Yamao Yukihiro, Suzuki Kengo, Kunieda Takeharu, Matsumoto Riki, Arakawa Yoshiki, Nakae Takuro, Nishida Sei, Inano Rika, Shibata Sumiya, Shimotake Akihiro, Kikuchi Takayuki, Sawamoto Nobukatsu, Mikuni Nobuhiro, Ikeda Akio, Fukuyama Hidenao, Miyamoto Susumu
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Hum Brain Mapp. 2017 Apr;38(4):1977-1991. doi: 10.1002/hbm.23498. Epub 2017 Jan 23.
In order to preserve postoperative language function, we recently proposed a new intraoperative method to monitor the integrity of the dorsal language pathway (arcuate fasciculus; AF) using cortico-cortical evoked potentials (CCEPs). Based on further investigations (20 patients, 21 CCEP investigations), including patients who were not suitable for awake surgery (five CCEP investigations) or those without preoperative neuroimaging data (eight CCEP investigations including four with untraceable tractography due to brain edema), we attempted to clarify the clinical impact of this new intraoperative method. We monitored the integrity of AF by stimulating the anterior perisylvian language area (AL) by recording CCEPs from the posterior perisylvian language area (PL) consecutively during both general anesthesia and awake condition. After tumor resection, single-pulse electrical stimuli were also applied to the floor of the removal cavity to record subcortico-cortical evoked potentials (SCEPs) at AL and PL in 12 patients (12 SCEP investigations). We demonstrated that (1) intraoperative dorsal language network monitoring was feasible even when patients were not suitable for awake surgery or without preoperative neuroimaging studies, (2) CCEP is a dynamic marker of functional connectivity or integrity of AF, and CCEP N1 amplitude could even become larger after reduction of brain edema, (3) a 50% CCEP N1 amplitude decline might be a cut-off value to prevent permanent language dysfunction due to impairment of AF, (4) a correspondence (<2.0 ms difference) of N1 onset latencies between CCEP and the sum of SCEPs indicates close proximity of the subcortical stimulus site to AF (<3.0 mm). Hum Brain Mapp 38:1977-1991, 2017. © 2017 Wiley Periodicals, Inc.
为了保留术后语言功能，我们最近提出了一种新的术中方法，即使用皮质-皮质诱发电位（CCEP）来监测背侧语言通路（弓状束；AF）的完整性。基于进一步的研究（20例患者，21次CCEP检查），包括不适合清醒手术的患者（5次CCEP检查）或术前没有神经影像学数据的患者（8次CCEP检查，其中4次因脑水肿而无法进行追踪纤维束成像），我们试图阐明这种新的术中方法的临床影响。我们通过在全身麻醉和清醒状态下连续记录来自后外侧裂周语言区（PL）的CCEP，刺激前外侧裂周语言区（AL）来监测AF的完整性。肿瘤切除后，还对12例患者（12次SCEP检查）的切除腔底部施加单脉冲电刺激，以记录AL和PL的皮质下-皮质诱发电位（SCEP）。我们证明：（1）即使患者不适合清醒手术或没有术前神经影像学研究，术中背侧语言网络监测也是可行的；（2）CCEP是AF功能连接或完整性的动态标志物，并且在脑水肿减轻后CCEP N1波幅甚至可能变大；（3）CCEP N1波幅下降50%可能是预防由于AF受损导致永久性语言功能障碍的临界值；（4）CCEP与SCEP总和之间N1起始潜伏期的对应关系（差异<2.0毫秒）表明皮质下刺激部位与AF接近（<3.0毫米）。《人类大脑图谱》38:1977 - 1991, 2017。© 2017威利期刊公司。
