Lu Jun-feng, Zhang Jie, Wu Jin-song, Yao Cheng-jun, Zhuang Dong-xiao, Qiu Tian-ming, Gong Xiu, Xu Geng, Mao Ying, Zhou Liang-fu
Department of Neurosurgery, Fudan University, Shanghai, China.
Zhonghua Wai Ke Za Zhi. 2011 Aug 1;49(8):693-8.
To evaluate preliminary clinical experience for combining awake craniotomy and intraoperative language brain mapping within the integrated 3.0 T intraoperative magnetic resonance imaging (iMRI) suite.
From December 2010 to April 2011, 11 right hand-dominant patients with left glioma were involved in, or adjacent to, eloquent cortex was carried out awake craniotomies with cortical stimulation within an integrated 3.0 T iMRI suite. Aphasia battery of Chinese was used to test the language function before the operation. During the procedure, after the occipital, temporal, and supraorbital nerves were blocked by the anesthesiologists, the head was fixed with a custom high-field MRI-compatible head holder. The skull and dura was opened as usual and language brain mapping was then performed. Language testing followed a set protocol: counting numbers from 1 to 50, naming objects, reading single words. Resection of the tumor was guided by neuronavigation system and continued until eloquent areas were encountered or the margin of assessment was reached. An interdissection MRI was acquired to evaluate the glioma removal in a movable MRI scanner after minimal draping. Meanwhile, adverse effects caused by electrical stimulation and iMRI were recorded. The follow-up speech tests were assessed on 7th day and 1 month at least after the operation.
The combined use of 3.0 T iMRI and awake craniotomy was performed safely in all patients. No adverse effects were reported. The duration of surgery was prolonged by 2 to 4 h. The patients' perception of iMRI during surgery was favorable. First-look MRI studies led to further resection attempts in 6/11 cases as well as a 3/11 increase in the number of gross-total resections. One week after surgery, baseline language function worsened in 4 cases. However, no patients had a persistent language deficit one month after surgery.
Awake craniotomy and direct cortical electrical stimulation can be performed safely and effectively within a 3.0 T iMRI suite. The combination of high-field iMRI and awake craniotomy may facilitate safe removal of eloquent glioma.
评估在集成式3.0 T术中磁共振成像（iMRI）设备内联合进行清醒开颅手术和术中语言脑图谱绘制的初步临床经验。
2010年12月至2011年4月，11例右利手、患有左侧胶质瘤且肿瘤累及或毗邻明确皮质的患者，在集成式3.0 T iMRI设备内接受了清醒开颅手术及皮质刺激。术前使用汉语失语成套测验来测试语言功能。手术过程中，在麻醉医生阻滞枕神经、颞神经和眶上神经后，使用定制的高场MRI兼容头架固定头部。像往常一样打开颅骨和硬脑膜，然后进行语言脑图谱绘制。语言测试遵循既定方案：从1数到50、命名物体、朗读单个单词。在神经导航系统的引导下切除肿瘤，直至遇到明确区域或达到评估边界。在简单铺巾后，在可移动的MRI扫描仪中采集术中解剖间MRI，以评估胶质瘤切除情况。同时，记录电刺激和iMRI引起的不良反应。术后至少在第7天和1个月进行随访语音测试评估。
所有患者均安全地联合使用了3.0 T iMRI和清醒开颅手术。未报告不良反应。手术时间延长了2至4小时。患者在手术期间对iMRI的感受良好。首次MRI检查促使11例中的6例进一步尝试切除肿瘤，全切除病例数增加了11例中的3例。术后1周，4例患者的基线语言功能恶化。然而，术后1个月没有患者存在持续性语言缺陷。
在3.0 T iMRI设备内可以安全有效地进行清醒开颅手术和直接皮质电刺激。高场iMRI与清醒开颅手术的联合应用可能有助于安全切除明确的胶质瘤。
