摘要
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。
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(285,1191)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.
作者
焦玉明
赵绍智
张钧泽
霍然
许宏远
曹勇
Jiao Yuming;Zhao Shaozhi;Zhang Junze;Huo Ran;Xu Hongyuan;Cao Yong(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,National Center for Clinical Medical Research of Neurological Diseases,Beijing 100070,China)
出处
《神经疾病与精神卫生》
2023年第2期86-91,共6页
Journal of Neuroscience and Mental Health
基金
国家自然科学基金(81901175)
北京市科技计划课题(D161100003816006)。
关键词
BROCA区
脑动静脉畸形
重塑
语言区
语言纤维束
Broca's area
Brain arteriovenous malformations
Plasticity
Language cortex
Language-related fiber tracts
