汉-英双语言脑功能区外科手术定位的探讨

Research of brain mapping and surgical location of Chinese-English bilingual eloquent areas

目的探讨中国人汉-英语的脑功能区定位及手术方法。方法对1例广东籍汉语普通话-英语双语言脑功能区低级别胶质瘤病人,术前通过汉、英语语义、语音和图文实验任务,经功能磁共振(fMRI)定位汉语和英语皮质区,由神经功能导航制定手术计划和定位,术中采用超声探测肿瘤,全麻唤醒下双语定位监测功能区,行显微手术切除病变。结果fMRI检出汉语激活区在肿瘤的前下外部,即额中下回后部,英语激活区则位于近肿瘤的额上中回后部。切除肿瘤过程中英语较汉语出现明显障碍征象。肿瘤获次全切除,术后出现短暂辅助运动区(SMA)综合征,英语运动性失语于术后1周内恢复;术后3个月,fMRI显示英语激活区重塑位移。术后8个月随访,病人恢复正常生活和工作,术前癫疒间症状消失。结论①采用双语方式进行fMRI扫描定位、神经导航功能区定位和术中清醒状态下双语监测,使双语言脑功能区病变病人的手术治疗成为可能。②在保留母语功能的前提下,对第2语言区病变做到最大限度切除后,其语言功能仍可能得到恢复。

Objective To study the brain mapping and surgical method of Chinese-English bilingual eloquent areas in China. Methods A cerebral eloquent operation was performed in a Cantonese bilingual patients with low grade glioma in the eloquent region, who spoke Mandarin, Cantonese and English. Based on semantic, speech and reading test of Chinese and English, functional magnetic resonance imaging （fMRI） was conducted to map the Chinese-English eloquent cerebral cortex before operation. The patient received the microsurgery for tumor resection under monitoring by Chinese and English, mapping bilingual eloquent areas under awake anaesthesia, and the surgical program was guided by neuronavigation and cortical-subcortical direct electrical stimulation, with tumor location by B-mode ultrasound in the operation. Results Both Chinese and English eloquent cerebral cortex transactivation domains were fotmd by fMRI. Chinese eloquent area was located in the inferior-anterior region near the tumor, namely the posterior part of left middle-inferior frontal gyrus, and English eloquent area located in the posterior part of left superior-middle frontal gyrus near the tumor. English speech disorder was fotmd more serious than Chinese during the resection of the tumor. Transient supplementary motor area （SMA） syndrome was observed after subtotal resection of the tumor. The patient suffered from English motor aphasia for a week after the surgery, fMRI revealed remodeling and displacement of English transactivation domain in 3 months after the operation. At follow up 8 months later, patient had gone back to his work post as a teacher and had normal life with free of epilepsy. Conclusions ①Mapping eloquent areas using fMRI based on bilingual mission, neuronavigation and bilingual monitoring under a waking state of patient make it possibly to remove the tumors in the bilingual eloquent area. ②Protection of mother tongue is the precondition of this kind of surgery. Linguistic function may be recovered after the maximal resection of the tumor in the second linguistic area.