Hund M, Rezai A R, Kronberg E, Cappell J, Zonenshayn M, Ribary U, Kelly P J, Llinás R
Department of Physiology, New York University School of Medicine, New York, USA.
Neurosurgery. 1997 May;40(5):936-42; discussion 942-3. doi: 10.1097/00006123-199705000-00011.
Surgical management of cortical lesions adjacent to or within the eloquent cerebral cortex requires a critical risk: benefit analysis of the procedure before intervention. This study introduced a measure of surgical risk, based on preoperative magnetoencephalographic (MEG) sensory and motor mapping, and tested its value in predicting surgical morbidity.
Forty patients (21 men and 19 women; mean age, 36.5 yr) with cortical lesions (12 arteriovenous malformations and 28 tumors) in the vicinity of the sensorimotor cortex were classified into high-, medium-, or low-risk categories by using the MEG-defined functional risk profile (FRP). This was based on the minimal distance between the lesion margin and the sensory and motor MEG sources, superimposed on a magnetic resonance imaging scan. Case management decisions were based on the MEG mapping-derived FRP in combination with biopsy pathological findings, radiographic findings, and anatomic characteristics of the lesion. A recently developed protocol was used to transform MEG source locations into the stereotactic coordinate system. This procedure provided intraoperative access to MEG data in combination with stereotactic anatomic data displays routinely available on-line during surgery.
It was determined that 11 patients diagnosed as having gliomas had high FRPs. The margin of the lesion was less than 4 mm from the nearest MEG dipole or involved the central sulcus directly. A nonoperative approach was used for six patients of this group, based on the MEG mapping-derived FRP. In the group with arteriovenous malformations, 6 of 12 patients with high or medium FRPs underwent nonoperative therapy. The remaining 28 patients, whose lesions showed satisfactory FRPs, underwent uneventful lesion resection, without postoperative neurological deficits.
Our results suggest that MEG mapping-derived FRPs can serve as powerful tools for use in presurgical planning and during surgery.
对于紧邻或位于明确的大脑皮层内的皮质病变，手术治疗在干预前需要对手术风险与获益进行严格分析。本研究引入了一种基于术前脑磁图（MEG）感觉和运动图谱的手术风险测量方法，并测试其在预测手术并发症方面的价值。
40例（21例男性和19例女性；平均年龄36.5岁）在感觉运动皮层附近有皮质病变（12例动静脉畸形和28例肿瘤）的患者，使用MEG定义的功能风险概况（FRP）分为高、中、低风险类别。这是基于病变边缘与感觉和运动MEG源之间的最小距离，并叠加在磁共振成像扫描上。病例管理决策基于MEG图谱得出的FRP，结合活检病理结果、影像学结果和病变的解剖特征。采用最近开发的方案将MEG源位置转换为立体定向坐标系。该程序在手术期间提供了术中获取MEG数据的途径，并结合了常规在线提供的立体定向解剖数据显示。
确定11例诊断为胶质瘤的患者具有高FRP。病变边缘距最近的MEG偶极小于4mm或直接累及中央沟。基于MEG图谱得出的FRP，该组6例患者采用了非手术方法。在动静脉畸形组中，12例高或中FRP的患者中有6例接受了非手术治疗。其余28例病变显示出满意FRP的患者，顺利进行了病变切除，术后无神经功能缺损。
我们的结果表明，MEG图谱得出的FRP可作为术前规划和手术期间的有力工具。
