脳腫瘍手術における術前・術中脳機能マッピング・モニタリング  [in Japanese] Pre- and Intraoperative Functional Brain Mapping and Monitoring for Brain Tumor Surgery  [in Japanese]

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Abstract

 本稿では脳腫瘍摘出手術に役立つ術前機能マッピングと術中機能モニタリングの具体的方法と臨床現場における評価, 信頼性について述べた. 現在術前機能マッピングによる運動野/中心溝局在, および優位半球の同定は現場で十分応用できる. しかし, 言語関連機能MRIの活動部の脳皮質電気刺激による検証では感度は80%, 特異度は60%程度でさらなる改良が必要である. 一方, tractographyは機能している皮質脊髄路と弓状束を正確に反映しているため, 手術計画に有用である. 術中脳機能モニタリング方法としては, 感覚誘発電位, 運動野, 皮質脊髄路電気刺激による運動誘発電位, および覚醒下手術がある. 感覚誘発電位, 皮質刺激運動誘発電位により確実な運動野/中心溝局在の同定が行える. また, 白質刺激運動誘発電位では刺激強度と切除腔と皮質脊髄路tractography間距離に強い相関関係があり, 刺激強度から皮質下構造までの距離を推測することもできる. 覚醒下手術では図形名称課題を用いることで, 効率的に言語皮質, 弓状束を同定・温存できる. 蛍光画像マッピングは悪性腫瘍浸潤領域の同定に有用であるが, さらなる定量的な検討方法の確立が必要である.

  We reviewed the present status of pre- and intraoperative functional mapping and monitoring for brain tumor surgery. Functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) have become gold standards to identify the central sulcus with electrical stimulation to the median nerve and language lateralization using word reading or verb generation tasks. For white matter mapping, diffusion tensor imaging (DTI) -based tractography is the only technique available, which visualizes the eloquent subcortical fibers including the corticospinal tract (CST) and the arcuate fascicles (AF). Cortical somatosensory evoked potentials, motor evoked potentials (MEP) with cortical and subcortical stimulation, and awake craniotomy are available for intraoperative functional monitoring. There were strong correlations between stimulus intensity for MEP with the fiber stimulation and the distance between CST and the stimulus points. The results indicate that a minimum stimulus intensity of 20, 15, 10 and 5 mA had stimulus points of approximately 20, 15, 10 and 5 mm far from CST, respectively. Subcortical electrical stimulation to AF consistently induced paranomia during awake craniotomy. These facts indicate that tractography is a reliable technique for brain tumor resection. Finally, even though fluorescent imaging has the potential to navigate us to the tumor border, it is still necessary to develop quantitative analyses for this technique.

Journal

  • Japanese Journal of Neurosurgery

    Japanese Journal of Neurosurgery 23(4), 296-305, 2014

    The Japanese Congress of Neurological Surgeons

Codes

  • NII Article ID (NAID)
    130003397708
  • Text Lang
    JPN
  • ISSN
    0917-950X
  • Data Source
    J-STAGE 
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