Araújo David, Machado Hélio Rubens, Oliveira Ricardo Santos, Terra-Bustamante Vera, Barros de Araújo Dráulio, Santos Antônio Carlos, Sakamoto Américo Ceiki
Department of Neurology, Hospital de Clínicas de Ribeirão Preto, Av. Bandeirantes 3900, Ribeirão Preto, SP 14048-900, Brazil.
Childs Nerv Syst. 2006 Sep;22(9):1122-6. doi: 10.1007/s00381-006-0063-1. Epub 2006 May 4.
Resective surgeries around eloquent areas challenge neurosurgeons and neuroimaging professionals due to difficulties to find anatomic references during surgery. Advances in magnetic resonance (MR) may prevent such deficits and provide information for accurate surgical planning. However, most of these techniques are expensive and not feasible in most centers. Using brain surface reformatted imaging (BSRI) of 3-D MR images, we sought to obtain data for surgical planning in patients with lesions around the motor cortex.
Thirteen patients with lesions around the eloquent areas and considered for resective surgery were evaluated. Patients had different ages with tumors and malformative lesions. They were scanned in a 1.5-T Siemens magnet with volumetric sequence after injection of Gadolinium. Postprocessing was done in an auxiliary console using MRI station software. We performed reformatting as described by Hattingen et al. [J Neurosurg 102:302-310, 2005] and used fixed skull and vascular structures as anatomical references. Distances to the reference points were measured to allow surgical planning and locate sites for cortical stimulation. Patients were also studied by blood-oxygen-level-dependent functional magnetic resonance imaging to locate the hand area before the surgical procedure. All patients had cortical stimulation during the resective procedure or chronic electrode stimulation before surgery.
There was concordance between data from functional and structural data. In one case, partial resection was performed due to the high risk of severe deficits. Even in this case, there were clinical improvements and no additional deficits were observed.
BSRI may be a useful tool for surgical planning around eloquent areas. It can reduce surgical time and morbidity and showed correlation with functional studies. Added to this is the low cost and feasibility in most centers that have standard MR scanners with Multiplanar Reformatting software.
由于在手术过程中难以找到解剖学参考，在功能区周围进行切除手术对神经外科医生和神经影像专业人员构成了挑战。磁共振（MR）技术的进展可能会预防此类功能缺损，并为精确的手术规划提供信息。然而，这些技术大多价格昂贵，在大多数中心都不可行。我们利用三维MR图像的脑表面重新格式化成像（BSRI），试图获取运动皮层周围病变患者手术规划的数据。
对13例功能区周围有病变且考虑进行切除手术的患者进行评估。患者年龄各异，患有肿瘤和发育畸形性病变。在注射钆剂后，他们在1.5-T西门子磁体中进行容积序列扫描。在辅助控制台使用MRI工作站软件进行后处理。我们按照哈廷根等人[《神经外科学杂志》102:302 - 310, 2005]所述进行重新格式化，并使用固定的颅骨和血管结构作为解剖学参考。测量到参考点的距离，以便进行手术规划并确定皮层刺激的部位。患者在手术前还通过血氧水平依赖性功能磁共振成像进行研究，以定位手部区域。所有患者在切除手术过程中都进行了皮层刺激，或在手术前进行了慢性电极刺激。
功能数据和结构数据之间存在一致性。在1例患者中，由于严重功能缺损风险高，进行了部分切除。即便如此，该患者仍有临床改善，且未观察到额外的功能缺损。
BSRI可能是功能区周围手术规划的有用工具。它可以减少手术时间和发病率，并且与功能研究具有相关性。此外，在大多数拥有具备多平面重建软件的标准MR扫描仪的中心，其成本低廉且可行。
