Passive language mapping combining real-time oscillation analysis with cortico-cortical evoked potentials for awake craniotomy
Passive language mapping combining real-time oscillation analysis with cortico-cortical evoked potentials for awake craniotomy
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DOI：
10.3171/2015.4.jns15193
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发表时间：
2016-12-01
影响因子：
4.1
通讯作者：
Kamada, Kyousuke
中科院分区：
文献类型：
--
作者：
Tamura, Yukie;Ogawa, Hiroshi;Kamada, Kyousuke
目的 皮层电刺激 (ECS) 是功能性大脑绘图的黄金标准；然而，对于语言缺陷患者来说，精确的功能映射仍然很困难。皮层电图上 80 至 140 Hz 之间的高伽马活动 (HGA) 被认为反映了局部皮层处理，而皮层诱发电位 (CCEP) 可以反映在没有患者合作时单相脉冲刺激对语言皮层引起的双向反应。作者建议在有意识切除脑肿瘤期间结合 HGA 标测和 CCEP 记录来使用“被动”标测，无需主动任务。方法 5 名患者，每人的优势半球都有轴内肿瘤，通过被动标测进行了有意识的病灶切除。作者使用实时 HGA 映射，通过被动聆听语言声音，对接受语言区域进行了功能定位。此外，将单个电脉冲传递到已识别的颞语言接受区以检测额叶中的 CCEP。所有映射结果均经过ECS验证，并评估了敏感性和特异性。结果语言HGA映射快速识别了颞叶的语言区域。通过语言 HGA 映射到已识别的颞接受语言区域进行电刺激，在额叶上诱发 CCEP。语言 HGA 和额叶 CCEP 的结合不需要患者的合作或努力。在这个小病例系列中，敏感性和特异性分别为 93.8% 和 89%。 结论 所描述的技术允许简单快速的功能性脑图测，其灵敏度和特异性比 ECS 测图更高。作者认为，这可以提高功能性大脑图谱的可靠性，并促进理性客观的操作。被动映射还揭示了人脑语言的潜在生理机制。
OBJECTIVE Electrocortical stimulation (ECS) is the gold standard for functional brain mapping; however, precise functional mapping is still difficult in patients with language deficits. High gamma activity (HGA) between 80 and 140 Hz on electrocorticography is assumed to reflect localized cortical processing, whereas the cortico-cortical evoked potential (CCEP) can reflect bidirectional responses evoked by monophasic pulse stimuli to the language cortices when there is no patient cooperation. The authors propose the use of "passive" mapping by combining HGA mapping and CCEP recording without active tasks during conscious resections of brain tumors.METHODS Five patients, each with an intraaxial tumor in their dominant hemisphere, underwent conscious resection of their lesion with passive mapping. The authors performed functional localization for the receptive language area, using real-time HGA mapping, by listening passively to linguistic sounds. Furthermore, single electrical pulses were delivered to the identified receptive temporal language area to detect CCEPs in the frontal lobe. All mapping results were validated by ECS, and the sensitivity and specificity were evaluated.RESULTS Linguistic HGA mapping quickly identified the language area in the temporal lobe. Electrical stimulation by linguistic HGA mapping to the identified temporal receptive language area evoked CCEPs on the frontal lobe. The combination of linguistic HGA and frontal CCEPs needed no patient cooperation or effort. In this small case series, the sensitivity and specificity were 93.8% and 89%, respectively.CONCLUSIONS The described technique allows for simple and quick functional brain mapping with higher sensitivity and specificity than ECS mapping. The authors believe that this could improve the reliability of functional brain mapping and facilitate rational and objective operations. Passive mapping also sheds light on the underlying physiological mechanisms of language in the human brain.