.com.
  • About author:Jinjiang Li☆, M.D., Attending physician. Jinjiang Li and Xiaolei Chen contributed equally to this paper.

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摘要：

如何在提高岛叶病变手术切除程度同时又保护神经功能完整性一直是神经外科的挑战。岛叶病变术后运动功能障碍是常见的并发症，因此评价病变区域的皮质脊髓束就显得尤为重要。我们应用弥散张量成像技术对2009-02/2011-05在解放军总医院行手术治疗的89例岛叶病变患者的皮质脊髓束进行评价。术后运动功能评估发现，57例术后无运动功能改变，32例术后出现功能障碍或原有运动功能障碍加重，其中20例短期功能障碍患者在6-12个月的随访期间运动功能恢复，另12例长期功能障碍随访超过12个月未完全恢复。重建皮质脊髓束后比较不同预后患者不同时间段的各向异性分数结果显示，术后无运动功能改变的患者术前、术中及术后6－12个月的标准化各向异性分数均高于术后出现功能障碍或原有运动功能障碍加重者；与短期功能障碍组相比，长期功能障碍组的术中标准化各向异性分数下降更明显。可见术中弥散张量成像测得的皮质脊髓束各向异性分数可以作为岛叶病变运动功能预后的指标。

关键词: 神经再生, 神经影像, 磁共振成像, 弥散张量成像, 各向异性分数, 岛叶, 皮质脊髓束, 运动功能, 基金资助文章

Abstract:

Insular lesions remain surgically challenging because of the need to balance aggressive resection and functional protection. Motor function deficits due to corticospinal tract injury are a common complication of surgery for lesions adjacent to the internal capsule and it is therefore essential to evaluate the corticospinal tract adjacent to the lesion. We used diffusion tensor imaging to evaluate the corticospinal tract in 89 patients with insular lobe lesions who underwent surgery in Chinese PLA General Hospital from February 2009 to May 2011. Postoperative motor function evaluation revealed that 57 patients had no changes in motor function, and 32 patients suffered motor dysfunction or aggravated motor dysfunction. Of the affected patients, 20 recovered motor function during the 6–12-month follow-up, and an additional 12 patients did not recover over more than 12 months of follow-up. Following reconstruction of the corticospinal tract, fractional anisotropy comparison demonstrated that preoperative, intraoperative and follow-up normalized fractional anisotropy in the stable group was higher than in the transient deficits group or the long-term deficits group. Compared with the transient deficits group, intraoperative normalized fractional anisotropy significantly decreased in the long-term deficits group. We conclude that intraoperative fractional anisotropy values of the corticospinal tracts can be used as a prognostic indicator of motor function outcome.

Key words: neural regeneration, neuroimaging, magnetic resonance imaging, diffusion tensor imaging, fractional anisotropy, insular lobe, corticospinal tracts, motor function, grants-supported paper, neuroregeneration