中文摘要：

目的探讨血氧水平依赖功能磁共振成像（BOLD-fMRI）及弥散张量纤维束成像（DTT）技术、术中超声辅助神经导航结合电生理监测在大脑运动区胶质瘤切除术中的应用价值。 方法安徽医科大学附属省立医院神经外科自2012年1月至2014年12月应用BOLD-fMRI及DTT技术、术中超声辅助神经导航并结合术中电生理监测手术治疗45例大脑运动区胶质瘤患者，术中实时定位中央沟边界，确认中央前、后回以及肿瘤位置，选择合适的脑沟入路，术中利用MRI图像与超声图像引导神经导航判断肿瘤边界，最大程度切除肿瘤。结果术前DTT显示锥体束单纯受推挤22例、受浸润或破坏23例。术中均准确定位肿瘤，电生理监测准确定位中央沟并成功选择合适的脑沟入路，避免损伤运动区皮层及锥体束。全切除38例，次全切除7例。无死亡和其他严重并发症。术后15例肢体肌力稍下降（1个月后10例肌力逐渐恢复正常），其中锥体束单纯受推挤组患者术后肌力下降4例，锥体束受浸润或破坏组患者术后肌力下降11例，肌力下降发生率差异有统计学意义（χ2 =4.430 ，P=0.035）。结论在多模态图像与术中超声图像辅助神经导航引导下，术中可准确定位大脑运动区胶质瘤，结合BOLD-fMRI及DTT技术和术中电生理监测可有效避免损伤运动区皮层及锥体束。

英文摘要：

Objective To investigate the operation process and clinical value of blood oxygen level dependent functional MRI （BOLD-IMRI）, diffusion tensor tractography （DTT）, intraoperative ultrasound and neuronavigation combined with electrophysiologic monitoring applied in resection of intracranial gliomas involving motor cortex. Methods From January 2012 to November 2014, there were 45 patients with intracranial gliomas involving motor cortexes which were resected with the help of BOLD-fiVIRI, DTT, intraoperative ultrasound, neuronavigation combined with electrophysiologic monitoring. By the above-mentioned methods, the boundary of the central sulcus and the tumors wereidentified and localized accurately, and the tumors were resected at the highest possible. After the operation, MR imaging was performed again. Their clinical data and treatment efficacy were retrospectively analyzed. Results All the 45 intracranial gliomas involving motor cortex were localized accurately. Preoperative DTT indicated 22 of tractus pyramidalis being pressed and 23 of tractus pyramidalis being infiltrated/destroyed. From the appropriate brain ditch, all the tumors were resected without damaging motor cortex and pyramidal tract. Total removal of the gliomas was achieved in 38 patients, and subtotal resection in 7. There were no death or serious complications occurred in all the patients. There were 15 patients whose muscle strength was worse after operation, of which, 10 recovered to preoperative levels one month after surgery; 4 patients were recorded muscle weakness in 22 of tractus pyramidalis being pressed while 11 patients were recorded muscle weakness in 23 of tractus pyramidalis being infiltrated/destroyed, with significant difference （x2=4.430, P=0.035）. Conclusion The gliomas could be localized accurately with the help of intraoperative ultrasound and neuronavigation, and be resected at the highest possible without damage of motor cortex and pyramidal tract by BOLD-fMRI, DTT and electrophysiologic monitoring.