Kaplan A M, Bandy D J, Manwaring K H, Chen K, Lawson M A, Moss S D, Duncan J D, Wodrich D L, Schnur J A, Reiman E M
Department of Child Neurology, Phoenix Children's Hospital/Good Samaritan Regional Medical Center, Arizona 85006, USA.
J Neurosurg. 1999 Nov;91(5):797-803. doi: 10.3171/jns.1999.91.5.0797.
The purpose of this report is to demonstrate the value of functional brain mapping using the positron emission tomography (PET) method for preoperative neurosurgical planning in children with brain tumors. Brain maps were used to characterize the relationship between potentially resectable tumors and functionally eloquent brain areas.
Five children, ranging in age from 3 to 13 years, with hemispheric brain tumors adjacent to eloquent cortex were studied. Magnetic resonance (MR) imaging was used to identify the brain tumors; PET imaging after injection of [18F] fluorodeoxyglucose (FDG), [11C]L-methionine (CMET), or a combination of the two was performed to grade the tumors; and a [15O] H2O uptake study was used to characterize the anatomical relationships of the tumors to functional cortex. The cortical activation maps were obtained during control periods and during behavioral tasks and were used to document motor, visual, and speech and language organizational areas. Wada tests were performed in two patients. Language and speech activation was concordant with the results of Wada testing.
Functional brain mapping using PET scans and coregistered MR images provided the neurosurgeon with precise definitions of structural and functional cortical areas; this altered surgical management in some cases and/or was used to predict outcome. The combination of PET imaging with FDG and/or CMET and measurements of [15O] water uptake was useful in characterizing and grading tumors and instrumental in achieving effective neurosurgical planning. Postoperative results in the five cases suggest that preoperative functional brain mapping has the potential to improve outcome by defining a surgical plan to maximize resection and minimize the risk of neurological sequelae.
本报告旨在证明使用正电子发射断层扫描（PET）方法进行功能脑图谱绘制在儿童脑肿瘤术前神经外科手术规划中的价值。脑图谱用于描述潜在可切除肿瘤与功能明确的脑区之间的关系。
对5名年龄在3至13岁之间、患有与明确皮层相邻的半球脑肿瘤的儿童进行了研究。使用磁共振（MR）成像来识别脑肿瘤；注射[18F]氟脱氧葡萄糖（FDG）、[11C]L-蛋氨酸（CMET）或两者组合后进行PET成像以对肿瘤进行分级；使用[15O]H2O摄取研究来描述肿瘤与功能皮层的解剖关系。在对照期和行为任务期间获取皮层激活图谱，并用于记录运动、视觉以及言语和语言组织区域。对两名患者进行了Wada测试。语言和言语激活与Wada测试结果一致。
使用PET扫描和配准的MR图像进行功能脑图谱绘制为神经外科医生提供了结构和功能皮层区域的精确定义；这在某些情况下改变了手术管理和/或用于预测结果。PET成像与FDG和/或CMET的组合以及[15O]水摄取测量在肿瘤特征描述和分级方面很有用，并且有助于实现有效的神经外科手术规划。这5例患者的术后结果表明，术前功能脑图谱绘制有可能通过制定手术计划来最大化切除并最小化神经后遗症风险，从而改善预后。
