基于功能磁共振的Broca区脑动静脉畸形术后皮质和皮质下 重塑模式研究
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国家自然科学基金(81901175);北京市科技计划课题(D161100003816006)


Study of functional magnetic resonance-based postoperative cortical and subcortical reorganization after resection in patients with brain arteriovenous malformations located in Broca's area
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    目的 探 讨 Broca 区 脑 动 静 脉 畸 形 患 者 语 言 皮 层 和 语 言 相 关 白 质 纤 维 的 可 塑 性。 方法 前瞻性选取 2016 年 9 月至 2019 年 5 月在北京天坛医院接受显微手术切除的 5 例 Broca 区脑动静 脉畸形患者为研究对象。在手术前 1 周内和术后 6 个月对患者进行血氧水平依赖性功能磁共振(BOLDfMRI)和弥散张量成像(DTI)检查,评估语言相关的脑白质功能区纤维束及其对侧的同源纤维走形,计 算病变和对侧半球中激活的语言皮层体素之间的偏侧化指数(LI)。结果 术后 6 个月,5 例患者术后左 半球弓状束纤维数量为 67(20,217),低于术前的 781(285,1 191);术后左半球钩束的纤维数量为 386(190, 852),高于术前的 220(114,422),差异有统计学意义(P< 0.05)。5 例患者术前、术后 6 个月两个半球的 弓状束前段、弓状束后段、下纵束和下额枕束的纤维数量比较,差异无统计学意义(P> 0.05)。5 例患者 术前 Broca 区 LI 为 1.000(0.753,1.000),高于术后的 0.070(-0.890,0.537),差异有统计学意义(Z=-0.023, P=0.043)。结论 手术切除 Broca 区脑动静脉畸形后,患者大脑 Broca 区的对侧同源区域和同侧半球钩 束参与代偿,为 Broca 区损伤后的功能重组提供了证据。

    Abstract:

    Objective To explore the plasticity of language cortex and language-related white matter fibers in patients with cerebral arteriovenous malformations in Broca region. Methods A total of 5 patients with cerebral arteriovenous malformations in Broca region (B-BAVM) who underwent microsurgical resection in Beijing Tiantan Hospital from September 2016 to May 2019 were prospectively selected as the study subjects. Blood oxygen level-dependent functional MRI (BOLD-fMRI) and diffusion tensor imaging (DTI) were performed within 1 week before and 6 months after microsurgery. The fiber bundle of the language-related white matter functional area and its homologous fiber profile on the opposite side were evaluated. The laterality index (LI) between the lesion and the activated voxels of the language cortex in the opposite hemisphere was calculated. Results Six months after operation, the number of arcuate fibers in the left hemisphere of the 5 patients was 67 (20,217), lower than 781 (285,1 191) before operation; The number of fibers in the left hemisphere hook bundle after operation was 386 (190,852), higher than 220 (114,422) before operation, and the differences were statistically significant (P< 0.05). There was no statistically significant difference in the number of fibers in the anterior segment, posterior segment, inferior longitudinal segment and inferior fronto-occipital segment of the arcuate tract between the two hemispheres of 5 patients before and 6 months after operation (P> 0.05). The preoperative LI of Broca area was 1.000 (0.753,1.000), higher than the postoperative LI of 0.070 (-0.890, 0.537), and the difference was statistically significant (Z=-0.023, P < 0.05). Conclusions After surgical resection of cerebral arteriovenous malformations in the Broca region, the contralateral homologous region and the ipsilateral hemispheric hook bundle in the Broca region of the patient's brain participated in compensation, providing evidence for the functional reorganization of the Broca region after injury.

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焦玉明,赵绍智,张钧泽,霍然,许宏远,曹勇.基于功能磁共振的Broca区脑动静脉畸形术后皮质和皮质下 重塑模式研究[J].神经疾病与精神卫生,2023,23(2).
DOI :10.3969/j. issn.1009-6574.2023.02.003.

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  • 在线发布日期: 2023-04-03