Neurological Surgery 脳神経外科35巻3号

2007年03月発行

連載 脳神経外科医療のtranslational research（5）

脳神経外科領域における新規画像診断法―解剖・機能画像の進歩

著者： 大石誠¹ 宇塚岳夫¹ 米岡有一郎¹ 五十嵐博中² 藤井幸彦¹²

所属機関： ¹新潟大学脳研究所脳神経外科学教室 ²新潟大学脳研究所統合脳機能研究センター

ページ範囲：P.291 - P.300

Ⅰ．はじめに

　脳神経外科領域では，手術をより確実で安全なものとするために少しでも多くの情報を得ようと，形態のみならず機能をも可視化する画像診断法が積極的に導入されてきた．最近は，術中ナビゲーションシステムに解剖や機能に関する様々な画像情報を統合したfunctional neuronavigationも汎用されてきており，脳神経外科手術自体が画像情報を駆使したスタイルへと変遷を遂げている．

　新規画像診断技術の開発に関して脳神経外科医の立場から言えば，顕微鏡を駆使した繊細な手術を手掛けるがために「さらに詳細な解剖を知りたい」，またquality of lifeにかかわる脳機能の温存に努めるがために「直接見ることのできない機能を可視化したい」という2つの大きな欲求が根底にある．前者に対しては，3.0T装置をはじめとするMRIの高磁場化や3次元画像構築技術の進歩があり，後者に対しては functional MRI（fMRI），positron emission tomography（PET），magnetoencephalography（MEG）をはじめとした機能画像法の開発や，diffusion tensor imaging（DTI）による白質情報の画像化，MR spectroscopy（MRS）のような代謝性産物の分子イメージングなどの発展があった．これら新規画像診断法を臨床の中で運用していくにあたって，脳神経外科医は唯一脳そのものに触れることができる立場にあるものとして，術中モニタリングや頭蓋内マッピングなどの神経生理学的手法での検証や，摘出標本の病理学的所見との比較に絶えず取り組み，また新たな画像法開発のためにその結果をフィードバックしていかなくてはならない．

　われわれは，脳研究所所属の脳神経外科学教室として，他の脳研究部門との連携が自由にある環境を生かし^注1)，今まで「脳腫瘍」「脳血管障害」「機能性疾患」などの各脳神経外科領域に適応すべき高解像度解剖画像や機能画像診断法の確立，つまり脳神経外科領域での画像診断法において一貫したtranslational researchに取り組んできた．本報告では，MRI画像の研究に関しては新潟大学統合脳機能研究センターと，MEGとてんかんの研究に関しては国立病院機構西新潟中央病院てんかんセンターと，optical imagingに関しては新潟大学脳研究所システム脳生理学教室とともに手掛けて来た研究を中心に，脳神経外科領域における新規画像診断について現在のトピックと今後の展望を交えて紹介する．

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