导航经颅磁刺激定位汉语语言功能区的研究

Mapping language eloquent cortices in Chinese： a navigated transcranial magnetic stimulationstudy

目的建立基于导航经颅磁刺激（nTMS）技术的汉语关键语言功能皮层定位方法，进一步利用该技术研究汉语天键语言功能区的分布特征。方法征集20名健康志愿者（均为天津医科大学研究生院学生）执行图片命名任务，在完成任务的同时于神经导航系统的引导下给予同步的重复经颅磁刺激，确定受试者的关键语言功能脑区。结果（1）nTMS技术能够在90％（18／20）的受试者人群中稳定的诱导出言语错误。（2）中文语言功能区在个体水平有较大的差异，总体看来，关键语言功能皮层在额叶主要集111于腹侧中央前回36％（17／47），额叶岛盖部23％（11／47）：在颞叶主要集中在颢上回中后部58％（14／24）以及颞中回中后部25％（6／24）；仵顶下小叶则主要分布在缘上回83％（15／18），角回17％（3／18）4存在少量的语言功能分布。结论（1）nTMS技术能够用于定位汉语语言功能区。（2）汉语关键语言脑区在个体水平有较为离散的分布，而在整体水平上存在特定脑区的聚集。（3）汉语语言功能区分布模式的确定能够进一步指导陔区域的手术治疗。

Objective To investigate the feasibility of using navigated transcranial magnetic stimulation （nTMS） to identify Chinese eloquent language area and further reveal the distribution pattern of essential language area in Chinese. Methods Twenty volunteers （students from Graduate School, Tianjin Medical University） were given a synchronized repetitive TMS with the guidance of navigation system while accomplishing the picture naming task. The performances of volunteers were video recorded and further analyzed to identify the areas which could induce language error. Results （1） The nTMS was capable of inducing repeatable language errors in 90% of volunteers （18/20） and all the volunteers presented a good tolerability. No side effect of nTMS was observed. （2） The distribution pattern of essential language areas of Chinese in individual level had a substantial variability; the overall distribution pattern presented aggregation in some particular brain regions; in frontal lobe, the ventral precentral gyrus （36%, 17/47） and the frontal operculum （23%, 11/47） went with a high concentration of essential language functions; in temporal lobe, middle and posterior part of superior temporal gyms （58%, 14/24） and middle and posterior middle temporal gyms （25%, 6/24） presented a concentration of essential language functions; in the parietal lobe, the supramarginal gyrus （83%, 15/18） was the main area possessing essential language functions while angular gyrus （17%, 3/18） was also responsible for a small part of essential language fimctions. Coneluslons The nTMS is capable of mapping essential language area ill Chinese which is different from alphabetic language, The variability of individual essential language area indicates the importance of individualized language mapping. The aggregation of essential language area in group level provides useful infonnation tbr surgery management when dealing with lesions in these areas,