导航经颅磁刺激技术在语言功能区定位中的应用

发布时间：2019-07-02 17:10

【摘要】：研究目的:胶质瘤是中枢神经系统(central nervous system,CNS)最常见的肿瘤。胶质瘤的治疗手段包括手术、放疗、化疗、靶向药物治疗等。其中手术切除是大部分胶质瘤治疗的第一步也是最为重要的一步。目前胶质瘤的手术原则为“最大程度的安全切除”。“最大程度”的切除原则在术中磁共振系统、神经导航系统、显微操作系统等技术的支持下能够较好的实现。而“安全”的切除原则则受到目前功能区定位技术的局限,个体化定位功能区上还存在很多不足,需要进一步提高。导航经颅磁刺激技术(navigated transcranial magnetic stimulation,nTMS)能够产生时变磁场,并无创的穿透颅骨,进而在大脑皮层形成感应电流,完成对大脑特定区域的精准刺激,具有语言功能区定位的应用前景。本研究拟建立基于nTMS技术的汉语关键语言功能皮层定位方法,并利用该技术结合弥散张量纤维追踪(diffusion tensor tractography,DTT)技术研究汉语关键语言功能区的分布特征及其同皮层下纤维之间的关系,为胶质瘤的手术治疗提供可靠的语言功能区定位方法,完善手术切除的“安全”原则。研究方法:本研究分为两部分。第一部分:建立基于nTMS技术的汉语语言功能区定位方法。首先,对应用于定位语言功能区的重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)技术的刺激模式进行探索。应用不同强度和频率的rTMS对同一个受试者进行语言功能区定位,分析统计定位结果,明确最适合汉语语言人群应用的刺激模式。其次,探索应用于汉语语言功能区定位的最优任务。应用不同的任务模式以及相同的刺激模式对同一受试者进行语言功能区定位,分析定位结果,明确nTMS在定位汉语语言功能中的最优任务。最后,在理想刺激模式以及任务模式下,应用nTMS技术对汉语语言功能区的分布模式进行研究。第二部分:明确语言相关纤维的皮层投射模式以及与关键语言皮层的关系。首先,应用DTT技术在个体水平对语言相关纤维进行重建,并分析其在大脑皮层的投射情况。其次,结合nTMS的语言区定位结果,分析语言功能在额下回后部的神经通路-拓扑学机制。最后,通过分析弓状纤维(arcuate fasciculus,AF)同关键语言位点的关系,明确依靠纤维投射终末皮层定位关键语言皮层的可行性,即应用白质纤维的解剖学标志定位语言功能区的可行性。研究结果:第一部分(1)随着刺激强度以及频率的提高,nTMS诱发的言语错误率也随之提升。结合VAS评分、错误率以及错误位点的分布,我们认为110%RMT,5Hz-10 pulses的刺激模式为最优刺激模式。由于个体之间具有一定的差异,部分受试者可在此基础上对刺激模式进行微调。(2)不同任务态下的定位结果提示,图片命名任务所诱发的错误率最高,并且在分布模式上比数数任务、中文阅读任务、语义判断任务要广泛。所以我们认为对汉语语言人群,图片命名任务是用于nTMS语言功能区定位的理想任务。(3)通过使用理想的刺激模式和任务,我们揭示了健康汉语人群的脑语言功能区的位置。提示汉语关键语言脑区在个体水平有较为离散的分布,而在整体水平上存在特定脑区的聚集,如额叶的腹侧中央前回,颞叶的颞上回中后部,顶下小叶的缘上回。第二部分(1)皮层下纤维重建明确了不同的语言相关纤维的皮层投射规律。(2)额下回后部不同位置的关键语言位点,其功能由不同的语言相关纤维承载。腹侧中央前回的关键语言位点主要由弓状纤维前段和长段负责;额叶岛盖部的关键语言位点主要由额斜行纤维负责;额叶三角部的关键语言位点主要由额枕下束负责。(3)应用弓状纤维投射末端皮层定位关键语言位点仅在腹侧中央前回区域有一定的可行性,在其他脑区应用弓状纤维末端定位关键语言区具有一定的风险。结论:(1)导航经颅磁刺激能够用于定位汉语语言区,汉语语言功能区虽然在个体水平分布离散,然而从总体水平看具有一定的聚集趋势。(2)语言功能是遵循神经通路-拓扑学原理的,关键语言功能区在不同区域由不同的语言相关纤维承载。然而通过语言相关纤维反向定位关键语言皮层位置仅在部分脑区具有可行性。
[Abstract]:Objective: Glioma is the most common tumor of central nervous system (CNS). The treatment of glioma includes operation, radiotherapy, chemotherapy, targeted drug treatment, etc. Surgical resection is one of the most important steps in the treatment of most glioma. At present, the surgical principle of glioma is the "maximum safety cut-off". The principle of ablation of the "maximum degree" can be realized with the support of the magnetic resonance system, the nerve navigation system, the micro-operating system and the like during the operation. However, the principle of ablation of the "safety" is limited by the current function of the function of the function area, and there are still a lot of defects on the individual positioning functional area, which needs to be further improved. The navigation transcranial magnetic stimulation (ntms) can generate time-varying magnetic field and non-invasively penetrate the skull. This study is to establish a method to locate the functional cortex of Chinese key language based on nTMS, and to study the distribution of the functional area of Chinese key language and its relationship with the subcortical fiber by using the technique of diffusion tensor tractography (DTT). To provide a reliable positioning method of the language functional area for the surgical treatment of glioma, and to improve the "safety" of surgical resection. The research method: This study is divided into two parts. The first part is to establish a Chinese language functional area positioning method based on nTMS technology. First, the stimulation pattern corresponding to the repeated transcranial magnetic stimulation (rTMS) technique used to locate the functional area of the language is explored. Using the rTMS of different intensity and frequency, the same subject was used to locate the same subject, and the result of the statistical localization was analyzed, and the stimulation pattern most suitable for the application of the Chinese language population was determined. Secondly, the author explores the optimal task applied to the positioning of the Chinese language functional area. Using different task modes and the same stimulation mode, the same subject is located in the language function area, and the positioning result