Current trends in intraoperative optical imaging for functional brain mapping and delineation of lesions of language cortex.
Current trends in intraoperative optical imaging for functional brain mapping and delineation of lesions of language cortex.
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DOI：
10.1016/j.neuroimage.2008.07.066
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发表时间：
2009-08
期刊：
影响因子：
5.7
通讯作者：
Toga AW
中科院分区：
文献类型：
--
作者：
Prakash N;Uhlemann F;Sheth SA;Bookheimer S;Martin N;Toga AW
理想情况下，切除脑动静脉畸形 (AVM)、癫痫病灶或神经胶质瘤的先决条件是，用显微镜勾画出与介导关键功能的正常灰质和白质相关的病变边界。目前，Wada 测试和功能磁共振成像 (fMRI) 用于关键功能的术前标测，而电刺激标测 (ESM) 用于术中标测。对于病灶勾画，术前使用 MRI 和正电子发射断层扫描 (PET)，而术中使用显微镜和组织学切片。然而，对于靠近语言皮层的病变，这些成像技术可能缺乏足够的分辨率来定义病变与语言功能之间的关系，从而无法准确确定哪些患者将受益于神经外科手术切除病变而不会出现医源性失语。术中内在信号光学成像 (iOIS) 等光学技术在精确绘制皮质功能图以及描绘动静脉畸形、癫痫病灶和神经胶质瘤的边界方面显示出巨大的前景。在这里，我们首先回顾神经影像学的生理学，然后进一步验证和论证使用术中光学技术，特别是与切除动静脉畸形、癫痫病灶和口才皮质附近或中的神经胶质瘤的神经外科规划有关。最后，我们对潜在的新型术中光学技术进行了简短描述。
Resection of a cerebral arteriovenous malformation (AVM), epileptic focus, or glioma, ideally has a prerequisite of microscopic delineation of the lesion borders in relation to the normal gray and white matter that mediate critical functions. Currently, Wada testing and functional magnetic resonance imaging (fMRI) are used for preoperative mapping of critical function, whereas electrical stimulation mapping (ESM) is used for intraoperative mapping. For lesion delineation, MRI and positron emission tomography (PET) are used preoperatively, whereas microscopy and histological sectioning are used intraoperatively. However, for lesions near eloquent cortex, these imaging techniques may lack sufficient resolution to define the relationship between the lesion and language function, and thus not accurately determine which patients will benefit from neurosurgical resection of the lesion without iatrogenic aphasia. Optical techniques such as intraoperative optical imaging of intrinsic signals (iOIS) show great promise for the precise functional mapping of cortices, as well as delineation of the borders of AVMs, epileptic foci, and gliomas. Here we first review the physiology of neuroimaging, and then progress towards the validation and justification of using intraoperative optical techniques, especially in relation to neurosurgical planning of resection AVMs, epileptic foci, and gliomas near or in eloquent cortex. We conclude with a short description of potential novel intraoperative optical techniques.
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