導航經(jīng)顱磁刺激技術(shù)在語言功能區(qū)定位中的應(yīng)用
發(fā)布時間：2019-07-02 17:10
【摘要】：研究目的:膠質(zhì)瘤是中樞神經(jīng)系統(tǒng)(central nervous system,CNS)最常見的腫瘤。膠質(zhì)瘤的治療手段包括手術(shù)、放療、化療、靶向藥物治療等。其中手術(shù)切除是大部分膠質(zhì)瘤治療的第一步也是最為重要的一步。目前膠質(zhì)瘤的手術(shù)原則為“最大程度的安全切除”�！白畲蟪潭取钡那谐瓌t在術(shù)中磁共振系統(tǒng)、神經(jīng)導航系統(tǒng)、顯微操作系統(tǒng)等技術(shù)的支持下能夠較好的實現(xiàn)。而“安全”的切除原則則受到目前功能區(qū)定位技術(shù)的局限,個體化定位功能區(qū)上還存在很多不足,需要進一步提高。導航經(jīng)顱磁刺激技術(shù)(navigated transcranial magnetic stimulation,nTMS)能夠產(chǎn)生時變磁場,并無創(chuàng)的穿透顱骨,進而在大腦皮層形成感應(yīng)電流,完成對大腦特定區(qū)域的精準刺激,具有語言功能區(qū)定位的應(yīng)用前景。本研究擬建立基于nTMS技術(shù)的漢語關(guān)鍵語言功能皮層定位方法,并利用該技術(shù)結(jié)合彌散張量纖維追蹤(diffusion tensor tractography,DTT)技術(shù)研究漢語關(guān)鍵語言功能區(qū)的分布特征及其同皮層下纖維之間的關(guān)系,為膠質(zhì)瘤的手術(shù)治療提供可靠的語言功能區(qū)定位方法,完善手術(shù)切除的“安全”原則。研究方法:本研究分為兩部分。第一部分:建立基于nTMS技術(shù)的漢語語言功能區(qū)定位方法。首先,對應(yīng)用于定位語言功能區(qū)的重復(fù)經(jīng)顱磁刺激(repetitive transcranial magnetic stimulation,rTMS)技術(shù)的刺激模式進行探索。應(yīng)用不同強度和頻率的rTMS對同一個受試者進行語言功能區(qū)定位,分析統(tǒng)計定位結(jié)果,明確最適合漢語語言人群應(yīng)用的刺激模式。其次,探索應(yīng)用于漢語語言功能區(qū)定位的最優(yōu)任務(wù)。應(yīng)用不同的任務(wù)模式以及相同的刺激模式對同一受試者進行語言功能區(qū)定位,分析定位結(jié)果,明確nTMS在定位漢語語言功能中的最優(yōu)任務(wù)。最后,在理想刺激模式以及任務(wù)模式下,應(yīng)用nTMS技術(shù)對漢語語言功能區(qū)的分布模式進行研究。第二部分:明確語言相關(guān)纖維的皮層投射模式以及與關(guān)鍵語言皮層的關(guān)系。首先,應(yīng)用DTT技術(shù)在個體水平對語言相關(guān)纖維進行重建,并分析其在大腦皮層的投射情況。其次,結(jié)合nTMS的語言區(qū)定位結(jié)果,分析語言功能在額下回后部的神經(jīng)通路-拓撲學機制。最后,通過分析弓狀纖維(arcuate fasciculus,AF)同關(guān)鍵語言位點的關(guān)系,明確依靠纖維投射終末皮層定位關(guān)鍵語言皮層的可行性,即應(yīng)用白質(zhì)纖維的解剖學標志定位語言功能區(qū)的可行性。研究結(jié)果:第一部分(1)隨著刺激強度以及頻率的提高,nTMS誘發(fā)的言語錯誤率也隨之提升。結(jié)合VAS評分、錯誤率以及錯誤位點的分布,我們認為110%RMT,5Hz-10 pulses的刺激模式為最優(yōu)刺激模式。由于個體之間具有一定的差異,部分受試者可在此基礎(chǔ)上對刺激模式進行微調(diào)。(2)不同任務(wù)態(tài)下的定位結(jié)果提示,圖片命名任務(wù)所誘發(fā)的錯誤率最高,并且在分布模式上比數(shù)數(shù)任務(wù)、中文閱讀任務(wù)、語義判斷任務(wù)要廣泛。所以我們認為對漢語語言人群,圖片命名任務(wù)是用于nTMS語言功能區(qū)定位的理想任務(wù)。(3)通過使用理想的刺激模式和任務(wù),我們揭示了健康漢語人群的腦語言功能區(qū)的位置。提示漢語關(guān)鍵語言腦區(qū)在個體水平有較為離散的分布,而在整體水平上存在特定腦區(qū)的聚集,如額葉的腹側(cè)中央前回,顳葉的顳上回中后部,頂下小葉的緣上回。第二部分(1)皮層下纖維重建明確了不同的語言相關(guān)纖維的皮層投射規(guī)律。(2)額下回后部不同位置的關(guān)鍵語言位點,其功能由不同的語言相關(guān)纖維承載。腹側(cè)中央前回的關(guān)鍵語言位點主要由弓狀纖維前段和長段負責;額葉島蓋部的關(guān)鍵語言位點主要由額斜行纖維負責;額葉三角部的關(guān)鍵語言位點主要由額枕下束負責。(3)應(yīng)用弓狀纖維投射末端皮層定位關(guān)鍵語言位點僅在腹側(cè)中央前回區(qū)域有一定的可行性,在其他腦區(qū)應(yīng)用弓狀纖維末端定位關(guān)鍵語言區(qū)具有一定的風險。結(jié)論:(1)導航經(jīng)顱磁刺激能夠用于定位漢語語言區(qū),漢語語言功能區(qū)雖然在個體水平分布離散,然而從總體水平看具有一定的聚集趨勢。(2)語言功能是遵循神經(jīng)通路-拓撲學原理的,關(guān)鍵語言功能區(qū)在不同區(qū)域由不同的語言相關(guān)纖維承載。然而通過語言相關(guān)纖維反向定位關(guān)鍵語言皮層位置僅在部分腦區(qū)具有可行性。
[Abstract]:Objective: Glioma is the most common tumor of central nervous system (CNS). The treatment of glioma includes operation, radiotherapy, chemotherapy, targeted drug treatment, etc. Surgical resection is one of the most important steps in the treatment of most glioma. At present, the surgical principle of glioma is the "maximum safety cut-off". The principle of ablation of the "maximum degree" can be realized with the support of the magnetic resonance system, the nerve navigation system, the micro-operating system and the like during the operation. However, the principle of ablation of the "safety" is limited by the current function of the function of the function area, and there are still a lot of defects on the individual positioning functional area, which needs to be further improved. The navigation transcranial magnetic stimulation (ntms) can generate time-varying magnetic field and non-invasively penetrate the skull. This study is to establish a method to locate the functional cortex of Chinese key