Van Poppel Mark, Wheless James W, Clarke Dave F, McGregor Amy, McManis Mark H, Perkins Freedom F, Van Poppel Katherine, Fulton Stephen, Boop Frederick A
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
J Neurosurg Pediatr. 2012 Aug;10(2):96-102. doi: 10.3171/2012.4.PEDS11301. Epub 2012 Jun 22.
Functional mapping is important for determining surgical candidacy and also in epilepsy surgery planning. However, in young children and uncooperative patients, language mapping has been particularly challenging despite the advances in performing noninvasive functional studies. In this study the authors review a series of children with epilepsy who underwent language mapping with magnetoencephalography (MEG) while sedated or sleeping, to determine receptive language localization for presurgical evaluation.
The authors undertook a retrospective review of patients who underwent MEG between December 2007 and July 2009, and identified 15 individuals who underwent passive language testing as part of their presurgical evaluation because they were unable to participate in traditional language testing, such as Wada or functional MRI. Factors necessitating passive language testing included age and neurocognitive development.
Three of the 15 patients were deemed candidates for epilepsy surgery based on the results from standard preoperative testing, including video electroencephalography, MRI, and passive receptive language testing using MEG technology. The MEG studies were used successfully to localize language in all 3 patients, creating opportunities for seizure freedom through surgery that would not otherwise have been available. All 3 patients then underwent resective epilepsy surgery without experiencing postoperative language deficits.
This case series is the first to look at language mapping during sleep (passive language mapping) in which MEG was used and is the first to evaluate passive language testing in a patient population with intracranial pathological entities. This case series demonstrates that MEG can provide an alternative method for receptive language localization in patients with barriers to more traditional language testing, and in these 3 cases surgery was performed safely based on the results.
功能定位对于确定手术适应症以及癫痫手术规划都很重要。然而，在幼儿和不合作的患者中，尽管非侵入性功能研究取得了进展，但语言定位一直极具挑战性。在本研究中，作者回顾了一系列癫痫患儿，他们在镇静或睡眠状态下接受了脑磁图（MEG）语言定位，以确定术前评估中接受性语言的定位。
作者对2007年12月至2009年7月期间接受MEG检查的患者进行了回顾性研究，确定了15名因无法参与传统语言测试（如Wada测试或功能磁共振成像）而在术前评估中接受被动语言测试的个体。需要进行被动语言测试的因素包括年龄和神经认知发育情况。
根据标准术前检查结果，包括视频脑电图、磁共振成像以及使用MEG技术进行的被动接受性语言测试，15名患者中有3名被认为是癫痫手术的候选者。MEG研究成功地对所有3名患者的语言进行了定位，为通过手术实现无癫痫发作创造了机会，否则这些机会是不存在的。所有3名患者随后都接受了切除性癫痫手术，且术后未出现语言功能缺损。
该病例系列是首个观察睡眠期间（被动语言定位）使用MEG进行语言定位的研究，也是首个在患有颅内病理实体的患者群体中评估被动语言测试的研究。该病例系列表明，对于那些难以进行更传统语言测试的患者来说，MEG可以为接受性语言定位提供一种替代方法，并且在这3个病例中，基于测试结果安全地实施了手术。
