Service de radiologie pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, APHP, Université de Paris, INSERM U1163, Institut Imagine, Paris, France; Service d'oto-rhino-laryngologie pédiatrique, Centre de Réference des Surdités Génétiques, Hôpital Necker Enfants Malades, AP-HP, Université de Paris, Paris, France; Laboratoire de correction auditive, Bizaguet, Paris, France; Institut de l'Audition, Paris, France.
Service de radiologie pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, APHP, Université de Paris, INSERM U1163, Institut Imagine, Paris, France.
Neuroimage Clin. 2021;29:102510. doi: 10.1016/j.nicl.2020.102510. Epub 2020 Nov 27.
Age at implantation is considered to be a major factor, influencing outcomes after pediatric cochlear implantation. In the absence of acoustic input, it has been proposed that cross-modal reorganization can be detrimental for adaptation to the new electrical input provided by a cochlear implant. Here, through a retrospective study, we aimed to investigate differences in cerebral blood flow (CBF) at rest prior to implantation in children with congenital deafness compared to normally hearing children. In addition, we looked at the putative link between pre-operative rest-CBF and the oral intelligibility scores at 12 months post-implantation. Finally, we observed the evolution of perfusion with age, within brain areas showing abnormal rest-CBF associated to deafness, in deaf children and in normally hearing children. In children older than 5 years old, results showed a significant bilateral hypoperfusion in temporal regions in deaf children, particularly in Heschl's gyrus, and a significant hyperperfusion of occipital regions. Furthermore, in children older than 5 years old, whole brain voxel-by-voxel correlation analysis between pre-operative rest-CBF and oral intelligibility scores at 12 months post-implantation, showed significant negative correlation localized in the occipital regions: children who performed worse in the speech perception test one year after implantation were those presenting higher preoperative CBF values in these occipital regions. Finally, when comparing mean relative perfusion (extracted from the temporal regions found abnormal on whole-brain voxel-based analysis) across ages in patients and controls, we observed that the temporal perfusion evolution was significantly different in deaf children than in normally hearing children. Indeed, while temporal perfusion increased with age in normally hearing children, it remained stable in deaf children. We showed a critical period around 4 years old, where in the context of auditory deprivation, there is a lack of synaptic activity in auditory regions. These results support the benefits of early cochlear implantation to maximize the effectiveness of auditory rehabilitation and to avoid cross-modal reorganization.
植入年龄被认为是一个主要因素，影响儿童人工耳蜗植入后的结果。在没有声学输入的情况下，有人提出，跨模态重组可能不利于适应人工耳蜗提供的新电输入。在这里，我们通过回顾性研究，旨在调查先天性耳聋儿童与听力正常儿童在植入前静息状态下脑血流 (CBF) 的差异。此外，我们还研究了术前静息 CBF 与植入后 12 个月的口语清晰度评分之间的潜在联系。最后，我们观察了与耳聋相关的静息 CBF 异常的脑区随年龄的灌注演变，包括耳聋儿童和听力正常儿童。在 5 岁以上的儿童中，结果显示耳聋儿童的颞区双侧灌注减少，尤其是在 Heschl 回，枕区灌注增加。此外，在 5 岁以上的儿童中，术前静息 CBF 与植入后 12 个月口语清晰度评分的全脑体素-体素相关性分析显示，在枕区存在显著的负相关：植入后一年言语感知测试表现较差的儿童，这些儿童在前部的 CBF 值较高这些枕区。最后，当比较患者和对照组在基于全脑体素分析发现异常的颞区的平均相对灌注（从颞区提取）时，我们观察到耳聋儿童的颞区灌注变化与听力正常儿童明显不同。事实上，虽然听力正常儿童的颞区灌注随年龄增长而增加，但耳聋儿童的颞区灌注保持稳定。我们发现了一个关键时期，大约在 4 岁左右，在听觉剥夺的情况下，听觉区域缺乏突触活动。这些结果支持早期进行人工耳蜗植入的好处，以最大限度地提高听觉康复的效果，并避免跨模态重组。
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