Functional brain mapping in pediatric neurosurgery

描述（由申请人提供）：本研究的目标是：(i)验证“脑皮质电图（ECoG）上事件相关γ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在医学上难治性；顽固性局灶性癫痫患儿亚群受益于手术切除致痫区。脑肿瘤常与儿童局灶性癫痫相关，这类儿童应手术切除肿瘤并切除致痫灶。癫痫和脑肿瘤手术的目标都包括识别和保存语言皮层等雄辩皮层。然而，使用电刺激的传统脑图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，在这些儿童中，替代语言映射技术将是非常可取的。我们最近开发了一种新的语言映射方法，我们称之为“事件相关伽马振荡的体内动画”。这种创新的新方法对儿童的语言映射很有希望。下一步，我们将在本项目中使用电刺激和术后神经心理测试来验证这种映射方法。具体来说，我们将确定简短的听觉语言任务是否会先后描述负责接受语言功能、表达语言功能和显性语言的皮质部位的伽马增强。我们还将确定视觉语言任务是否会依次描述负责接受语言功能和表达语言功能的皮质部位的伽马增强。我们项目的创新之处包括：(i)研究重点是年龄范围广泛的年轻受试者（5 - 20岁），其中约40%的人很难通过电刺激识别语言皮层，（ii）在个体三维MRI上进行皮层激活的活体动画，具有良好的时间分辨率[10毫秒]和良好的空间分辨率[1厘米]，以及（iii）评估ECoG信号，这些信号受明显语音任务产生的人工产物的影响最小。该项目具有临床意义，因为结果将直接转化为患者管理，我们的事件相关ECoG分析有可能成为一种主流语言映射方法，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。公共卫生相关性：本研究的目标是：(1)验证新的映射技术：“皮质电图上语言诱发的伽马振荡的体内动画”，作为接受脑部手术的儿童的新诊断工具；(2)更好地理解人类语言系统。我们将对接受脑部手术的儿童进行简短的语言任务，并识别与语言相关的大脑区域，否则使用传统的电刺激方法难以定位。该研究结果将引入一种新颖、更省时、对患者更友好的语言映射方法，并有望改善儿童脑部手术后的语言结果。

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. PUBLIC HEALTH RELEVANCE: The goals of this research are (i) validation of the new mapping technique: "in-vivo animation of language- induced gamma oscillations on electrocorticography" as a new diagnostic tool for children who undergo brain surgeries and (ii) better understanding of the human language system. We will apply brief language tasks to children who undergo brain surgeries and identify the language-related brain areas, which are otherwise difficult to localize using the conventional electrical stimulation method. The results will introduce a novel, more time-efficient and patient-friendly language mapping method and are expected to improve the language outcome after brain surgeries in children.