经前额叶皮层造瘘手术切除侧脑室肿瘤对患儿认知功能恢复的影响  

Cognitive function recovery in children undergoing prefrontal cortex fistula surgery for lateral ventricle tumor resection

作　　者：余亚雄 李祉岑 陆峥[1] 宫剑[1,2] YU Yaxiong;LI Zhicen;LU Zheng(Department of Pediatric Neurosurgery,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100071,China)

机构地区：[1]首都医科大学附属北京天坛医院小儿神经外科,北京市100071 [2]北京市神经外科研究所小儿神外办公室

出　　处：《河北医药》2020年第8期1164-1168,共5页Hebei Medical Journal

摘　　要：目的研究小儿前额叶皮层造瘘手术后认知功能自我修复的情况,为临床医生选择手术入路提供参考。方法对18例经前额叶皮层造瘘手术的小儿患者进行了随访,使用韦氏儿童智力量表第4版:中文版(WISC-Ⅳ)进行一般智力和认知功能评估。此外,还进行了静息状态功能磁共振成像(fMRI)和弥散张量成像(DTI)以测量脑区共激活水平并探讨脑区之间的功能连接性。结果经前额叶皮层造瘘手术会对患儿认知功能产生明显影响,所有指标均较术前降低,总智商下降明显。通过1年的恢复,认知功能恢复明显。知觉推理,加工速度,总智商在3个测量的时间点的变化差异有统计学意义(P<0.05)。尽管DTI中显示纤维连接明显受损,但根据静息状态fMRI,手术区域和全脑之间的功能连接也得到了代偿。结论儿童认知功能存在自修复现象,尽管选择手术入路时应注意对认知功能的保护,但是保证手术安全、尽可能实现肿瘤全部切除仍然是前提。Objective To investigate the self-repair of cognitive function in children undergoing prefrontal cortex fistula surgery for lateral ventricle tumor resection,so as to provide reference for clinicians to choose the surgical approach.Methods Eighteen pediatric patients who underwent prefrontal cortical fistula surgery were followed up.The general intelligence and cognitive function were assessment by using the Wechsler Intelligence Scale for Children-the fourth edition:Chinese version(WISC-Ⅳ).In addition,resting state functional magnetic resonance imaging(fMRI)and diffusion tensor imaging(DTI)were performed to measure the levels of co-activation of the brain regions,and the functional connectivity between brain regions was analyzed.Results The trans-prefrontal cortex fistula surgery for lateral ventricle tumor resection had significant effects on children’s cognitive function,and all the indexes were significantly lower than those before surgery,and the total IQ was significantly decreased.After 1-year recovery,the cognitive function recovered obviously.There were significant differences in perceptual reasoning,processing speed,and total IQ changes in the three measured time points(P<0.05).The DTI showed that the fibrous connections were significantly impaired,but,the functional connection between the surgical area and the whole brain was compensated according to the resting state fMRI.Conclusion There is self-repair phenomenon in cognitive function of children undergoing prefrontal cortex fistula surgery for lateral ventricle tumor resection.Although the protection of cognitive function should be paid much attention to when choosing the surgical approach,it is still a prerequisite to ensure the safety of the operation and achieve the complete removal of the tumor.

关 键 词：儿童前额叶皮层造瘘手术 认知功能 认知功能自修复 

分 类 号：R739.41[医药卫生—肿瘤]