Applied Research About Protection Of Motor Function In Surgery Of Supratentorial Lesions On Motor Pathway

Part 1 Integration of Imagenavigator and Electrophysiologic Monitoring in Microsurgical Treatment of Motor Area TumorsObjective: To explore the clinical value of neuronavigator integrated of Blood Oxygen Level Dependent-functional Magnetic Resonance Imaging(BOLD-fMRI) and Diffusion Tensor Imaging-Fiber Tractography(DTI-FT) combined with intraoperative electrophysiological monitoring in surgical treatment of intracranial tumors located in motor area. Methods: 15 cases of tumor patients located in motor area were examined by 3DT1, BOLD-fMRI and DTI-FT preoperation. The three image integration of 3DT1, BOLD-fMRI and DTI-FT on navigation systems came to understand the relative relationship of tumor, motor area and pyramidal tract. Under the guidance of navigator intraoperative localization of tumor, motor area and pyramidal tract, combined with intraoperative electrophysiology real-time location of brain functional boundary around the tumor, to remove the tumor under the microscope guided by navigator. Results: Navigator precisly imaging, BOLD-fMRI was consistent with intraoperative electrophysiological, Motor area tumors were remove guided by DTI-FT which could protect cellulose. 15 cases of tumor were resection in 12 cases, subtotal resection in 2 cases, most resection in 1 case. The dystonias of 4 patients were aggravated transiently, and muscle strength of the rest of postoperative patients were similar and enhanced compared with preoperative patients. After follow-up 3 months to 10 months, 4 cases of muscle strength recovered to preoperative levels, and the remaining cases improved or unchanged comparing with preoperative patients. Conclusion: MRI, BOLD-fMRI and DTI-FT integrated with navigation, combined with intraoperative electrophysiological monitoring, maximumly resected motor area tumor by navigation under the microscope while minimizing the injury of motor area and the pyramidal tract, the effective protection of nerve function, improving postoperative quality of life. Part 2 Surgical Excision of Brain Cavernous Angioma Invovling Motor Area Using Keyhole-Approach Craniotomy under Integration of imagenavigatorObjective: To explore the clinical outcome of microsurgical excision of brain Cavernous Angioma(CA) located in motor area using keyhole-approach craniotomy under neuronavigator. Methods: 12 cases of CA invovling motor area were examined by 3D T1,BOLD-fMRI and DTI-FT before the surgery. After fusing with 3DT1 and BOLD-fMRI, CA was drawed and motor area,pyramidal tract were located. And we can have a craniotomy with keyhole bone window, guide CA by the neuronavigator,combine with electrophysiology to avoid impairing motor area. Microsurgical excision of CA was conducted by microscopical-neuronavigator. Results: The size and site of CA which was drawed was stereoimaged by the neuronavigator. The boundary of Motor area definited by BOLD-fMRI was basically consistent with electrophysiology in the surgery, 12 cases of CA were totally removed, and long-term function damage were not observed after the postoperative. Conclusion: Application of fusing images under microscopical-neuronavigator in keyhole surgery, combined with intraoperative electrophysiological location, enabling the removal of the motor area CA and avoiding the injury of motor area, can effectively protect neurological function and improve quality of life of patients.Part 3 Integration of Imagenavigator Combined With Intraoperative Electrophysiological Monitoring Of Surgical Treatment Of Intractable Epilepsy Caused by Focal Cortical DysplasiaObjective: To assess the role of neuronavigator combining with electrophysiology for the surgical treatment of intractable epilepsy caused by focal cortical dysplasia(FCD). Methods: 18 cases of intractable epilepsy with FCD were examined by 3D T1,BOLD-fMRI and DTI-FT which integration with navigator systems. Epileptogenic lesion resect was guided by neuronavigator system, combined with electrophysiology localized motor area, and EcoG localized epileptogenic lesion. Results: 18 cases of limbs motion function was simiar with the one before surgery. Pathologic diagnosis was consistent with FCD. Following up 1 year after postoperation and rechecking electroencephalogram, the result was 14 cases in gradeâ… , 2 cases in gradeâ…¡, 1 case in gradeâ…¢, 1 case in gradeâ…£according to Engel standard. Conclusion: Imagenavigator and electrophysiological monitoring, with intraoperative ECoG in surgery for intractable epilepsy caused by FCD, the accurate positioning could avoid the motor area, the smallest injury of motor function, to the removal of the epileptic focus and the maximum protection of motor function.