Krainik A, Lehéricy S, Duffau H, Capelle L, Chainay H, Cornu P, Cohen L, Boch A-L, Mangin J-F, Le Bihan D, Marsault C
Department of Neuroradiology, Hôpital de la Salpêtrière, Paris, France.
Neurology. 2003 Feb 25;60(4):587-94. doi: 10.1212/01.wnl.0000048206.07837.59.
Patients undergoing surgical resection of medial frontal lesions may present transient postoperative speech disorders that remain largely unpredictable.
To relate the occurrence of this speech deficit to the specific surgical lesion of the supplementary motor area (SMA) involved during language tasks using fMRI.
Twelve patients were studied using a verbal fluency task before resection of a low-grade glioma of the medial frontal lobe and compared with six healthy subjects. Pre- and postoperative MR variables including the hemispheric dominance for language, the extent of SMA removal, and the volume of resection were compared to the clinical outcome.
Following surgery, 6 of 12 patients presented speech disorders. The deficit was similar across patients, consisting of a global reduction in spontaneous speech, ranging from a complete mutism to a less severe speech reduction, which recovered within a few weeks or months. The occurrence of the deficit was related to the resection of the activation in the SMA of the dominant hemisphere for language (p < 0.01). Increased activation in the SMA of the healthy hemisphere on the preoperative fMRI was observed in patients with postoperative speech deficit.
fMRI is able to identify the area at risk in the SMA, of which resection is related to the occurrence of characteristic transient postoperative speech disorders. Increased SMA activation in the healthy hemisphere suggested that a plastic change of SMA function occurred in these patients.
接受额叶内侧病变手术切除的患者可能会出现术后短暂性言语障碍，且在很大程度上难以预测。
使用功能磁共振成像（fMRI）将这种言语缺陷的发生与语言任务期间涉及的辅助运动区（SMA）的特定手术病变相关联。
对12例患者在切除额叶内侧低级别胶质瘤前进行言语流畅性任务研究，并与6名健康受试者进行比较。将术前和术后的磁共振变量，包括语言的半球优势、SMA切除范围和切除体积，与临床结果进行比较。
手术后，12例患者中有6例出现言语障碍。患者之间的缺陷相似，表现为自发言语全面减少，从完全缄默到不太严重的言语减少，在几周或几个月内恢复。缺陷的发生与语言优势半球SMA激活的切除有关（p < 0.01）。术后有言语缺陷的患者在术前fMRI上观察到健康半球SMA激活增加。
fMRI能够识别SMA中存在风险的区域，其切除与特征性术后短暂性言语障碍的发生有关。健康半球SMA激活增加表明这些患者发生了SMA功能的可塑性变化。
