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

本研究利用脑磁图（magnetoencephalograms，MEG）、功能磁共振成像（functional MRI，fMRI）和正电子发射断层扫描（positron emission tomography，PET）建立言语区功能定位方法，并在此基础上对邻近Broca区的额叶肿瘤患者进行术前优化规划，以提高手术效果。20例健康志愿者作为对照组。言语区进行了检查与功能磁共振成像和脑磁图，同时执行一个动词生成任务在一个封闭的范式设计。在fMRI研究中，20名右利手志愿者中有19名在左额半球（额下回或额中回）发现了Broca区。采用MEG检查，确定所有病例的左半球言语优势。然而，激活区并不总是局限于Broca区，这表明MEG可以检测到与语言相关的脑区同时激活和顺序激活。 ...更多信息 1例脑内肿瘤在进行动词生成任务的同时进行了fMRI、MEG和PET检查。所有患者均表现出左额叶激活，其可清楚地位于肿瘤区域和邻近水肿之外，伴有不同程度的额外右额叶激活。根据术前功能定位，使用神经导航系统进行肿瘤切除。所有三名患者术前表现为运动性失语症，术后症状均有所改善。3例无语言障碍的患者中有2例在术后无语言障碍。1例术后出现短暂性运动性失语，10天左右症状消失。术后还进行了功能标测，结果表明，所有病例的言语区均得到保留。本研究表明，术前多模态功能映射的语言相关的脑区是有用的术前规划额叶脑肿瘤靠近语言区的患者。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