功能MRI对大脑半球弥漫性病变致癫痫患者的术前功能评估

Preoperative fMRI assessment of cerebral function in patients with intractable epilepsy induced by diffuse hemispheric lesions

目的通过功能MRI成像(fMRI)技术对大脑半球弥漫性病变致癫痫患者的患侧大脑半球的功能残存情况和健侧大脑半球的功能代偿情况进行综合评估,从而选择合理的手术方案。方法受试者为15例一侧大脑半球弥漫性病变致癫痫的患者,任务包括右手抓握运动、左手抓握运动、右脚抓握运动、左脚抓握运动、舌运动、默读语言等6项,采集fMRI数据并进行统计学分析,获取相应的皮质激活区图像。4例行解剖性大脑半球切除术,11例行多脑叶切除术。结果患侧手运动时的信号激活,6例在双侧半球相应区域;2例信号较弱,无明显激活区域;2例在健侧半球;5例在患侧半球。患侧脚运动时,8例信号激活在双侧半球相应区域;1例信号较弱,无明显激活区域;4例在健侧半球;2例在患侧半球。术后13例偏瘫无明显加重。术后随访20～52个月,12例癫痫控制为EngelⅠA级,2例为EngelⅡA级,1例为EngelⅢA级。结论 fMRI能够客观地评估顽固性癫痫患者运动功能的保留和代偿情况,是一种有效且无创的评估手段。

Objective To assess the motor of the extremities and language function before hemispherectomy by functional magnetic resonance imaging （fMRI） in patients with intractable epilepsy （IE） induced by diffuse hemispheric lesions （DHL）. Methods The fMRI examination, during which 6 tasks including right-hand movement, left-hand movement, right-foot movement, left-foot movement, tongue movement and silent-reading were performed in 15 patients with IE induced by DHL before the surgical treatments. Of 15 patients, 11 underwent multi-lobe resection and 4 hemispherectomy. Results The signals On fMRI were activated respectively in the bilateral hemispheres in 6 patients, in the hemispheres without the lesions in 2, and in the hemispheres with the lesions in 5 and no signals were activated in the bilateral hemisphere in 2 on the movement of the hemiplegic hands. The signal on fMRI were activated respectively in the bilateral hemispheres in 8 patients, in the hemispheres without the lesions in 4, and in the hemisphere with the lesion in 2 and no signals were activated in the bilateral hemisphere in 1 on movement of the hemiplegic feet. The following up from 20 to 52 months showed that of 15 patients, 12 has Engel grade Ⅰ outcomes, 2 grade Ⅱ A and 1 grade Ⅲ A. Conclusion The fMRI is an effective and no trauma method to assess cerebral domination of motor function of the extremities in patients with IE by DHL.