Hendrix Philipp, Senger Sebastian, Griessenauer Christoph J, Simgen Andreas, Linsler Stefan, Oertel Joachim
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
J Clin Neurosci. 2017 Jul;41:154-161. doi: 10.1016/j.jocn.2017.02.029. Epub 2017 Mar 9.
Eloquent neural structures including white matter tracts surround the trigone of the lateral ventricle. Surgical resection of trigonal tumors via the transparietal approach may cause neurological deterioration depending on the trajectory.
The authors retrospectively reviewed patients with trigonal tumors that underwent combined preoperative navigated transcranial magnetic stimulation (nTMS) and optic radiation tractography to guide a transparietal approach towards the trigone.
Five patients underwent preoperative nTMS motor mapping, rTMS language mapping, nTMS-derived corticospinal tract tractography, and optic radiation tractography. The information was used to select the optimal trajectory for a transparietal approach and for intraoperative neuronavigation. Four patients underwent surgical resection. None of them experienced a new permanent deficit.
Combination of preoperative nTMS and optic radiation tractography facilitates the identification of the optimal parietal trajectory towards the trigone. It allows for sparing of visual and motor pathways as well as cortical language areas.
包括白质束在内的明确神经结构环绕侧脑室三角区。经顶叶入路手术切除三角区肿瘤可能因手术路径不同而导致神经功能恶化。
作者回顾性分析了接受术前导航经颅磁刺激（nTMS）和视辐射纤维束成像以指导经顶叶入路至三角区的三角区肿瘤患者。
5例患者接受了术前nTMS运动功能映射、重复经颅磁刺激（rTMS）语言功能映射、nTMS衍生的皮质脊髓束纤维束成像和视辐射纤维束成像。这些信息用于选择经顶叶入路的最佳路径并用于术中神经导航。4例患者接受了手术切除。他们均未出现新的永久性神经功能缺损。
术前nTMS与视辐射纤维束成像相结合有助于确定经顶叶至三角区的最佳路径。它能够避免损伤视觉和运动通路以及皮质语言区。
