皮层功能制图在语言功能区脑肿瘤手术治疗中的应用

Application of cortical mapping in the surgical treatment of brain tumors in language areas

目的利用皮层功能制图进行语言功能区定位,实现语言功能区保护下肿瘤的最大程度切除。方法对16例语言功能区脑肿瘤患者,利用血氧依赖功能磁共振(BOLD-fMRI)技术和(或)术中唤醒麻醉下皮层直接电刺激(ECS)定位技术进行脑功能制图;对所获皮层功能制图资料进行个体化评估,术中辅助保护语言功能区,在神经导航指引下切除肿瘤。结果本组肿瘤病变全切除10例,次全切除3例,大部分切除3例。术后语言功能明显改善6例,无变化6例,短暂性感觉性失语2例,语言功能明显障碍2例。结论 BOLD-fMRI结合术中唤醒麻醉下ECS皮层功能制图定位语言功能区,可在保护语言功能的同时最大程度地切除肿瘤组织,提高患者术后生活质量。

Objective To study the methods of cortical mapping, preoperative localization of language areas with Bold- fMRI and（or） intraoperative electrical cortical stimulation of language areas with awaken surgery, assist to remove brain tumors in functional areas of language. Methods Cortical mapping data from such as oxygen dependent functional magnet- ic resonance imaging （BOLD-fMRI） technology, using the block design and reciting task to activate broca area and para- graph comprehension task to activate wernicke area, calculated cerebral laterality index （LI） to determine the dominant hemisphere ; using of the electrical cortical stimulation （ECS） to localizate language areas under awake anesthesia in pa- tients with surgery. The data combined with neuronavigation assist microscopic remove braim tomors in the language areas. Results Functional cortical mapping was used for localizate broca or wernicke area of 16 cases, image acquisition satisfied in 16 cases. Intraoperative awake and electrical stimulation of language areas in 4 cases. Lesion total resection in 10 cases, subtotal resection in 3 cases, partial resection in ] cases. Language function improved significantly after surgery in 6 cases, unchanged in 6 patients, transient sensory aphasia in 2 cases, deterioration of language function does in 2 cases. Conclu- sion Functional cortical mapping includings preoperative localization of language areas with BOLD-fMRI and intraoperative electrical cortical stimulation, has a good clinical value. Assisting with them increase the extent of tumor resection and re- duce postoperative morbidity and the lack of language features, to improve quality of life of the patients.