Bookheimer Susan
Center for Cognitive Neurosciences, Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA.
Neuropsychol Rev. 2007 Jun;17(2):145-55. doi: 10.1007/s11065-007-9026-x. Epub 2007 May 5.
Patients with lesions in or near eloquent cortex typically undergo one of several invasive techniques to prevent loss of function following surgery. One of the most promising potential clinical applications of functional magnetic resonance imaging (fMRI) is to map these functions as part of the pre-surgical work-up to identify patients at-risk, guide the surgical entry, or tailor the surgical procedure to prevent deficits. While motor and sensory mapping are relatively straightforward, language mapping is far more complex. The language system is variable in location across individuals and in many cases may reorganize partially or completely to the contralateral hemisphere. In addition, multiple regions of the brain contribute to language functioning including essential regions that must not be removed in surgery, and contributory regions that may result in transient or insignificant impairments post-surgery. Despite these challenges, an increasing number of studies have supported the use of fMRI for pre-surgical language mapping in a variety of disorders. This article reviews the literature from three disorders for which patients benefit from preoperative language mapping: epilepsy, brain tumors, and arteriovenous malformations. Each disorder presents unique challenges to language mapping. Specific case studies are presented highlighting the both the potential benefits of preclinical fMRI for language mapping as well as the potential risks and pitfalls.
在明确的脑皮质或其附近有病变的患者通常会接受几种侵入性技术中的一种，以防止手术后功能丧失。功能磁共振成像（fMRI）最有前景的潜在临床应用之一是将这些功能进行映射，作为术前检查的一部分，以识别有风险的患者、指导手术入路或调整手术程序以预防功能缺陷。虽然运动和感觉映射相对直接，但语言映射要复杂得多。语言系统在个体之间的位置各不相同，而且在许多情况下可能会部分或完全重新组织到对侧半球。此外，大脑的多个区域都参与语言功能，包括手术中绝不能切除的关键区域，以及手术后可能导致短暂或轻微损伤的辅助区域。尽管存在这些挑战，但越来越多的研究支持在各种疾病中使用fMRI进行术前语言映射。本文回顾了三种患者能从术前语言映射中获益的疾病的相关文献：癫痫、脑肿瘤和动静脉畸形。每种疾病在语言映射方面都有独特的挑战。文中给出了具体的案例研究，突出了临床前fMRI在语言映射方面的潜在益处以及潜在风险和陷阱。
