Pre-surgical language mapping with functional magnetic resonance imaging
Pre-surgical language mapping with functional magnetic resonance imaging
复制标题
DOI：
10.1007/s11065-007-9026-x
复制
发表时间：
2007-06-01
影响因子：
5.8
通讯作者：
Bookheimer, Susan
中科院分区：
文献类型：
--
作者：
Bookheimer, Susan
功能区皮层或其附近有病变的患者通常会接受几种侵入性技术之一，以防止手术后功能丧失。功能性磁共振成像（fMRI）最有前途的潜在临床应用之一是将这些功能映射为术前检查的一部分，以识别处于风险中的患者，引导手术进入或定制手术程序以防止缺陷。运动和感觉映射相对简单，语言映射则复杂得多。语言系统在个体之间的位置是可变的，并且在许多情况下可能部分或完全重组到对侧半球。此外，大脑的多个区域有助于语言功能，包括在手术中不能切除的重要区域，以及可能导致术后短暂或不明显损伤的贡献区域。尽管存在这些挑战，但越来越多的研究支持使用功能磁共振成像对各种疾病进行术前语言映射。本文回顾了三种疾病的文献，患者受益于术前语言映射：癫痫，脑肿瘤和动静脉畸形。每种疾病都对语言映射提出了独特的挑战。具体的案例研究，突出了两个潜在的好处，临床前功能磁共振成像的语言映射以及潜在的风险和陷阱。
Patients with lesions in or near eloquent cortex typically undergo one of several invasive techniques to prevent loss of function following surgery. One of the most promising potential clinical applications of functional magnetic resonance imaging (fMRI) is to map these functions as part of the pre-surgical work-up to identify patients at-risk, guide the surgical entry, or tailor the surgical procedure to prevent deficits. While motor and sensory mapping are relatively straightforward, language mapping is far more complex. The language system is variable in location across individuals and in many cases may reorganize partially or completely to the contralateral hemisphere. In addition, multiple regions of the brain contribute to language functioning including essential regions that must not be removed in surgery, and contributory regions that may result in transient or insignificant impairments post-surgery. Despite these challenges, an increasing number of studies have supported the use of fMRI for pre-surgical language mapping in a variety of disorders. This article reviews the literature from three disorders for which patients benefit from preoperative language mapping: epilepsy, brain tumors, and arteriovenous malformations. Each disorder presents unique challenges to language mapping. Specific case studies are presented highlighting the both the potential benefits of preclinical fMRI for language mapping as well as the potential risks and pitfalls.