本文選題：癲癇　切入點(diǎn)：高頻皮層腦電　出處：《清華大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：語(yǔ)言功能因其相關(guān)腦區(qū)分布分散、個(gè)體差異大及病理重塑等特點(diǎn),一直是神經(jīng)外科臨床功能定位中的一大難題。傳統(tǒng)語(yǔ)言區(qū)功能定位研究大多基于功能磁共振影像(functional magnetic resonance imaging,fMRI)技術(shù)或皮層電刺激(electriccortical stimulation,ECS)定位腦功能技術(shù),但這些方法現(xiàn)有發(fā)展水平尚不能滿足神經(jīng)外科臨床實(shí)踐中對(duì)功能定位精確和便捷的需求。其中,fMRI技術(shù)空間分辨率方面尚有不足,而皮層電刺激定位語(yǔ)言區(qū)又異常繁瑣,費(fèi)時(shí),文獻(xiàn)報(bào)告71%病人在電刺激時(shí)有后放電和其他負(fù)效應(yīng),干擾了定位的準(zhǔn)確性�；诟哳l皮層腦電技術(shù)(high gamma electrocorticograpy,high gamma ECoG)的大腦功能定位方法是近年來(lái)發(fā)展的新技術(shù)。其理論基礎(chǔ)是:不同認(rèn)知功能的執(zhí)行伴隨對(duì)應(yīng)大腦功能區(qū)域ECoG信號(hào),特別是高于60Hz的高頻波段的腦電能量變化。這可用于實(shí)現(xiàn)基于顱內(nèi)電極高頻腦電定位語(yǔ)言區(qū)的方法。本研究選擇14例經(jīng)利手評(píng)價(jià)及功能磁共振語(yǔ)言分析,優(yōu)勢(shì)半球在左側(cè)的,并行左額顳埋藏顱內(nèi)電極的癲癇病例,采用相同的語(yǔ)言測(cè)試任務(wù),分別應(yīng)用fMRI、ECS及high gamma ECoG方法定位語(yǔ)言區(qū)。并以ECS為標(biāo)準(zhǔn)比較分析三者定位語(yǔ)言區(qū)的敏感性和特異性;分析術(shù)后失語(yǔ)與三種方法定位語(yǔ)言區(qū)切除之間的關(guān)系;分析high gamma ECoG語(yǔ)言響應(yīng)點(diǎn)的數(shù)量、分布及位置對(duì)術(shù)后失語(yǔ)類型和失語(yǔ)程度以及失語(yǔ)恢復(fù)的影響。我們得出如下結(jié)論:high gamma ECoG定位語(yǔ)言區(qū)在敏感性和特異性方面均優(yōu)于功能磁共振,high gamma ECoG定位語(yǔ)言區(qū)和電刺激的結(jié)果吻合度高;high gamma ECoG定位語(yǔ)言區(qū)可以作為替代電刺激定位語(yǔ)言區(qū)的方法或者可以作為在high gamma ECoG定位語(yǔ)言區(qū)基礎(chǔ)上進(jìn)行電刺激以提高電刺激的效率的方法。癲癇間期放電影響high gamma ECoG語(yǔ)言區(qū)的分布,high gamma ECoG可以更敏感的反應(yīng)語(yǔ)言網(wǎng)絡(luò),包括語(yǔ)言潛在的和重塑網(wǎng)絡(luò),更敏感的反應(yīng)語(yǔ)言的傳導(dǎo)路徑及過(guò)程。high gamma ECoG語(yǔ)言響應(yīng)點(diǎn)的切除對(duì)語(yǔ)言功能的影響與以下因素相關(guān):切除的high gamma ECoG響應(yīng)密集區(qū)語(yǔ)言點(diǎn)3個(gè)以上的,有兩種語(yǔ)言任務(wù)激活的或者有電刺激陽(yáng)性的;切除部位位于Broca區(qū)、Broca區(qū)后上部(Broca向運(yùn)動(dòng)語(yǔ)言區(qū)的通路)或者Broca區(qū)后下部的(Broca區(qū)和感覺(jué)性語(yǔ)言區(qū)的通路)的失語(yǔ)程度要重、術(shù)后失語(yǔ)恢復(fù)更慢。
[Abstract]:Language function is characterized by scattered distribution of related brain regions, large individual differences and pathological remodeling. It has always been a difficult problem in neurosurgery clinical functional localization. Traditional language area functional localization research is based on functional magnetic resonance imaging of MRI (functional magnetic resonance imaging) or cortical electrical stimulation (ECS) for the localization of brain function. However, the present development level of these methods cannot meet the need of accurate and convenient functional localization in clinical practice of neurosurgery. Among them, the spatial resolution of fMRI technique is still insufficient, and the localization of language area by cortical electrical stimulation is extremely cumbersome and time-consuming. It was reported that 71% of the patients had post-discharge and other negative effects during electrical stimulation. The method of high gamma electrocorticograpy high gamma ECoG is a new technique developed in recent years. Its theoretical basis is that different cognitive functions are accompanied by corresponding ECoG signals in brain functional regions. This method can be used to localize the language area based on high frequency EEG of intracranial electrode. In this study, 14 cases were evaluated by hand and analyzed by functional magnetic resonance language (fMRI), the dominant hemispheres were located on the left side. The same language test task was used to localize the language area with the methods of fMRIECS and high gamma ECoG. The sensitivity and specificity of the three methods were compared and analyzed using ECS as the standard. To analyze the relationship between postoperative aphasia and three methods of localizing language area resection, and to analyze the number of response points in high gamma ECoG language. The effects of distribution and location on aphasia type, aphasia degree and aphasia recovery after operation were studied. We draw the following conclusions: the sensitivity and specificity of the high gamma ECoG localizing language region are better than those of the high gamma ECoG localizing language area. The results of electrical stimulation are highly consistent. The high gamma ECoG localization language area can be used as a substitute for electrical stimulation localization language area or as a way to improve the efficiency of electrical stimulation based on the high gamma ECoG localization language area. Interepileptic discharges affect the distribution of high gamma ECoG language regions and high gamma ECoG may be more sensitive to response language networks. Including language potential and network remodeling, more sensitive response language conduction pathways and processes. The effect of excision of high gamma ECoG response points on language function is related to the following factors: the excised high gamma ECoG response area has more than 3 language points. There were two types of language tasks activated or electrically stimulated; the excised site was located in the pathway from the posterior and upper part of the Broca region to the motor language area) or the pathway from the lower part of the Broca region to the Broca region and the sensory language area). Postoperative aphasia recovered more slowly.
【學(xué)位授予單位】：清華大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.1;R741.044

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