Abstract：
Surgical resection of brain tumours aims at the maximal safe resection of the pathological tissue with minimal functional impairment. To achieve this objective, reliable anatomical landmarks are indispensable to navigate into the brain. The neuronavigation system can provide information to target the location of the patient\'s lesion, but after the craniotomy, a brain shift and relaxation mismatch with it often occur. By contrast, sulci/gyri are topological cerebral landmarks in individual patients and do shift with the brain parenchyma during lesion removal, but remain independent from brain shift in relation to the sulci/gyri. Here, we present a case report of a novel strategy based on anatomical landmarks to guide intraoperative brain tumour resection, without using a standard neuronavigation system. A preoperative brain mapping of the peri-tumoural sulci by the MRI and surface reconstruction was followed by confirmation of the anatomical landmarks for the motor cortex using navigated transcranial magnetic stimulation. The resulting location was used as a seed for diffusion tensor imaging tractography to reconstruct the corticospinal tracts. These selected cortical landmarks (sulci/gyri) delimited the margins of the two lesions and the specific location under which the corticospinal tract courses, thus facilitating monitoring of the peri-tumoural region during brain resection. In this case, 96% of the brain tumour from the pericentral somatomotor region was successfully removed without chronic post-operative motor impairments. This approach is based on cortical anatomy that is fixed during surgery and does not suffer from the brain shift that could misplace the lesion according to the neuronavigation system.
摘要：
脑肿瘤的手术切除旨在最大程度地安全切除病理组织，而功能损害最小。为了实现这一目标,可靠的解剖标志是不可或缺的导航到大脑。神经导航系统可以提供针对患者病变位置的信息，但开颅手术后,经常发生大脑移位和放松不匹配的情况。相比之下,沟/回是个别患者的拓扑脑标志，并且在病灶清除期间随着脑实质发生移位，但与脑移位有关的沟/回保持独立。这里,我们提出了一种基于解剖标志的新策略来指导术中脑肿瘤切除的病例报告，不使用标准的神经导航系统.通过MRI和表面重建对肿瘤周围沟进行术前脑定位，然后使用导航经颅磁刺激确认运动皮质的解剖标志。所得位置用作扩散张量成像纤维束成像的种子，以重建皮质脊髓束。这些选定的皮质标志（沟/回）界定了两个病变的边缘和皮质脊髓束行进的具体位置，因此，有助于在脑切除术期间监测肿瘤周围区域。在这种情况下,成功切除了中央周围躯体运动区域96％的脑肿瘤，而没有慢性术后运动障碍。这种方法基于在手术期间固定的皮质解剖结构，并且不会遭受根据神经导航系统可能错位病变的脑移位。
