Background: The intracarotid amobarbital procedure (IAP) is widely used in the preoperative evaluation for epilepsy surgery to lateralize language dominance and memory functions. However, language mapping has most oft...Background: The intracarotid amobarbital procedure (IAP) is widely used in the preoperative evaluation for epilepsy surgery to lateralize language dominance and memory functions. However, language mapping has most often been accomplished with cortical brain stimulation. Objective: To examine left temporal lobe language cortex representation using this technique in patients with bilateral language (BL) as compared with patients with left language dominance (LD). Methods: The language maps of each patient were reviewed retrospectively. Group I consisted of 10 patients with BL and Group II consisted of 10 matched control patients with LD. Each stimulation trial included a brief assessment of confrontation naming, automatic speech, reading, repetition, and comprehension. Clusters of errors that included comprehension, repetition, and naming defined primary temporal lobe language areas. Results: Mapping revealed two distinct language areas in 60% of patients in Group I and 10% in Group II (p = 0.019). In Group I, two patients had both language areas in the same gyrus (either the superior or the middle temporal gyrus), whereas two showed one language area each in the superior and middle temporal gyri and the remaining two had one in the superior temporal gyrus and the other intermixed between the superior and middle temporal gyri. In Group II, both language areas were intermixed between the superior and middle temporal gyri. Conclusions: Bilateral language (BL) representation in the intracarotid amobarbital procedure is frequently associated with more than one noncontiguous language area in the left temporal lobe. A careful search for multiple language areas, particularly in patients with BL, is prudent prior to surgical resection.展开更多
Background Localization of sensory cortical areas during the operation is essential to preserve the sensory function. Intraoperative direct electrostimulation under awake anesthesia is the golden standard but time-con...Background Localization of sensory cortical areas during the operation is essential to preserve the sensory function. Intraoperative direct electrostimulation under awake anesthesia is the golden standard but time-consuming. We applied 3T high field blood oxygen level-dependent （BOLD） functional magnetic resonance imaging （fMRI） to identify the relationship between glioma and cortical sensory areas preoperatively and to guide intraoperative direct electrostimulation for quick and precise localization. Methods Five glioma patients with sensory cortex involvement by or next to the lesion had preoperative BOLD fMRI to determine the spatial relationship of cortical sensory areas to the tumours. Bilateral hand opposite movement was performed by these patients for fMRI. Precentral and postcentral gyri were identified by electrical stimulation during the operation. Karnofsky Performance Status scores of the patients＇ pre- and postoperative and the role of BOLD fMRI were evaluated. Results The cortical sensory areas were all activated in five glioma patients involving postcentral gyrus areas by BOLD fMRI with bilateral hand opposite movement. The detected activation areas corresponded with the results from cortical electrical stimulation. Conclusions The relationship between cortical sensory areas and tumour can be accurately shown by BOLD fMRI before operation. And the information used to make the tumour resection could obtain good clinical results.展开更多
文摘Background: The intracarotid amobarbital procedure (IAP) is widely used in the preoperative evaluation for epilepsy surgery to lateralize language dominance and memory functions. However, language mapping has most often been accomplished with cortical brain stimulation. Objective: To examine left temporal lobe language cortex representation using this technique in patients with bilateral language (BL) as compared with patients with left language dominance (LD). Methods: The language maps of each patient were reviewed retrospectively. Group I consisted of 10 patients with BL and Group II consisted of 10 matched control patients with LD. Each stimulation trial included a brief assessment of confrontation naming, automatic speech, reading, repetition, and comprehension. Clusters of errors that included comprehension, repetition, and naming defined primary temporal lobe language areas. Results: Mapping revealed two distinct language areas in 60% of patients in Group I and 10% in Group II (p = 0.019). In Group I, two patients had both language areas in the same gyrus (either the superior or the middle temporal gyrus), whereas two showed one language area each in the superior and middle temporal gyri and the remaining two had one in the superior temporal gyrus and the other intermixed between the superior and middle temporal gyri. In Group II, both language areas were intermixed between the superior and middle temporal gyri. Conclusions: Bilateral language (BL) representation in the intracarotid amobarbital procedure is frequently associated with more than one noncontiguous language area in the left temporal lobe. A careful search for multiple language areas, particularly in patients with BL, is prudent prior to surgical resection.
基金This work was supported by a grant from the country ＂11th Five-Year Plan＂ （No. 2007BAI05B08）, Major Program of the National Natural Science Foundation of China （No. 30730035） and Key Project of Chinese National Programs for Fundamental Research and Development （973 Program, No. 2007CB512500）.
文摘Background Localization of sensory cortical areas during the operation is essential to preserve the sensory function. Intraoperative direct electrostimulation under awake anesthesia is the golden standard but time-consuming. We applied 3T high field blood oxygen level-dependent （BOLD） functional magnetic resonance imaging （fMRI） to identify the relationship between glioma and cortical sensory areas preoperatively and to guide intraoperative direct electrostimulation for quick and precise localization. Methods Five glioma patients with sensory cortex involvement by or next to the lesion had preoperative BOLD fMRI to determine the spatial relationship of cortical sensory areas to the tumours. Bilateral hand opposite movement was performed by these patients for fMRI. Precentral and postcentral gyri were identified by electrical stimulation during the operation. Karnofsky Performance Status scores of the patients＇ pre- and postoperative and the role of BOLD fMRI were evaluated. Results The cortical sensory areas were all activated in five glioma patients involving postcentral gyrus areas by BOLD fMRI with bilateral hand opposite movement. The detected activation areas corresponded with the results from cortical electrical stimulation. Conclusions The relationship between cortical sensory areas and tumour can be accurately shown by BOLD fMRI before operation. And the information used to make the tumour resection could obtain good clinical results.
