基于高频响应的自由对话式皮层语言功能区定位方法在致痫灶切除术中的临床价值分析  

Clinical value of free-talk language functional cortex mapping methods based on high frequency response in epileptogenic focus resection

作　　者：高鑫 周晓霞[1] 温建斌[2] 周天一 倪端宇[1] 乔梁[1] 王雪原[1] 张晓华[1] 李小俚[2] 遇涛[1] Gao Xin;Zhou Xiaoxia;Wen Jianbin;Zhou Tianyi;Ni Duanyu;Qiao Liang;Wang Xueyuan;Zhang Xiaohua;Li Xiaoli;Yu Tao(Department of Functional Neurosurgery,Beijing Institute of Functional Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;State Key Laboratory of Cognitive Neuroscience and Learning,Beijing Normal University,Beijing 100875,China)

机构地区：[1]首都医科大学宣武医院功能神经外科,北京功能神经外科研究所,100053 [2]北京师范大学认知神经科学与学习国家重点实验室,北京100875

出　　处：《中华神经医学杂志》2021年第10期989-995,共7页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81771395)。

摘　　要：目的探讨基于高频响应的自由对话式皮层语言功能区定位方法在癫痫患者致痫灶切除术中的临床价值。方法将自2016年1月至2019年5月于首都医科大学宣武医院功能神经外科接受致痫灶切除术的20例难治性癫痫患者,依据术中皮层语言功能区定位方法的不同分为测试组[10例,应用基于高频响应的自由对话式方法(新方法)定位+皮层电刺激(ECS)定位]与对照组(10例,仅应用ECS定位),计算测试组中2种方法定位皮层语言功能区结果的重合率以及分析2组患者的术后随访结果。结果10例测试组患者应用新方法在Broca区及Wernicke区均共检测到33个阳性位点,应用ECS在Broca区及Wernicke区分别共检测到16个、8个阳性位点,二者阳性位点重合率分别为93.75%(15/16)、75.00%(6/8)。10例对照组患者应用ECS在Broca区及Wernicke区分别共检测到18个、3个阳性位点。测试组患者术后Engel分级Ⅰ级7例,出现短暂性语言功能损伤2例;对照组术后Engel分级Ⅰ级5例,出现短暂性语言功能损伤4例。结论新方法定位皮层语言功能区与ECS结果有较高的重合率,二者结合应用有助于减少癫痫患者致痫灶切除术后的语言功能损伤。Objective To investigate the clinical value of free-talk language functional cortex mapping methods based on high frequency response in epileptic foci resection.Methods Twenty patients with intractable epilepsy admitted to our hospital from January 2016 to May 2019 were chosen in our study.According to the different intraoperative mapping methods of language functional region,these patients were divided into test group(n=10,using free-talk language function localization based on high frequency response[new method]+electrical cortical stimulation[ECS])and control group(n=10,using ECS localization only).The overlap rate of the two methods in the test group were calculated and the postoperative follow-up results of patients in the two groups were analyzed.Results In 10 patients from the test group,33 positive loci in the Broca's area and 33 positive loci in the Wernicke's area were detected by new method;at the meantime,16 positive loci in the Broca's area and 8 positive loci in the Wernicke's area were detected by ECS method,which had a overlap rate of 93.75%(15/16)in the Broca's area and 75.00%(6/8)in the Wernicke's area,respectively,as compared with the new method.In the 10 patients from the control group,18 positive loci in the Broca's area and 3 positive loci in the Wernicke's area were detected by ECS method.In the test group,7 patients achieved Engel grading I and 2 patients developed transient language function impairment after surgery;while in the control group,5 patients achieved Engel grading I and 4 patients developed transient language function impairment after surgery.Conclusion The new method has a high overlap rate with ECS method;the combination of the two methods can help to decrease the speech function impairment after excision of epileptogenic foci in patients with epilepsy.

关 键 词：难治性癫痫 皮层语言功能区 基于高频响应的自由对话式方法 皮层电刺激 

分 类 号：R651.1[医药卫生—外科学]