Deng Xiaofeng, Shi Qiji, Han Zekun, Wang Shuo, Cao Yong, Chen Xiaolin, Zhang Yan, Wang Bo, Jian Minyu, Zong Fangrong, Zhao Jizong
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
CNS Neurosci Ther. 2025 Sep;31(9):e70602. doi: 10.1111/cns.70602.
Unruptured brain arteriovenous malformations (AVMs) typically do not cause aphasia, even when the traditional language areas are affected by the nidus. We attempted to elucidate its language reorganization mechanism by analyzing the alterations in functional connectivity using functional connectivity (FC) and track-weighted static functional connectivity (TW-sFC) approaches.
This cross-sectional study prospectively enrolled patients with AVMs involving left-hemisphere language areas and healthy controls. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging scans. Conventional FC analysis was used to investigate the spatially segregated functional connectivity in the gray matter, and the TW-sFC method was applied to explore the functional connectivity constrained by the white matter.
34 AVM patients with lesions involving the left cerebral hemisphere and 27 healthy subjects were included. FC analysis findings revealed decreased FC intensity between the left-hemisphere language-associated regions and their right-hemisphere homologs in AVM patients. Additionally, increased FC intensity was observed between the anterior cingulate cortex (ACC) and the language-related areas in bilateral cerebellar hemispheres (lobule VIII, VIIb, Crus I, and Crus II). The TW-sFC results demonstrated increased intensity in multiple right-hemisphere fiber bundles, the left anterior thalamic radiation (ATR) and the callosum.
Three factors may contribute to maintaining intact language function in AVM patients, including the weakened inhibitory effect from the left dominant cerebral hemisphere over the right cerebral hemisphere leading to activation of the potential language functions of the right cerebral hemisphere (inter-cerebral connection reorganization), the functional upregulation of the cerebral language areas by cerebellar language-related brain regions via ACC (cerebrocerebellar connection reorganization), as well as the enhanced functions of the brain areas surrounding the lesion in the left cerebral hemisphere (intracerebral connection reorganization).
This study is registered in the Chinese Trial Registry (clinical trial number: ChiCTR1900020993).
未破裂的脑动静脉畸形（AVM）通常不会导致失语，即使传统语言区域受到病灶影响。我们试图通过使用功能连接（FC）和轨迹加权静态功能连接（TW-sFC）方法分析功能连接的变化来阐明其语言重组机制。
这项横断面研究前瞻性纳入了涉及左半球语言区域的AVM患者和健康对照者。所有参与者均接受静息态功能磁共振成像（rs-fMRI）和扩散张量成像扫描。采用传统的FC分析来研究灰质中空间分离的功能连接，并应用TW-sFC方法来探索受白质约束的功能连接。
纳入了34例左脑半球有病变的AVM患者和27名健康受试者。FC分析结果显示，AVM患者左半球语言相关区域与其右半球对应区域之间的FC强度降低。此外，在前扣带回皮质（ACC）与双侧小脑半球（小叶VIII、VIIb、 Crus I和Crus II）的语言相关区域之间观察到FC强度增加。TW-sFC结果表明，多个右半球纤维束、左前丘脑辐射（ATR）和胼胝体的强度增加。
三个因素可能有助于维持AVM患者完整的语言功能，包括左优势大脑半球对右大脑半球的抑制作用减弱，导致右大脑半球潜在语言功能的激活（脑间连接重组），小脑语言相关脑区通过ACC对大脑语言区域的功能上调（脑小脑连接重组），以及左脑半球病变周围脑区功能的增强（脑内连接重组）。
本研究已在中国临床试验注册中心注册（临床试验编号：ChiCTR1900020993）。
