皮质下语言通路的丧失与脑肿瘤患者手术相关失语症的相关性：基于重复导航经颅磁刺激的扩散张量成像纤维追踪研究
Loss of Subcortical Language Pathways Correlates with Surgery-Related Aphasia in Patients with Brain Tumor: An Investigation via Repetitive Navigated Transcranial Magnetic Stimulation-Based Diffusion Tensor Imaging Fiber Tracking.
作者信息
Negwer Chiara, Beurskens Eva, Sollmann Nico, Maurer Stefanie, Ille Sebastian, Giglhuber Katrin, Kirschke Jan S, Ringel Florian, Meyer Bernhard, Krieg Sandro M
机构信息
Department of Neurosurgery, Klinikum rechts der Isar, TU München, Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Munich, Germany.
Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, TU München, Munich, Germany.
出版信息
World Neurosurg. 2018 Mar;111:e806-e818. doi: 10.1016/j.wneu.2017.12.163. Epub 2018 Jan 5.
BACKGROUND
Within language function research, there is a shift of focus from cortical specialization to a more hodotopical view including subcortical fiber tracts in functional and oncologic considerations. Diffusion tensor imaging fiber tracking (DTI FT) is well established to visualize subcortical fiber tracts. Recently, a new technique has been developed using cortical regions mapped via repetitive navigated transcranial magnetic stimulation (rTMS) as seed regions. This study investigates if rTMS-based DTI FT for language pathways is also feasible postoperatively and whether preoperative versus postoperative fiber changes correlate with changes and severity of the patients' aphasia grades.
METHODS
rTMS-based DTI FT was performed preoperatively and postoperatively in 24 patients with left hemispheric perisylvian tumors. Language pathways were analyzed individually preoperatively and postoperatively with 5 different settings of minimum fiber length and fractional anisotropy. Transient aphasia was defined as any new or worse language impairment caused by surgery that resolved within the regular 3-month follow-up interval. Because postoperative aphasia does not allow rTMS language mapping, preoperative rTMS data were used throughout.
RESULTS
Patients with transient aphasia postoperatively had a significant reduction in fiber count compared with patients without deficit (321.5 ± 242.8 fibers vs. 518.0 ± 435.2 fibers; P = 0.01). Furthermore, in this patient group, the arcuate fascicle was lost postoperatively twice as often compared with patients with no deficit after surgery (52% vs. 26%; P < 0.01).
CONCLUSIONS
This study shows that rTMS-based DTI FT is feasible for postoperative examination of language pathways. Moreover, changes in preoperative versus postoperative fibers correlate well with the grade of aphasia.
背景
在语言功能研究中，研究重点已从皮质特化转向更具定位性的观点，在功能和肿瘤学考量中纳入了皮质下纤维束。扩散张量成像纤维追踪（DTI FT）已被广泛用于可视化皮质下纤维束。最近，一种新技术已经开发出来，该技术使用通过重复导航经颅磁刺激（rTMS）绘制的皮质区域作为种子区域。本研究旨在调查基于rTMS的语言通路DTI FT在术后是否可行，以及术前与术后纤维变化是否与患者失语症分级的变化及严重程度相关。
方法
对24例左侧大脑半球外侧裂周围肿瘤患者在术前和术后进行基于rTMS的DTI FT检查。术前和术后分别采用5种不同的最小纤维长度和分数各向异性设置对语言通路进行个体分析。短暂性失语定义为由手术引起的任何新的或更严重的语言障碍，且在常规3个月随访期内恢复。由于术后失语不允许进行rTMS语言映射，因此全程使用术前rTMS数据。
结果
术后出现短暂性失语的患者与无功能缺损的患者相比，纤维数量显著减少（321.5±242.8根纤维 vs. 518.0±435.2根纤维；P = 0.01）。此外，在该患者组中，与术后无功能缺损的患者相比，术后弓状束缺失的发生率高出两倍（52% vs. 26%；P < 0.01）。
结论
本研究表明，基于rTMS的DTI FT对于术后语言通路检查是可行的。此外，术前与术后纤维的变化与失语症分级密切相关。
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