Rosengarth Katharina, Pai Delin, Dodoo-Schittko Frank, Hense Katharina, Tamm Teele, Ott Christian, Lürding Ralf, Bumes Elisabeth, Greenlee Mark W, Schebesch Karl Michael, Schmidt Nils Ole, Doenitz Christian
Department of Neurosurgery, Regensburg University Hospital, 93053 Regensburg, Germany.
Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, 39106 Magdeburg, Germany.
J Clin Med. 2021 Feb 8;10(4):655. doi: 10.3390/jcm10040655.
(1) Background-Mapping language using direct cortical stimulation (DCS) during an awake craniotomy is difficult without using more than one language paradigm that particularly follows the demand of DCS by not exceeding the assessment time of 4 s to prevent intraoperative complications. We designed an intraoperative language paradigm by combining classical picture naming and verb generation, which safely engaged highly relevant language functions. (2) Methods-An evaluation study investigated whether a single trial of the language task could be performed in less than 4 s in 30 healthy subjects and whether the suggested language paradigm sufficiently pictured the cortical language network using functional magnetic resonance imaging (fMRI) in 12 healthy subjects. In a feasibility study, 24 brain tumor patients conducted the language task during an awake craniotomy. The patients' neuropsychological outcomes were monitored before and after surgery. (3) Results-The fMRI results in healthy subjects showed activations in a language-associated network around the (left) sylvian fissure. Single language trials could be performed within 4 s. Intraoperatively, all tumor patients showed DCS-induced language errors while conducting the novel language task. Postoperatively, mild neuropsychological impairments appeared compared to the presurgical assessment. (4) Conclusions-These data support the use of a novel language paradigm that safely monitors highly relevant language functions intraoperatively, which can consequently minimize negative postoperative neuropsychological outcomes.
(1) 背景——在清醒开颅手术期间，若不采用一种以上的语言范式，很难通过直接皮层刺激（DCS）来绘制语言功能区，特别是这种范式要符合DCS的要求，不超过4秒的评估时间以预防术中并发症。我们通过结合经典的图片命名和动词生成设计了一种术中语言范式，该范式能安全地激活高度相关的语言功能。(2) 方法——一项评估研究调查了30名健康受试者能否在4秒内完成单次语言任务试验，以及12名健康受试者使用功能磁共振成像（fMRI）时，所建议的语言范式是否能充分描绘皮层语言网络。在一项可行性研究中，24名脑肿瘤患者在清醒开颅手术期间进行了语言任务。对患者手术前后的神经心理学结果进行了监测。(3) 结果——健康受试者的fMRI结果显示，在（左侧）外侧裂周围的语言相关网络有激活。单次语言试验可在4秒内完成。术中，所有肿瘤患者在进行新的语言任务时均出现了DCS诱发的语言错误。与术前评估相比，术后出现了轻度神经心理学损伤。(4) 结论——这些数据支持使用一种新的语言范式，该范式可在术中安全地监测高度相关的语言功能，从而将术后负面神经心理学结果降至最低。
