Functional brain mapping in pediatric neurosurgery

描述（由申请人提供）：本研究的目的是：（i）验证“脑皮层电图（ECoG）上事件相关伽马振荡的体内动画”作为接受脑部手术的儿童的语言映射方法，以及（ii）更好地理解人类语言系统。一般人群中约有1%患有癫痫;五分之一的儿童癫痫是药物难治性的;患有难治性局灶性癫痫的儿童亚组受益于致痫区的手术切除。脑肿瘤常伴有儿童局灶性癫痫，手术切除肿瘤及致痫灶是治疗此类儿童的有效方法。癫痫和脑肿瘤手术的目标都包括识别和保护语言皮层等功能皮层。然而，使用电刺激的传统大脑映射缺乏足够的灵敏度来识别10岁以下儿童的语言区域，通常需要几个小时才能完成，并且有刺激诱发癫痫发作的风险。因此，替代语言映射技术将是非常可取的，在这些儿童。我们最近开发了一种新的语言映射方法，我们称之为“事件相关的伽马振荡的体内动画”。这种新的和创新的方法似乎很有前途的语言映射儿童。下一步，我们将在本项目中使用电刺激和术后神经心理学测试来验证这种映射方法。具体来说，我们将确定是否短暂的记忆语言任务将连续描绘伽马增强负责接受性语言功能，表达性语言功能和公开讲话的皮层网站。我们还将确定视觉语言任务是否会连续描绘伽马增强负责接受性语言功能和表达性语言功能的皮质部位。我们项目的创新包括：（i）研究集中于不同年龄的青少年受试者，（5 - 20岁），其中约40%的人使用电刺激难以识别语言皮层，（ii）在具有良好时间分辨率[10 msec]和良好空间分辨率[1 cm]的个体三维MRI上的皮层激活的体内动画，以及（iii）评估受源自明显语音任务的伪影影响最小的ECoG信号。该项目具有临床意义，因为其结果将直接转化为患者管理，并且我们的事件相关ECoG分析有可能成为主流语言映射方法，与目前使用的电刺激方法相比，该方法侵入性更小，更省时，对患者更友好。

DESCRIPTION (provided by applicant): The objectives of this research are: (i) validation of "in-vivo animation of event-related gamma-oscillations on electrocorticography (ECoG)" as a language mapping method for children who undergo brain surgeries, and (ii) better understanding of the human language system. About 1% of the general population has epilepsy; one-fifth of epilepsy in children is medically intractable; subsets of children with intractable focal epilepsy benefit from surgical resection of the epileptogenic zone. Brain tumor is often associated with focal epilepsy in children, and surgical resection of tumor together with the epileptogenic focus is indicated in such children. The goals of both epilepsy and brain tumor surgeries include identification and preservation of the eloquent cortices such as the language cortex. However, conventional brain mapping using electrical stimulation lacks sufficient sensitivity to identify the language areas in children under age 10 years, often takes several hours to complete, and has a risk of stimulation-induced seizures. Thus, alternative language mapping techniques would be highly desirable in these children. We have recently developed a novel language mapping method which we refer to as "in-vivo animation of event-related gamma-oscillations". This new and innovative method appears promising for language mapping in children. As the next step, we will validate this mapping method using electrical stimulation and postoperative neuropsychological testing in this project. Specifically, we will determine whether brief auditory-language tasks will successively delineate gamma augmentation in the cortical sites responsible for receptive language function, expressive language function and overt speech. We will also determine whether a visual-language task will successively delineate gamma augmentation in the cortical sites responsible for receptive language function and expressive language function. Innovation in our project includes: (i) the study focusing on young subjects across a wide range of age (5 - 20 years), in about 40% of whom identification of the language cortex is difficult using electrical stimulation, (ii) in-vivo animation of cortical activation on an individual three-dimensional MRI with a good temporal resolution [10 msec] and a good spatial resolution [1 cm], and (iii) assessment of ECoG signals least affected by artifacts derived from overt speech tasks. This project is clinically significant since the results will be directly translatable into patient management and our event-related ECoG analysis has the potential to become a mainstream language mapping method which is less-invasive, more time-efficient, and more patient-friendly compared to the currently used electrical stimulation method.