Durner Gregor, Pala Andrej, Federle Lena, Grolik Brigitta, Wirtz Christian R, Coburger Jan
Department of Neurosurgery, Campus Günzburg, University of Ulm, Günzburg, Germany -
Department of Neurosurgery, Campus Günzburg, University of Ulm, Günzburg, Germany.
J Neurosurg Sci. 2019 Apr;63(2):106-113. doi: 10.23736/S0390-5616.18.04591-5. Epub 2018 Sep 25.
Non-invasive language mapping is commonly facilitated via two different approaches, functional magnetic resonance imaging (fMRI) and navigated transcranial magnetic stimulation (nTMS). The aim of our examination was to compare both methods regarding hemispheric dominance and detection of involved cortex in speech-processing.
Since 2015, patients with language eloquent tumors received both fMRI and nTMS language mapping in our facility. Hemispheric dominance for fMRI (word pairing task) and nTMS (picture naming) was defined according to activation/response predominance between hemispheres. For a detailed comparison of methods, we used a cortical parcellation system and correlated activations of each gyrus. Statistical analysis was performed using Sign test, Spearman's rank correlation coefficient and Mann-Whitney-U test.
Twenty-three patients with predominantly frontal and temporal tumors were enrolled. fMRI and nTMS predicted the same hemispheric dominance in 67% of examinations. No significant difference was found between the tests (P=0.63). When examining the correlation of anatomical areas with speech relevance between the two methods, we found significant differences in activation patterns of language relevant areas when comparing patients inter-individually. Using 2/3 rule for evoked language errors in nTMS improved congruence in perisylvian regions.
fMRI and nTMS lead to comparable results in determining hemispheric dominance, however they show significantly different results in predicting language relevant areas. We recommend using 2/3 rule for nTMS to improve congruence. Both tools seem to be valuable methods for preoperative planning. However, surgical decision making concerning resectability of language eloquent lesions should be based on awake craniotomy, furthermore.
非侵入性语言图谱绘制通常通过两种不同方法实现，即功能磁共振成像（fMRI）和导航经颅磁刺激（nTMS）。我们此次检查的目的是比较这两种方法在半球优势以及言语处理中所涉及皮层检测方面的情况。
自2015年起，患有语言功能区明确肿瘤的患者在我们机构接受了fMRI和nTMS语言图谱绘制检查。fMRI（词语配对任务）和nTMS（图片命名）的半球优势根据半球间的激活/反应优势来定义。为了对方法进行详细比较，我们使用了一种皮质分区系统，并对每个脑回的激活情况进行了相关性分析。使用符号检验、斯皮尔曼等级相关系数和曼-惠特尼-U检验进行统计分析。
纳入了23例主要患有额叶和颞叶肿瘤的患者。在67%的检查中，fMRI和nTMS预测出相同的半球优势。两种检测方法之间未发现显著差异（P = 0.63）。在个体间比较患者时，当检查两种方法之间与言语相关性的解剖区域的相关性时，我们发现语言相关区域的激活模式存在显著差异。在nTMS中使用2/3规则来处理诱发的语言错误，可提高外侧裂周围区域的一致性。
fMRI和nTMS在确定半球优势方面得出了可比的结果，然而它们在预测语言相关区域方面显示出显著不同的结果。我们建议在nTMS中使用2/3规则以提高一致性。这两种工具似乎都是术前规划的有价值方法。然而，关于语言功能区明确病变可切除性的手术决策应进一步基于清醒开颅手术。
