Integrated analysis of language area using MEG, functional MRI and PET. -Clinical application to brain tumor surgery-

本研究旨在利用脑磁图（MEG）、功能磁共振成像（fMRI）和正电子发射断层扫描（PET）建立言语区功能作图方法，并基于功能作图优化手术方案，改善靠近Broca区额叶脑肿瘤患者的治疗效果。健康志愿者20名作为对照组。在阻塞范式设计中执行动词生成任务时，用功能磁共振成像和脑磁图检查语音区域。在功能磁共振成像研究中，在20名右撇子志愿者中，有19人的布洛卡区位于左额叶半球（额叶下回或额叶中回）。通过脑磁图研究，确定了所有病例的左半球语言优势。然而，激活区域并不总是局限于Broca区，这表明MEG可以检测到同时和顺序激活的言语相关脑区。6例（年龄31-56岁）左额叶肿瘤患者在执行动词生成任务时，采用功能磁共振成像、脑磁图和PET检查更多脑内肿瘤。所有患者均表现为左侧额叶激活，可以清楚地定位于肿瘤区域外，邻近水肿伴不同程度的右侧额叶额外激活。基于术前功能定位，使用神经导航系统进行肿瘤切除。术前表现为运动失语症的3例患者术后症状均有改善。3例患者中2例术前无言语障碍，术后无症状。其余1例术后出现一过性运动失语，约10天症状消失。术后也进行了功能映射，结果表明所有病例的语言区域都得到了保留。本研究表明，术前语言相关脑区多模态功能映射对靠近语言区的额叶脑肿瘤患者的术前计划是有用的。少

The present study was carried out to establish the functional mapping method of speech area using magnetoencephalogram (MEG), functional MRI (fMRI) and positron emission tomography (PET) and to improve the treatment results of the patients with frontal brain tumors in close vicinity to Broca area by optimum presurgical planning based on the functional mapping. 20 healthy volunteers were served as the control group. Speech areas were examined with fMRI and MEG while performing a verb generation task in a blocked paradigm design. In the fMRI study, the Broca area was identified at the left frontal hemisphere (inferior or middle frontal gyrus) in ninteen of the 20 right handed volunteers. With MEG study, left hemispheric speech dominance was determined in all cases. However, activation area was not always localized to Broca area indicating that MEG can detect speech-related brain areas activated simultaneously and sequentially.Six patients (ages 31-56 years) suffering from the left fronta … More l intracerebral tumors were examined with fMRI, MEG and PET while performing a verb generation task. All patients demonstrated left frontal activation which could be clearly located outside the tumor area and adjacent edema with varying degrees of additional right frontal activation. Based on the presurgical functional mapping, tumor resection was performed using a neuronavigation system. All three patients presenting with motor aphasia preoperatively showed improvement on the symptom after surgery. Two of the 3 patients without preexisting speech disturbance were symptom-free on the postoperative course. Remaining one patient showed transient motor aphasia postoperatively, and the symptom disappeared in about 10 days. Functional mapping was also undertaken postoperatively, and it was demonstrated that speech areas were preserved in all cases. The present study is indicating that preoperative multi-modality functional mapping of speech-related brain areas is useful for presurgical planning in the patients with frontal brain tumors close to language areas. Less