Functional brain mapping in pediatric neurosurgery

小儿神经外科的功能性脑图谱

• 批准号: 8914042
• 负责人: EISHI ASANO
• 金额: $ 33.43万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8914042
• 关键词: Accounting; Acute; Affect; Age; Area; Auditory area; Brain; Brain Injuries; Brain Mapping; Broca' s area; Child; Childhood; Chronic; Clinical; Data; Diagnostic; Diagnostic Procedure; Diffusion Magnetic Resonance Imaging; Electric Stimulation; Electrocorticogram; Electroencephalography; Epilepsy; Evoked Potentials; Excision; Fiber; Functional Magnetic Resonance Imaging; Funding; General Population; Generations; Goals; Gold; Handedness; Health; Hour; Human; Impairment; Inferior frontal gyrus; Language; Language Disorders; Lateral; Left; Lobe; Location; Magnetic Resonance Imaging; Mainstreaming; Maps; Measures; Methods; Modality; Modeling; Morphologic artifacts; Names; Noise; Odds Ratio; Operative Surgical Procedures; Outcome; Outcome Measure; Partial Epilepsies; Pathway interactions; Patients; Performance; Physiologic pulse; Postoperative Period; Precentral gyrus; Predictive Value; Process; Quality of life; Recovery of Function; Reporting; Risk; Sampling; Seizures; Semantics; Signal Transduction; Site; Speech; Speech Therapy; Structure; Symptoms; System; Techniques; Temporal Lobe; Theoretical model; Therapeutic; Work; base; brain surgery; compliance behavior; cortex mapping; focal brain damage; follow-up; frontal lobe; improved; innovation; multimodality; nervous system disorder; neuropsychological; neurosurgery; phonology; sound; temporal measurement; therapeutic target; white matter

DESCRIPTION (provided by applicant): The goals of this project are: (i) to generate an empirical model to predict the long-term language outcome following epilepsy surgery and (ii) to better understand 'how' the language system works during speech. About 1% of the general population has epilepsy, while one-fifth of epilepsy is medically intractable. Subsets of patients with intractable focal epilepsy benefit from surgical resection of the seizure focus with functionally-important areas preserved. Yet, in reality, accurate identification of language areas is difficult, especially in children, since electrical stimulation mapping lacks sufficient sensitiity, often takes hours to complete, and has a risk of stimulation-induced seizures. In the first funding period, we demonstrated that naming-related augmentation of gamma activity (50-120 Hz) on electrocorticography (ECoG) recording can delineate the language circuitry, and that surgical damage of sites showing such gamma-augmentation predicted the acute postoperative language outcome better than electrical stimulation mapping. An important next step is to determine how well the long-term language outcome can be predicted, since some but not all children recover language function well after the resection of language networks. To maximize the predictive performance, we will determine the language cortex and subcortical pathway, while combining ECoG gamma mapping with diffusion weighted imaging (DWI) fiber tractography. Furthermore, the prediction model will take into account the chronic effect of functional recovery in addition to the acute effect of damaged language networks on neuropsychological outcome measures. This project is significant since the results will be directly translatable into patient management, and our innovative multimodality technique has the potential to become a mainstream method to localize functionally-important brain structures. We will also determine the anatomical and functional connectivity within the language networks, using ECoG gamma mapping, DWI tractography and cortico-cortical evoked potentials (CCEPs). Theoretical models of human speech propose that phonologic and semantic information is transferred, via the arcuate fasciculus, between the temporal and frontal language areas. Yet, the exact location of each arcuate pathway for phonologic and semantic information has not been elucidated. Furthermore, directional efficiency of signal transferring in each pathway has not been clarified, although a modern theoretical model indicates the presence of bi-directional signal transferring between the frontal and temporal lobes. In this project, we will specifically determine if these sites involved in phonological and semantic functions are differentially connected via distinct arcuate fasciculus fibers. We will also determine 'in which direction' electrical signals propagate more efficiently within and across the two lobes involved in language. The model refined or revised by this empirical study will help in prediction of specific language symptoms following focal brain damage, and ultimately may better localize the therapeutic targets for improving different types of language impairments in neurological diseases.

描述（由申请人提供）：该项目的目标是：(i)生成一个经验模型来预测癫痫手术后的长期语言结果；（ii）更好地理解语言系统在讲话时的“工作原理”。大约1%的普通人群患有癫痫，而五分之一的癫痫在医学上是难治性的。顽固性局灶性癫痫患者的亚群受益于手术切除发作病灶，保留重要的功能区域。然而，在现实中，准确识别语言区域是困难的，特别是对儿童，因为电刺激测绘缺乏足够的灵敏度，通常需要数小时才能完成，并且有刺激诱发癫痫发作的风险。在第一次融资中