高频脑电定位额叶语言区的方法及临床应用研究

发布时间：2018-03-22 15:43

本文选题：癫痫　切入点：高频皮层脑电　出处：《清华大学》2014年博士论文　论文类型：学位论文

【摘要】：语言功能因其相关脑区分布分散、个体差异大及病理重塑等特点,一直是神经外科临床功能定位中的一大难题。传统语言区功能定位研究大多基于功能磁共振影像(functional magnetic resonance imaging,fMRI)技术或皮层电刺激(electriccortical stimulation,ECS)定位脑功能技术,但这些方法现有发展水平尚不能满足神经外科临床实践中对功能定位精确和便捷的需求。其中,fMRI技术空间分辨率方面尚有不足,而皮层电刺激定位语言区又异常繁琐,费时,文献报告71%病人在电刺激时有后放电和其他负效应,干扰了定位的准确性。基于高频皮层脑电技术(high gamma electrocorticograpy,high gamma ECoG)的大脑功能定位方法是近年来发展的新技术。其理论基础是:不同认知功能的执行伴随对应大脑功能区域ECoG信号,特别是高于60Hz的高频波段的脑电能量变化。这可用于实现基于颅内电极高频脑电定位语言区的方法。本研究选择14例经利手评价及功能磁共振语言分析,优势半球在左侧的,并行左额颞埋藏颅内电极的癫痫病例,采用相同的语言测试任务,分别应用fMRI、ECS及high gamma ECoG方法定位语言区。并以ECS为标准比较分析三者定位语言区的敏感性和特异性;分析术后失语与三种方法定位语言区切除之间的关系;分析high gamma ECoG语言响应点的数量、分布及位置对术后失语类型和失语程度以及失语恢复的影响。我们得出如下结论:high gamma ECoG定位语言区在敏感性和特异性方面均优于功能磁共振,high gamma ECoG定位语言区和电刺激的结果吻合度高;high gamma ECoG定位语言区可以作为替代电刺激定位语言区的方法或者可以作为在high gamma ECoG定位语言区基础上进行电刺激以提高电刺激的效率的方法。癫痫间期放电影响high gamma ECoG语言区的分布,high gamma ECoG可以更敏感的反应语言网络,包括语言潜在的和重塑网络,更敏感的反应语言的传导路径及过程。high gamma ECoG语言响应点的切除对语言功能的影响与以下因素相关:切除的high gamma ECoG响应密集区语言点3个以上的,有两种语言任务激活的或者有电刺激阳性的;切除部位位于Broca区、Broca区后上部(Broca向运动语言区的通路)或者Broca区后下部的(Broca区和感觉性语言区的通路)的失语程度要重、术后失语恢复更慢。
[Abstract]:Language function is characterized by scattered distribution of related brain regions, large individual differences and pathological remodeling. It has always been a difficult problem in neurosurgery clinical functional localization. Traditional language area functional localization research is based on functional magnetic resonance imaging of MRI (functional magnetic resonance imaging) or cortical electrical stimulation (ECS) for the localization of brain function. However, the present development level of these methods cannot meet the need of accurate and convenient functional localization in clinical practice of neurosurgery. Among them, the spatial resolution of fMRI technique is still insufficient, and the localization of language area by cortical electrical stimulation is extremely cumbersome and time-consuming. It was reported that 71% of the patients had post-discharge and other negative effects during electrical stimulation. The method of high gamma electrocorticograpy high gamma ECoG is a new technique developed in recent years. Its theoretical basis is that different cognitive functions are accompanied by corresponding ECoG signals in brain functional regions. This method can be used to localize the language area based on high frequency EEG of intracranial electrode. In this study, 14 cases were evaluated by hand and analyzed by functional magnetic resonance language (fMRI), the dominant hemispheres were located on the left side. The same language test task was used to localize the language area with the methods of fMRIECS and high gamma ECoG. The sensitivity and specificity of the three methods were compared and analyzed using ECS as the standard. To analyze the relationship between postoperative aphasia and three methods of localizing language area resection, and to analyze the number of response points in high gamma ECoG language. The effects of distribution and location on aphasia type, aphasia degree and aphasia recovery after operation were studied. We draw the following conclusions: the sensitivity and specificity of the high gamma ECoG localizing language region are better than those of the high gamma ECoG localizing language area. The results of electrical stimulation are highly consistent. The high gamma ECoG localization language area can be used as a substitute for electrical stimulation localization language area or as a way to improve the efficiency of electrical stimulation based on the high gamma ECoG localization language area. Interepileptic discharges affect the distribution of high gamma ECoG language regions and high gamma ECoG may be more sensitive to response language networks. Including language potential and network remodeling, more sensitive response language conduction pathways and processes. The effect of excision of high gamma ECoG response points on language function is related to the following factors: the excised high gamma ECoG response area has more than 3 language points. There were two types of language tasks activated or electrically stimulated; the excised site was located in the pathway from the posterior and upper part of the Broca region to the motor language area) or the pathway from the lower part of the Broca region to the Broca region and the sensory language area). Postoperative aphasia recovered more slowly.
【学位授予单位】：清华大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R742.1;R741.044

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