CAJ | 학술논문

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 tensor imaging,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fMRI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.
목적 탐토공능자공진(functional magnetic resonance imaging, fMRI)도항재한어운동성어언구부근병변수술중적응용개치.방법 대43례대뇌피층운동성어언구부근병변환자,통과조괴설계적한어랑독임무,이용혈양수평의뢰성공능자공진성상(BOLD-fMRI)획득운동성어언구격활,이용자공진미산장량성상기술(diffusion tensor imaging,DTI)획득백질섬유속주행,장결구영상、fMRI공능영상여DTI적각항이성계수(FA)도상동시전입도항계통,술중정위fMRI학정적어언구,재환성상태이용피층전자격기술진행어언구험증,피개운동성어언구재현미경하절제병변.결과 본조환자29례술전어언공능정상,14례유불동정도어언공능장애.38례획득료유효적fMRI어언구격활,진행료36례핵심격활뇌구여피층전자격비교:25례위중첩관계,11례위린근관계.수술전절제17례,차전절제14례,대부빈절제12례.술후어언공능8례교술전호전,31례무변화,4례출현단잠성운동성실어.결론 한어랑독임무소획득적fMRI운동성어언구격활구유량호적민감성여준학성;fMRI도항수술가이제고한어운동성어언구부근병변절제정도,감소술후운동성실어적발생.
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 cm 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 Broca's area.