Yang Wei-dong, Chen Zhi-juan, Yu Qing, Wang Zeng-guang, Hao Zhi-dong, Li Hong, Zhang Cheng-zhou
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
Zhonghua Yi Xue Za Zhi. 2010 Oct 26;90(39):2755-8.
To explore the applications of blood oxygenation level dependent-functional magnetic resonance imaging (BOLD-fMRI), diffusion tensor imaging (DTI) and cortical somatosensory evoked potentials (Co-SEP), motor evoked potentials (MEP) and electrocorticogram (ECoG) in secondary epileptic surgery of primary motor area (M1).
In 19 patients, preoperative BOLD-fMRI were performed to display the relationship between active zone, fiber bundle and epileptogenic lesions. Besides, Co-SEP, MEP and ECoG were also carried out intra-operatively to direct the resection of epileptogenic lesion and epileptogenic focus. At the same time, the nervous functions were protected as much as possible. Then fMRI was performed again to ensure that the post-operative nervous function was excellent.
In preoperative BOLD-fMRI and DTI examinations, active zone and fiber bundle could be seen at the edge of lesions (n = 12); range reduced, become deformed or removed (n = 6); glioma epileptogenic lesion was close-up with M1 (n = 1). The central sulcus was confirmed by Co-SEP in all cases. And two cases were inconsistent with anatomical location; Stimulating precentral gyrus, MEP were elicited post-operatively from orbicularis oris, muscle of thenar, hypothenar muscle or flexor digitorum brevis. Under the monitoring of ECoG, spike-wave was monitored in all cases. Of these, epileptogenic focus was in M1 (n = 15). After treatment, spike-wave were reduced significantly or disappeared. At a post-operative follow-up of 6 - 12 months, seizure improvement has achieved Engel III level or above (n = 18). On re-examinations of BOLD-fMRI and DTI, active zone became bigger than before and fiber bundle was symmetric with opposite side. Two of 19 cases had transient motor aphasia incompletely or hemiparesis. No permanent neurological dysfunction occurred. There was no relapse in cases of glioma.
BOLD-fMRI and Co-SEP, MEP and ECoG are complementary in M1 of secondary epilepsy surgery. It is effective to preserve nervous functions and enhance the quality of life for patients with epilepsy.
探讨血氧水平依赖性功能磁共振成像（BOLD-fMRI）、弥散张量成像（DTI）以及皮层体感诱发电位（Co-SEP）、运动诱发电位（MEP）和皮层脑电图（ECoG）在原发性运动区（M1）继发性癫痫手术中的应用。
对19例患者术前进行BOLD-fMRI检查，以显示活动区、纤维束与致痫灶的关系。此外，术中还进行Co-SEP、MEP和ECoG检查，以指导致痫灶和致痫灶的切除。同时，尽可能保护神经功能。然后再次进行fMRI检查，以确保术后神经功能良好。
术前BOLD-fMRI和DTI检查中，12例病变边缘可见活动区和纤维束；6例范围缩小、变形或消失；1例胶质瘤致痫灶与M1紧邻。所有病例均通过Co-SEP确认中央沟。2例与解剖位置不符；刺激中央前回，术后口轮匝肌、大鱼际肌、小鱼际肌或指短屈肌引出MEP。在ECoG监测下，所有病例均监测到棘波。其中，致痫灶位于M1区15例。治疗后，棘波明显减少或消失。术后6～12个月随访，癫痫发作改善达到Engel III级及以上18例。BOLD-fMRI和DTI复查时，活动区较术前增大，纤维束与对侧对称。19例中有2例出现短暂性运动性失语不完全或偏瘫。无永久性神经功能障碍发生。胶质瘤病例无复发。
BOLD-fMRI与Co-SEP、MEP和ECoG在继发性癫痫手术的M1区具有互补性。对保留癫痫患者神经功能、提高生活质量有效。
