Bittar R G, Olivier A, Sadikot A F, Andermann F, Reutens D C
Montreal Neurological Institute and Hospital, Quebec, Canada.
J Neurosurg. 2000 Feb;92(2):242-8. doi: 10.3171/jns.2000.92.2.0242.
Changes in cortical representation in patients with cerebral lesions may alter the correlation between cortical anatomy and function. This is of potential clinical significance when the extent of cortical resection is based on surface anatomical landmarks.
Fifty-one patients with supratentorial lesions were studied. Nineteen harbored noncentral lesions (no involvement of pre- or postcentral gyrus), whereas 32 had central lesions. Control studies consisted of stimulation of the hand contralateral to the unaffected hemisphere. Positron emission tomography activation studies were performed using the [15O]H2O tracer. Somatosensory stimulation of the hand or foot was performed using a mechanical vibrator. Motor activation consisted of hand clenching or foot tapping. The t-statistic volumes were generated from images showing the mean change in regional cerebral blood flow, and coregistered with a T1-weighted magnetic resonance image. At the threshold selected, exclusive contralateral primary sensorimotor cortex activation was elicited in 100% of the control studies. A different pattern of cortical activation was associated with central lesions in 35 (78%) of 45 patients, which occurred significantly more often than with noncentral lesions (eight [31%] of 26 patients). The most common difference in the pattern of activation with central lesions was activation of cortical regions outside the central area (including the supplementary sensorimotor area and the secondary somatosensory cortex). No sensorimotor activation was observed in gyri adjacent to the pre- or postcentral gyrus.
Central lesions are more frequently associated with altered patterns in activation than lesions in noncentral locations. Characteristic patterns include activation of secondary sensorimotor areas. The absence of activation in gyri adjacent to the sensorimotor strip has clinical significance for the planning of resections in the central area.
脑损伤患者皮质代表区的变化可能会改变皮质解剖结构与功能之间的相关性。当基于表面解剖标志确定皮质切除范围时，这具有潜在的临床意义。
对51例幕上病变患者进行了研究。19例患有非中央区病变（未累及中央前回或中央后回），而32例患有中央区病变。对照研究包括刺激未受影响半球对侧的手。使用[15O]H2O示踪剂进行正电子发射断层扫描激活研究。使用机械振动器对手或脚进行体感刺激。运动激活包括手部紧握或足部轻敲。t统计量体积由显示局部脑血流平均变化的图像生成，并与T1加权磁共振图像进行配准。在选定的阈值下，100%的对照研究引发了对侧初级感觉运动皮质的独家激活。45例患者中有35例（78%）的中央区病变与不同的皮质激活模式相关，这比非中央区病变（26例患者中有8例[31%]）更为常见。中央区病变激活模式最常见的差异是中央区以外的皮质区域（包括辅助感觉运动区和次级体感皮质）的激活。在中央前回或中央后回相邻的脑回中未观察到感觉运动激活。
与非中央部位的病变相比，中央区病变更常与激活模式改变相关。特征性模式包括次级感觉运动区的激活。感觉运动带相邻脑回未激活对中央区切除术的规划具有临床意义。
