Reithmeier T, Krammer M, Gumprecht H, Gerstner W, Lumenta C B
Department of Neurosurgery, Academic Hospital Munich-Bogenhausen, Technical University of Munich, Munich, Germany.
Minim Invasive Neurosurg. 2003 Apr;46(2):65-71. doi: 10.1055/s-2003-39334.
The purpose of this study was to achieve a more radical resection of tumors in the area of the motor cortex via minimal craniotomy using a combination of neuronavigation and neurophysiological monitoring with direct electrical cortical stimulation and to compare retrospectively the clinical outcome and postoperative magnetic resonance imaging with a control group that was operated on in our service when the combination of these monitoring techniques was not available. A total of 42 patients with tumors in or near the central region underwent surgery with neuronavigation guidance and neurophysiological monitoring. The primary motor cortex was identified intraoperatively by the somatosensory evoked phase reversal method and direct cortical stimulation. The functional areas were transferred into the neuronavigation system. By stimulating the identified primary motor cortex and displaying the motor area in the operating microscope a permanent control of the motor function was possible during the whole operation. Using these techniques a more radical tumor resection - evaluated by postoperative MRI - was achieved in the study group (p = 0.04) and also a trend toward a better neurological outcome.
本研究的目的是通过采用神经导航和神经生理监测相结合的方法，即直接皮层电刺激，经微创开颅手术，在运动皮层区域实现更彻底的肿瘤切除，并将临床结果和术后磁共振成像与在我们科室接受手术的对照组进行回顾性比较，该对照组在这些监测技术联合应用不可用时接受手术。共有42例中央区或其附近有肿瘤的患者在神经导航引导和神经生理监测下接受了手术。术中通过体感诱发电位相位反转法和直接皮层刺激确定初级运动皮层。将功能区导入神经导航系统。通过刺激已确定的初级运动皮层并在手术显微镜下显示运动区，在整个手术过程中可以对运动功能进行持续监测。采用这些技术，研究组实现了更彻底的肿瘤切除（通过术后MRI评估，p = 0.04），并且在神经功能预后方面也有改善的趋势。
