Language functional MRI and direct cortical stimulation in epilepsy preoperative planning.
Language functional MRI and direct cortical stimulation in epilepsy preoperative planning.
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DOI：
10.1002/ana.24899
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发表时间：
2017-04
影响因子：
11.2
通讯作者：
Theodore WH
中科院分区：
文献类型：
--
作者：
Austermuehle A;Cocjin J;Reynolds R;Agrawal S;Sepeta L;Gaillard WD;Zaghloul KA;Inati S;Theodore WH
术前语言评估有助于将癫痫切除手术中对口才皮质的损害降至最低。术前语言定位的两种方法是功能磁共振成像(FMRI)和植入硬膜下电极的直接皮质刺激(DC)。我们将fMRI结果与分布式控制系统进行比较，以帮助优化非侵入性语言本地化，并评估其有效性。我们研究了19名接受耐药癫痫术前评估的患者。患者在术前功能磁共振检查中完成了4项语言任务。硬膜下电极植入后，用分散控制系统对语言区进行定位。对于每个刺激点，我们确定语言正电极对是否与语言任务的显著fMRI活动簇相交。灵敏度和特异度取决于电极ROI半径和统计阈值。对于至少有一个语言阳性刺激部位的患者，听觉描述决策任务提供了灵敏度和特异度之间的最佳折衷。对于没有语言阳性刺激点的患者，fMRI是排除雄辩语言加工的可靠方法。语言功能磁共振成像是电极植入前确定语言偏侧化的有效工具，尤其有助于排除意外的关键语言区域。它可以帮助指导硬膜下电极植入，并通过分布式控制系统缩小对有能力的皮质区域的搜索范围。
Presurgical language assessment can help minimize damage to eloquent cortex during resective epilepsy surgery. Two methods for presurgical language mapping are functional MRI (fMRI) and direct cortical stimulation (DCS) of implanted subdural electrodes. We compared fMRI results to DCS to help optimize non-invasive language localization and assess its validity. We studied 19 patients referred for presurgical evaluation of drug-resistant epilepsy. Patients completed 4 language tasks during preoperative fMRI. After subdural electrode implantation, we used DCS to localize language areas. For each stimulation site, we determined whether language positive electrode pairs intersected with significant fMRI activity clusters for language tasks. Sensitivity and specificity depended on electrode ROI radii and statistical thresholding. For patients with at least one language positive stimulation site, an auditory description decision task provided the best tradeoff between sensitivity and specificity. For patients with no language positive stimulation sites, fMRI was a dependable method of excluding eloquent language processing. Language fMRI is an effective tool for determining language lateralization prior to electrode implantation, and is especially useful for excluding unexpected critical language areas. It can help guide subdural electrode implantation and narrow the search for eloquent cortical areas via DCS.