fMRI功能导航下切除汉语运动性语言区附近病变

The Application of fMRI in brain surgery for the lesions in or around the Broca's area of brain

目的探讨功能磁共振(functional magnetic resonance imaging,fMRI)导航在汉语运动性语言区附近病变手术中的应用价值。方法对43例大脑皮层运动性语言区附近病变患者,通过组块设计的汉语朗读任务,利用血氧水平依赖性功能磁共振成像(BOLD-fMRI)获得运动性语言区激活,利用磁共振弥散张量成像技术(diffusion tensori maging,DTI)获得白质纤维束走行,将结构影像、fMRI功能影像与DTI的各项异性系数(FA)图像同时传入导航系统,术中定位fMRI确定的语言区,在唤醒状态利用皮层电刺激技术进行语言区验证,避开运动性语言区在显微镜下切除病变。结果本组患者29例术前语言功能正常,14例有不同程度语言功能障碍。38例获得了有效的fM-RI语言区激活,进行了36例核心激活脑区与皮层电刺激比较:25例为重叠关系,11例为邻近关系。手术全切除17例,次全切除14例,大部份切除12例。术后语言功能8例较术前好转,31例无变化,4例出现短暂性运动性失语。结论汉语朗读任务所获得的fMRI运动性语言区激活具有良好的敏感性与准确性;fMRI导航手术可以提高汉语运动性语言区附近病变切除程度,减少术后运动性失语的发生。

Objective To evaluate the value of fMRI guided brain surgery for the lesions in or around Broca＇s area. Methods Forty-three patients with lesions in or adjacent to the Broca＇s area were studied, fMRI imaging was obtained by BOLD technique with the tasks of reciting. Fiber tract imaging of white matter was obtained by DTI technique. All functional imaging and anatomic imaging were transferred to neuronavigation system. The technique of direct cortical stimulation was used to validate the language cortex in fMRI. The lesions were resected in microscope. Results Broca＇s area activation was detected in 38 cases.. The distance between the fMRI peak and direct cortical stimulation was rated as overlapping （ 〈 1 em diatance） in 25 cases and neighbouring （ 〈 2 cm diatance） in 11 cases. Total lesion resection was achieved in 17 cases, subtotal resection in 14 cases, and partial resection in 12 cases. Postoperative neurological functions were improved in 8 cases, unchanged in 31 cases, and temporary worsen in 4 cases. Conclusions The identification of the Broca＇s area by reciting task in fMRI is sensitive and precise. The fMRI is helpful to decrease the side effect injury in the brain surgery for the lesions in or around the Broea＇s area.