Niizuma Kuniyasu, Fujimura Miki, Kumabe Toshihiro, Higano Shuichi, Tominaga Teiji
Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
J Clin Neurosci. 2006 Dec;13(10):1028-32. doi: 10.1016/j.jocn.2004.11.025. Epub 2006 Oct 27.
Surgical treatment of deep-seated lesions involving the corticospinal tract is one of the most challenging areas of contemporary neurosurgery, even given the recent development of radiological methods including three-dimensional anisotropy contrast magnetic resonance imaging (MRI) axonography. Fibre tracking using diffusion tensor imaging is another MRI technique that can be used to visualize anisotropy and the orientation of white matter tracts in the brain. We report herein a patient with a paraventricular cavernous angioma manifesting as hemiparesis caused by haemorrhage. Preoperative conventional MRI failed to determine the anatomical relationship between the paraventricular lesion and the corticospinal tract, whereas fibre tracking using free software (dTV for MR-DTI analysis) indicated that the corticospinal tract was displaced anterolaterally from the medial side. The paraventricular lesion was completely removed without damaging the corticospinal tract using a transcortical transventricular approach. Preoperative fibre tracking is useful in surgical planning for procedures involving deep-seated lesions adjacent to the corticospinal tract, and may avoid postoperative morbidity due to corticospinal tract injury.
即使有包括三维各向异性对比磁共振成像（MRI）轴突造影术在内的放射学方法的最新进展，涉及皮质脊髓束的深部病变的外科治疗仍是当代神经外科最具挑战性的领域之一。使用扩散张量成像的纤维追踪是另一种MRI技术，可用于可视化大脑中白质束的各向异性和方向。我们在此报告一名患有室旁海绵状血管瘤的患者，该血管瘤因出血表现为偏瘫。术前传统MRI未能确定室旁病变与皮质脊髓束之间的解剖关系，而使用免费软件（用于MR-DTI分析的dTV）进行的纤维追踪表明，皮质脊髓束从内侧向前外侧移位。采用经皮质经脑室入路，在不损伤皮质脊髓束的情况下完全切除了室旁病变。术前纤维追踪对于涉及与皮质脊髓束相邻的深部病变的手术规划很有用，并且可以避免因皮质脊髓束损伤导致的术后并发症。