is analyzed, and the optimal task of nTMS in the function of positioning Chinese language is determined. Finally, in the ideal stimulation mode and the task mode, the distribution pattern of the Chinese language functional area is studied by using the nTMS technology. The second part is to specify the cortical projection pattern of the language-related fibers and the relationship with the critical language cortex. First of all, the application of DTT technique to the reconstruction of the language-related fibers at the individual level and the analysis of its projection in the cerebral cortex. Secondly, based on the results of the localization of the language area of nTMS, the mechanism of the neural pathway-mechanism of the back of the function of the language is analyzed. Finally, by analyzing the relationship between the arcuate fasciculus (AF) and the key language site, it is clear that the feasibility of positioning the key language cortex by means of the terminal cortex of the fiber is determined, that is, the feasibility of using the anatomical landmarks of the white matter fiber to locate the functional language functional area. The results showed that the first part (1), with the increase of the intensity of the stimulation and the frequency, the rate of nTMS-induced speech error rate was also improved. In combination with the VAS score, the error rate, and the distribution of the error sites, we think the stimulation pattern of 110% RMT,5 Hz-10 pulses is the optimal stimulation mode. Because there is a certain difference between the individual, some subjects can fine-tune the stimulation pattern on this basis. (2) The result of the positioning in different task states indicates that the error rate induced by the picture naming task is the highest, and in the distributed mode it is more than the number of tasks, the Chinese reading task and the semantic judgment task are wide. So we think that for Chinese language people, the picture naming task is the ideal task for the positioning of the nTMS language functional area. (3) Through the use of the ideal stimulation mode and task, we have revealed the position of the brain language functional area of the healthy Chinese population. It is suggested that the Chinese key-language brain regions have a relatively discrete distribution in the individual level, but there are the aggregation of the specific brain regions at the whole level, such as the ventral central frontal gyrus of the frontal lobe, the back of the upper back of the lower lobe, and the margin of the lower lobule. The reconstruction of the subcortical fiber of the second part (1) defines the cortical projection of different language-related fibers. (2) The function is carried by different language-related fibers. The key language site of the ventral central frontal gyrus is mainly responsible for the anterior segment and the long segment of the bow-shaped fiber; the key language site of the frontal lobe cover is mainly responsible for the amount of oblique line fibers; and the key language site of the frontal lobe triangle is mainly responsible for the lower beam of the frontal lobe. (3) The localization of the key language site in the end cortex of the arch-shaped fiber is of a certain feasibility only in the ventral central anterior region, and it is a certain risk in other brain regions to locate the key language area in the end of the arch-like fiber. Conclusion: (1) The navigation transcranial magnetic stimulation can be used to locate the Chinese language area, while the Chinese language functional area has a certain concentration tendency from the overall level. (2) The function of the language is to follow the principle of the nerve path-topology, and the key language functional area is carried by different language-related fibers in different areas. However, that position of the cortical position of the key language in the reverse position of the language-related fib is only feasible in some brain regions.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R739.41

【相似文献】