Subcortical language and non-language mapping in awake brain surgery: the use of multimodal tests
Subcortical language and non-language mapping in awake brain surgery: the use of multimodal tests
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DOI：
10.1007/s00701-014-2317-0
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发表时间：
2015-04-01
影响因子：
2.4
通讯作者：
Marien, P.
中科院分区：
文献类型：
--
作者：
De Witte, E.;Satoer, D.;Marien, P.
清醒开颅术目前被认为是最大限度地扩大切除范围和减少功能区附近幕上肿瘤患者术后缺陷的金标准。除了皮质的直接电刺激（DES）外，术中皮质下标测也越来越多地使用，因为它通过减少（永久性）术后神经功能缺损来优化受益风险比。然而，只有很少注意到皮层下映射程序，特别是要used.In这篇文章中，语言和非语言测试在皮层下水平的描述和讨论，通过三个右撇子的情况下，在左半球的胶质瘤。为了评估皮质下功能，开发了一种名为快速混合测试（QMT）的多模式测试。详细描述和讨论了术前、术中和术后的测试结果。基于对这些初步观察结果的分析，可以对术中皮质下标测提出一些临床建议：（1）选择一套语言和非语言测试需要根据受肿瘤病变影响的皮质下功能区和患者的特点量身定制（工作/爱好/日常生活活动）;（2）在皮层下刺激期间，语言和非语言测试应该以多模式和交替的方式呈现，因为这种方法能够同时或在很短的时间内筛选各种功能，以及（3）自发言语是标准化测试的一个有用的辅助工具，因为它最类似于日常生活对话。皮质下DES，如实验性QMT，可能有助于识别功能通路，从而避免永久性神经损伤。
Awake craniotomy is currently considered the gold standard to maximise the extent of resection and to minimise postoperative deficits in patients with supratentorial tumours near eloquent areas. In addition to direct electrical stimulation (DES) of the cortex, intraoperative subcortical mapping is increasingly used as it optimises the benefit-to-risk ratio by decreasing (permanent) postoperative neurological deficits. However, only little attention has been paid to subcortical mapping procedures and especially the tasks to be used.In this article, language and non-language testing at the subcortical level is described and discussed by means of three right-handed cases with a glioma in the left hemisphere. To assess subcortical functions, a multimodal test named the Quick Mixed Test was developed (QMT). Pre-, intra- and postoperative test results are described and discussed in detail.Based on the analysis of these preliminary observations, a number of clinical recommendations for intraoperative subcortical mapping may be made: (1) the selection of a set of language and non-language tests needs to be tailored according to the functional corticosubcortical regions affected by the tumoral lesion and the patient's characteristics (job/hobby/daily life activities); (2) language and non-language tests should be presented in a multimodal and alternating way during subcortical stimulation since this approach enables screening various functions simultaneously or in a very short period of time and (3) spontaneous speech is a useful adjunct to standardised tests since it most resembles daily life conversation.Administration of multimodal tests during subcortical DES such as the experimental QMT may facilitate identification of eloquent pathways leading to avoidance of permanent neurological impairments.