Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Neurology, Icerenkoy Mahallesi, Kayisdagi Cd. No: 32, Atasehir, 34752, Istanbul, Turkey.
Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Neurology, Icerenkoy Mahallesi, Kayisdagi Cd. No: 32, Atasehir, 34752, Istanbul, Turkey.
Clin Neurol Neurosurg. 2020 Mar;190:105672. doi: 10.1016/j.clineuro.2020.105672. Epub 2020 Jan 8.
The aim of our study was to determine any association between preservation of long latency response evoked by electrophysiological mapping of the caudal part of the pars opercularis (inferior frontal gyrus Broca area) and postoperative speech function after tumour removal in patients under general anesthesia.
Twelve native Turkish-speaking patients with tumors in the dominant left frontal lobe, near the Broca area, were included in a single-center prospective cohort study. Hooked-wire electrodes were placed in both cricothyroid muscles (CTHY) before anesthesia and a monopolar electrode was used to stimulate the caudal portion of the pars opercularis of the inferior frontal gyrus before and after tumor removal. A long latency response (LLR) elicited at the contralateral (CTHY) muscle was interpreted as a positive stimulation of the Broca area. Patients received one pre-op and two post-op cognitive assessments. The Montreal Cognitive Assessment (MoCA) was used to assess global cognition and a "Cookie Theft" picture description task from the Boston Diagnostic Aphasia Examination test was used in assessing the language functions.
Electrical stimulation elicited a long latency response (LLR) in 9 (75 %) out of the 12 patients. The mean latency of the LLR was 50 ± 11 ms. Four (33.3 %) of the 12 patients showed temporary impairment in fluent speech postoperatively and all had full recovery during the 3-month follow-up period.
The use of electrophysiological mapping methods by using EMG recording from laryngeal muscles may help to identify the opercular part of the Broca area under general anesthesia in order to preserve fluent speech functions.
本研究旨在确定在全身麻醉下通过对后份岛盖部（Broca 区额下回）进行电生理描记来保留长潜伏期反应与肿瘤切除术后患者言语功能之间的任何关联。
本单中心前瞻性队列研究纳入了 12 名母语为土耳其语、左侧优势大脑半球额叶近 Broca 区肿瘤的患者。在麻醉前，在双侧环甲肌（CTHY）中放置钩状电极，在肿瘤切除前后使用单极电极刺激额下回后份岛盖部。对来自对侧（CTHY）肌肉的长潜伏期反应（LLR）进行解释，认为是对 Broca 区的阳性刺激。患者接受了一次术前和两次术后认知评估。采用蒙特利尔认知评估量表（MoCA）评估整体认知功能，采用波士顿诊断性失语症检查中的“曲奇偷窃”图片描述任务评估语言功能。
电刺激在 12 名患者中的 9 名（75%）引发了长潜伏期反应（LLR）。LLR 的平均潜伏期为 50±11ms。12 名患者中的 4 名（33.3%）术后出现流畅性言语暂时性受损，所有患者在 3 个月的随访期间均完全恢复。
在全身麻醉下使用肌电图记录从喉肌进行电生理描记的方法，可能有助于确定 Broca 区的岛盖部，以保留流畅的言语功能。
