Kumabe T, Nakasato N, Inoue T, Yoshimoto T
Department of Neurosurgery, Tohoku University School of Medicine, Sendai.
Neurol Med Chir (Tokyo). 2000 Aug;40(8):393-401; discussion 402-3. doi: 10.2176/nmc.40.393.
Useful landmarks on magnetic resonance (MR) images were identified for preoperative prediction of the relationship of a tumor to the primary sensory cortex of the thumb. Functional MR (fMR) imaging and magnetoencephalography were used to retrospectively localize the hand-digit sensorimotor area in four patients who underwent tumor resection around the central sulcus with intraoperative neurophysiological mapping. fMR imaging revealed the hand-digit motor cortex in the so-called "precentral knob" inside the characteristic inverted-omega on axial MR images. Equivalent current dipoles of the N20 m response in somatosensory evoked fields (SEFs) of the thumb, median nerve, and ulnar nerve stimuli were localized at the lateral portion of the inverted omega-shape from the lateral to medial directions. The SEF-based thumb sensory cortex was verified by intraoperative functional mapping with a neuronavigation system. The hand-digit somatosensory cortices were localized at the lateral shoulder of the inverted-omega, in the lateral anterior inferior position to the hand-digit motor cortices in the precentral knob. Axial MR imaging can provide useful preoperative planning information for the surgical treatment of tumors within or adjacent to the motor-somatosensory cortex.
在磁共振（MR）图像上确定了有用的解剖标志，用于术前预测肿瘤与拇指初级感觉皮层的关系。使用功能磁共振（fMR）成像和脑磁图，对4例在中央沟周围接受肿瘤切除术并术中进行神经生理学定位的患者进行回顾性手部数字感觉运动区定位。fMR成像显示，在轴向MR图像上特征性倒“ω”形内所谓的“中央前结节”中存在手部数字运动皮层。拇指、正中神经和尺神经刺激的体感诱发电场（SEF）中N20 m反应的等效电流偶极从外侧到内侧位于倒“ω”形的外侧部分。基于SEF的拇指感觉皮层通过术中使用神经导航系统的功能定位得到验证。手部数字体感皮层位于倒“ω”形的外侧肩部，在中央前结节中手部数字运动皮层的外侧前下位置。轴向MR成像可为运动-体感皮层内或其附近肿瘤的手术治疗提供有用的术前规划信息。
