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Neurological Surgery No Shinkei Geka Volume 26, Issue 7 （July 1998）

Neurological Surgery 脳神経外科 26巻7号（1998年7月発行）

Japanese English

研究

運動領近傍神経膠腫症例に対する運動機能温存手術—術前の運動野同定と術中モニタリングの有用性 Surgical Management for Preserving Motor Function in Patients with Gliomas near the Primary Motor Cortex : usefulness of preoperative identification of motor cortex and intraoperative monitoring of motor evoked potentials 大上史朗 ¹ , 久門良明 ¹ , 河野兼久 ¹ , 長戸重幸 ¹ , 中川晃 ¹ , 大田信介 ¹ , 榊三郎 ¹ , 楠勝介 ² Shiro OHUE ¹ , Yoshiaki KUMON ¹ , Kanehisa KOHNO ¹ , Shigeyuki NAGATO ¹ , Kou NAKAGAWA ¹ , Shinsuke OHTA ¹ , Saburo SAKAKI ¹ , Katsusuke KUSUNOKI ² ¹愛媛大学脳神経外科 ²和昌会貞本病院脳神経外科 ¹Department of Neurological Surgery, Ehime University School of Medicine ²Department of Neurological Surgery, Washokai Sadamoto Hospital キーワード： brain tumor , primary motor cortex , functional mapping , intraoperative monitoring , motor evoked potential Keyword: brain tumor , primary motor cortex , functional mapping , intraoperative monitoring , motor evoked potential pp.599-606

発行日 1998年7月10日 Published Date 1998/7/10

DOI https://doi.org/10.11477/mf.1436901588

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Abstract 文献概要
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I．はじめに

　脳腫瘍の摘出に際しては，腫瘍の摘出度ばかりでなく，術後の機能予後も考慮しなければならない．特に腫瘍がeloquent areaの近傍に存在する場合には，運動麻痺や失語症等の神経症状を悪化させないためにさまざまな注意が必要である^1,6,9）．術前に腫瘍の解剖学的な局在と共に隣接する脳の機能局在を明らかにし，適切な手術の到達方向や切除範囲を決定しなければならない．そのために，まず運動野や言語野の解剖学的および機能的な同定を行い，その結果を生かすためのナビゲーションシステムの使用と，さらに機能を反映し得る術中モニタリングの応用が必要となる^13）．

　われわれは，運動野近傍に存在した神経膠腫症例に対し，運動機能の温存を目的として，術前に神経放射線学的検査や電気生理学的検査により腫瘍と一次運動野の位置関係を同定し，手術に際しては運動誘発電位（motor evoked potential，MEP）をモニタリングしつつ腫瘍摘出を行い，良好な結果が得られたので，報告する．

Preoperative identification of precentral gyrus and intraoperative monitoring of motor evoked potentials(MEPs) were performed to preserve postoperative motor function in seven patients with gliomas near theprimary motor cortex. Tumors were astrocytomas in 3 patients, glioblastomas in 2 patients, anaplasticastrocytoma and mixed glioma in one patient each. Preoperative identification of the primary motor cortexwas performed by three-dimensional (3D) display of magnetic resonance (MR) images and by functionalimages using MR imaging and single-photon emission tomography. The primary motor cortex identified by3D display of MR images coincided well with that identified by functional images. 3D display of MR im-ages was also useful for detecting the relationship between the- tumor and the primary motor cortex. In-traoperatively, the central sulcus was confirmed by the finding of phase reversal of cortical somatosensoryevoked potential, and this corresponded with the preoperative identifications by 3D display and by func-tional mapping. The primary motor cortex was stimulated electric-ally, and MEP corticospinal evokedpotential) was continuously monitored during surgery using electrodes inserted in the cervical epiduralspace. The amplitude of direct waves of MEPs during surgery was maintained above half of that recordedat the beginning of tumor removal, and all patients showed preservation of preoperative motor function.These results suggest that preoperative identification of precentral gyrus and intraoperative MEP monitor-ing provide useful information for preserving motor function in patients with glion-iis near the primarymotor cortex.