视辐射重建对前颞叶切除术视野的保护研究

目的探讨扩散张量纤维束示踪成像（DTT）技术重建视辐射与术中MRI（i MRI）和显微镜下导航在前颞叶切除术中对视野的保护作用。方法采用前颞叶切除术治疗24例难治性颞叶癫患者,术前采用DTT技术重建视辐射,术中同时行i MRI和显微镜下导航,根据视辐射前缘（Meyer环）至颞极距离切除前颞叶,术后3个月复查静态视野和Engel分级评价癫发作控制情况。结果本组患者均成功重建视辐射,均行i MRI扫描,无一例发生术区和远隔部位出血。手术切除颞叶1.90～5.10 cm,平均3.29 cm。术后随访3～21个月,平均11.33个月。术后3个月复查静态视野,16例（66.67%）无视野缺损、8例（33...

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Published in中国现代神经疾病杂志 Vol. 15; no. 9; pp. 707 - 711
Main Author 崔志强 凌至培 潘隆盛 陈晓雷 王群 张治中 齐叶青 徐欣 毛之奇 王伟君 孙璐 余新光 栾国明
Format Journal Article
LanguageChinese
Published 解放军总医院神经外科, 北京,100853 2015
Subjects
前颞叶切除术
弥散
磁共振成像
神经导航
视神经
视野
磁共振成像,弥散
视神经
Optic nerve
Diffusion magnetic resonance imaging
Neuronavigation
视野
神经导航
前颞叶切除术
Anterior temporal lobectomy
Visual fields
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ISSN1672-6731
DOI10.3969/j.issn.1672-6731.2015.09.005

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Summary:目的探讨扩散张量纤维束示踪成像（DTT）技术重建视辐射与术中MRI（i MRI）和显微镜下导航在前颞叶切除术中对视野的保护作用。方法采用前颞叶切除术治疗24例难治性颞叶癫患者,术前采用DTT技术重建视辐射,术中同时行i MRI和显微镜下导航,根据视辐射前缘（Meyer环）至颞极距离切除前颞叶,术后3个月复查静态视野和Engel分级评价癫发作控制情况。结果本组患者均成功重建视辐射,均行i MRI扫描,无一例发生术区和远隔部位出血。手术切除颞叶1.90～5.10 cm,平均3.29 cm。术后随访3～21个月,平均11.33个月。术后3个月复查静态视野,16例（66.67%）无视野缺损、8例（33.33%）有轻度视野缺损（〈1/4象限）,其中1例术前即有轻度视野缺损,术后无加重;Engel分级Ⅰ级19例（79.17%）、Ⅱ级4例（16.67%）、Ⅲ级1例（4.17%）。结论对于诊断明确的药物难治性颞叶癫患者,DTT技术重建视辐射联合i MRI和显微镜下导航,于视辐射前缘切除颞叶,可以减少视辐射损伤,减轻视野缺损。
Bibliography:CUI Zhi-qiang, LING Zhi-pei, PAN Long-sheng, CHEN Xiao-lei, WANG Qun, ZHANG Zhi-zhong, QI Ye-qing, XU Xin, MAO Zhi-qi, WANG Wei-jun, SUN Lu, YU Xin-guang, LUAN Guo-ming（ 1Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China 2Department of Neurosurgery, Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital Capital Medical University, Beijing 100093, China）
Anterior temporal lobectomy; Optic nerve; Visual fields; Diffusion magneticresonance imaging; Neuronavigation
Objective To explore the clinical value of optic radiation reconstruction in protecting against visual field deficits （VFDs） in anterior temporal lobectomy （ATL）. Methods We retrospectively analyzed 24 patients with medically refractory temporal lobe epilepsy undergoing ATL between January 2013 and June 2014. The surgical operations were aided by combining optic radiation reconstruction by diffusion tensor tractography （DTT）, microscopy- based neuronavigation and intraoperative MRI （iMRI） techniques. ATL was performed acco
ISSN:1672-6731
DOI:10.3969/j.issn.1672-6731.2015.09.005