| ObjectiveUsing direct subcortical electrical stimulation(DsCS) to validate and comparison with the pyramidal tracts traced by fMRI motion activated area as the ROI method(fMRI guided DTI-FT) and by the anatomy of primary motor cortex as ROI method (traditional DTI-FT). And further explore the accuracy and reliability of the fMRI guided DTI-FT method and the traditional DTI-FT method, in order to improve the traditional method, and make the functional area operation more accurate, safe and effective. Eventually, reduce the neural dysfunction rate and seizure.Methods18 cases with lesions epilepsy involving the central area have received the BOLD-fMRI and DTI examination, BOLD-fMRI used hand thumb and index finger to finger movement and foot thumb dorsal flexion as task stimulation. All the data were offline post-processing, the DTI data were processed by stealthviz software, after gotten the FA map and DEC map, fused the the image of activation of BOLD-fMRI area and DEC image together. Then used the fMRI guided DTI-FT method and the traditional DTI-FT method traced pyramidal tract respectively. Then resected the lesions asssisted by neuronavigation and DsCS,the same stimulation positive point and two methods of pyramidal tract imaging distance were recorded, and the coincidence rate of two methods were compared by DsCS in order to verify the accuracy and reliability of them.Finally, resected the lesion and epileptogenic cortex assisted by DsCS and protect the eloquent areas and pyramidal tracts.ResultsExcept 1 patient were failed traced by the fMRI guided DTI-FT method,1 cases of electrical stimulation negative, the other patients were successfully using two methods of pyramidal tract imaging, and applied in the intraoperative cortical electrical stimulation assisted resection of lesions in functional neuronavigation guided. Two methods of imaging of pyramidal tract and the coincidence rate compared with DsCS were 74% and 58%, the average shortest distance between 23 DsCS positive sites and pyramidal tracts imaging traced by two kinds of methods were (4.5+2.5) mm and (6.4 +2.4) mm, the pyramidal tract imaging traced by improved method were more closer to the positive site than traditional method under the same stimulation intensity, so it is relatively more accurate (t=0.573, P=0.012< 0.05), and the coincidence rate of improved method compared with DsCS were higher than that of the traditional method (χ2=7.804, P=0.008< 0.05).Total resected 16 cases, subtotal reseced 2 cases,5 cases of patients with postoperative lesion of the contralateral limb temporary hemiplegia,3 cases of upper limb muscle strength temporary hemiplegia, no change of 10 patients before and after operation,1 weeks after the operation,6 cases of limb movement with preoperative or more improved preoperatively, the remaining 2 cases are still hemiplegia, the average Fugl-Meyer score was 92.1, the WAB score was 94.3,1-2 kinds of AED were taken after operation, and epilepsy were under satisfactory control.ConclusionsFor the central area of the lesions involved motor area, the fMRI guided DTI-FT method tracer of pyramidal tract is better than the traditional method in accuracy and reliability,can also protect the function of the cortex and the pyramidal tract assisted by neuronavigation. But it still need to be supported by the application of DCS and DsCS, which do more help to deal with lesions and effectively protect the brain function area, so as to avoid postoperative permanent neurological dysfunctions and reduce seizure effectivelly. of pyramidal tract imaging, and applied in the intraoperative cortical electrical stimulation assisted resection of lesions in functional neuronavigation guided. Two methods of imaging of pyramidal tract and the coincidence rate compared with DsCS were 74% and 58%, the average shortest distance between 23 DsCS positive sites and pyramidal tracts imaging traced by two kinds of methods were (4.5+2.5) mm and (6.4 +2.4) mm, the pyramidal tract imaging traced by improved method were more closer to the positive site than traditional method under the same stimulation intensity, so it is relatively more accurate (t=0.573, P=0.012< 0.05), and the coincidence rate of improved method compared with DsCS were higher than that of the traditional method (χ2=7.804, P=0.008< 0.05).Total resected 16 cases, subtotal reseced 2 cases,5 cases of patients with postoperative lesion of the contralateral limb temporary hemiplegia,3 cases of upper limb muscle strength temporary hemiplegia, no change of 10 patients before and after operation,1 weeks after the operation,6 cases of limb movement with preoperative or more improved preoperatively, the remaining 2 cases are still hemiplegia, the average Fugl-Meyer score was 92.1, the WAB score was 94.3,1-2 kinds of AED were taken after operation, and epilepsy were under satisfactory control.ConclusionsFor the central area of the lesions involved motor area, the fMRI guided DTI-FT method tracer of pyramidal tract is better than the traditional method in accuracy and reliability,can also protect the function of the cortex and the pyramidal tract assisted by neuronavigation. But it still need to be supported by the application of DCS and DsCS, which do more help to deal with lesions and effectively protect the brain function area, so as to avoid postoperative permanent neurological dysfunctions and reduce seizure effectivelly. |
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