左弓状束切除后语言网络连接的重组:一个案例研究。

Reorganized language network connectivity after left arcuate fasciculus resection: A case study.

机构信息

Department of Psychology, Carnegie Mellon University, USA.

Department of Cognitive Sciences, University of California Irvine, USA.

出版信息

Cortex. 2020 Feb;123:173-184. doi: 10.1016/j.cortex.2019.07.022. Epub 2019 Nov 5.

Abstract

Understanding the neural mechanisms that support spontaneous recovery of cognitive abilities can place important constraints on mechanistic theories of brain organization and function, and holds potential to inform clinical interventions. Connectivity-based MRI measures have emerged as a way to study how recovery from brain injury is modulated by changes in intra- and inter-hemispheric connectivity. Here we report a detailed and multi-modal case study of a 26 year-old male who presented with a left inferior parietal glioma infiltrating the left arcuate fasciculus. The patient underwent pre- and post-operative functional MRI and Diffusion Tensor Imaging, as well as behavioral assessments of language, motor, vision and praxis. The surgery for removal of the tumor was carried out with the patient awake, and direct electrical stimulation mapping was used to evaluate cortical language centers. The patient developed a specific difficulty with repeating sentences toward the end of the surgery, after resection of the tumor and partial transection of the arcuate fasciculus. The patient recovered from the sentence repetition impairments over several months after the operation. Coincident with the patient's cognitive recovery, we document a pattern whereby intra-hemispheric functional connectivity was reduced in the left hemisphere, while inter-hemispheric connectivity increased between classic left hemisphere language regions and their right hemisphere homologues. These findings suggest that increased synchrony between the two hemispheres, in the setting of focal transection of the left arcuate fasciculus, can facilitate functional recovery.

摘要

理解支持认知能力自发恢复的神经机制,可以对大脑组织和功能的机械论理论施加重要限制,并有可能为临床干预提供信息。基于连接的 MRI 测量方法已经出现,用于研究脑损伤恢复如何受到大脑内和大脑间连接变化的调节。在这里,我们报告了一例详细的多模态病例研究,涉及一名 26 岁男性,该患者患有左顶下胶质瘤,浸润左侧弓状束。该患者接受了术前和术后功能 MRI 和弥散张量成像,以及语言、运动、视力和实践行为的行为评估。手术切除肿瘤时,患者处于清醒状态,并使用直接电刺激图来评估皮质语言中枢。在肿瘤切除和弓状束部分横断后,患者在手术结束时出现了特定的句子重复困难。手术后几个月,患者的句子重复障碍逐渐恢复。与患者的认知恢复同时,我们记录了一种模式,即左半球的半球内功能连接减少,而经典左半球语言区域与其右侧同源区域之间的半球间连接增加。这些发现表明,在左弓状束局灶性横断的情况下,两个半球之间的同步增加可以促进功能恢复。

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