ABSTRACT

Objective: The aim of this study was to investigate whether preoperative functional imaging and intraoperative magnetic resonance imaging (iMRI) facilitate surgery and improve outcomes in the surgical treatment of cavernous malformations of the brain (CM).

Materials and Methods: Retrospective data analysis was performed for consecutive patients diagnosed with a CM who underwent surgical treatment at a single academic institution during a 12 year period. A total of 91 patients was eligible for analysis with a mean age of 38.8 ± 15 years (range 2–72 years). Altogether, 89.0% of CM had supratentorial and 11% infratentorial location.

Results: Neuronavigation and iMRI was used in 69 (75.8%) patients with 28 (30.8%) of them together with functional MRI (fMRI) all in the supratentorial location. In 4.3% (3 cases) an intraoperative second-look surgery was performed. Altogether, a complete resection was achieved in 93% of the patients. In supratentorial surgeries, surgical times were significantly shorter in the fMRI group (p = 0.036), but altogether, infratentorial CM surgery took significantly longer (p = 0.014). Moreover, in the fMRI group, reduction of seizure medication was achieved significantly more often (p = 0.026). At an FU of 6.1± 3.1 years, 96% of the patients were assessed modified Rankin Scale 0 or 1.

Conclusion: Neuronavigation together with intraoperative and functional MRI had a significant impact on resection amount, surgical time, and neurological and seizure outcome of supratentorial CM. In addition, iMRI was beneficial in few-selected cases.

摘要

目的：本研究的目的是探讨术前功能成像和术中磁共振成像 (iMRI) 是否有助于手术并改善脑海绵状血管畸形 (CM) 的手术治疗结果。

材料和方法：对在 12 年内在单一学术机构接受手术治疗的连续诊断为 CM 的患者进行回顾性数据分析。共有 91 名患者符合分析条件，平均年龄为 38.8 ± 15 岁（范围 2-72 岁）。总共有 89.0% 的 CM 位于幕上，11% 位于幕下。

结果： 69 例（75.8%）患者使用神经导航和 iMRI，其中 28 例（30.8%）与功能性 MRI（fMRI）均在幕上位置。在 4.3%（3 例）中进行了术中第二眼手术。总而言之，93% 的患者实现了完全切除。在幕上手术中，fMRI 组的手术时间显着缩短（p = 0.036），但总的来说，幕下 CM 手术花费的时间明显更长（p = 0.014）。此外，在 fMRI 组中，癫痫药物减少的频率明显更高（p = 0.026）。在 6.1±3.1 年的 FU 时，96% 的患者被评估为改良 Rankin 量表 0 或 1。

结论：神经导航结合术中和功能性 MRI 对幕上 CM 的切除量、手术时间以及神经和癫痫发作结果有显着影响。此外，iMRI 在少数选定病例中是有益的。