fMRI神经导航下切除汉语感觉性语言中枢邻近区域胶质瘤

Application of fMRI neuronavigation in the treatment of glioma in or around the Wernicke area of brain

目的评价fMRI定位感觉性语言中枢的敏感性与准确性,探讨fMRI神经导航系统在感觉性语言中枢邻近区域胶质瘤手术中的应用价值。方法采用组块设计的语言理解任务和血氧水平依赖性功能磁共振成像(BOLD-fMRI)激活31例感觉性语言中枢邻近区域胶质瘤患者的感觉性语言中枢,于神经导航系统下进行结构像与功能像融合以定位感觉性语言中枢;手术中采用皮质电刺激定位感觉性语言中枢。根据fMRI与皮质电刺激吻合度进行分类,以避开感觉性语言中枢,于显微镜下切除胶质瘤。结果 31例患者中感觉性语言中枢功能像达"非常好"标准19例,图像"清楚"10例,图像"采集不成功"2例。感觉性语言中枢与皮质电刺激相关性评价显示,28例中24例为重叠关系,4例为邻近关系。肿瘤完全切除11例,次全切除10例,大部切除10例。手术后语言功能较手术前明显改善9例,无变化19例,短暂性感觉性失语3例。感觉性语言中枢与切除大脑皮质间距离>10mm者,手术后均未出现语言功能恶化。结论 fMRI定位感觉性语言中枢具有良好的敏感性与准确性。fMRI神经导航系统下切除胶质瘤可以减少感觉性语言中枢邻近区域胶质瘤患者手术后语言理解障碍的发生,提高肿瘤完全切除率。感觉性语言中枢与切除大脑皮质之间的相对安全距离为10mm。

Objective To explore the value of functional magnetic resonance imaging （fMRI） neuronavigation in the treatment of glioma in or around Wernicke area of brain, and to evaluate the sensitivity and accuracy of Wernieke area in fMRI. Methods Thirty-one glioma patients in or around Wernicke area were studied, fMRI was obtained by blood oxygenation level-dependent fMRI （BOLD-fMRI） with the tasks of paragraph comprehension. With the help of neuronavigation we infused the MRI and fMRI together and located the position of Wernicke area and lesion. In the course of operation the patients were awake, the technique of cortical electrical stimulation （CES） was used to assess the sensitivity and correlation of Wernicke area in fMRI. Results The success of fMRI paradigm was rated by ＂very good＂, ＂fair＂ and ＂unsuccessful＂. Nineteen cases were ＂very good＂, 10 cases were ＂fair＂, 2 cases were ＂unsuccessful＂. The distance between fMRI and CES was rated as ＂overlapping＂ （〈 1 cm distance）, ＂neighbouring＂ （1-2 em distance） and ＂contradictory＂ （〉 2 cm distance）. We finished 28 cases measurement, 24 cases were ＂overlapping＂, 4 cases were ＂neighbouring＂, no cases showed ＂contradictory＂. Total resection of the lesion was achieved in 11 cases, subtotal reseetion in 10 cases, partial resection in 10 cases. Post- operatively the neurologic function was improved in 9 cases, unchanged in 19 cases, temporary worsen in 3 cases. Resection border 〉 10 mm from Wernicke area was safe. Conclusion fMRI is sensitive and accurate for the location of Wernicke area. With the help of fMRI neuronavigation, the complication of glioma operation in or around Wernicke area can be decreased, and the total resection rate can be enhancedi The safe distanCe between resection border and Wernicke area is 10 mm.