language based on nTMS, and to study the distribution of the functional area of Chinese key language and its relationship with the subcortical fiber by using the technique of diffusion tensor tractography (DTT). To provide a reliable positioning method of the language functional area for the surgical treatment of glioma, and to improve the "safety" of surgical resection. The research method: This study is divided into two parts. The first part is to establish a Chinese language functional area positioning method based on nTMS technology. First, the stimulation pattern corresponding to the repeated transcranial magnetic stimulation (rTMS) technique used to locate the functional area of the language is explored. Using the rTMS of different intensity and frequency, the same subject was used to locate the same subject, and the result of the statistical localization was analyzed, and the stimulation pattern most suitable for the application of the Chinese language population was determined. Secondly, the author explores the optimal task applied to the positioning of the Chinese language functional area. Using different task modes and the same stimulation mode, the same subject is located in the language function area, and the positioning result is analyzed, and the optimal task of nTMS in the function of positioning Chinese language is determined. Finally, in the ideal stimulation mode and the task mode, the distribution pattern of the Chinese language functional area is studied by using the nTMS technology. The second part is to specify the cortical projection pattern of the language-related fibers and the relationship with the critical language cortex. First of all, the application of DTT technique to the reconstruction of the language-related fibers at the individual level and the analysis of its projection in the cerebral cortex. Secondly, based on the results of the localization of the language area of nTMS, the mechanism of the neural pathway-mechanism of the back of the function of the language is analyzed. Finally, by analyzing the relationship between the arcuate fasciculus (AF) and the key language site, it is clear that the feasibility of positioning the key language cortex by means of the terminal cortex of the fiber is determined, that is, the feasibility of using the anatomical landmarks of the white matter fiber to locate the functional language functional area. The results showed that the first part (1), with the increase of the intensity of the stimulation and the frequency, the rate of nTMS-induced speech error rate was also improved. In combination with the VAS score, the error rate, and the distribution of the error sites, we think the stimulation pattern of 110% RMT,5 Hz-10 pulses is the optimal stimulation mode. Because there is a certain difference between the individual, some subjects can fine-tune the stimulation pattern on this basis. (2) The result of the positioning in different task states indicates that the error rate induced by the picture naming task is the highest, and in the distributed mode it is more than the number of tasks, the Chinese reading task and the semantic judgment task are wide. So we think that for Chinese language people, the picture naming task is the ideal task for the positioning of the nTMS language functional area. (3) Through the use of the ideal stimulation mode and task, we have revealed the position of the brain language functional area of the healthy Chinese population. It is suggested that the Chinese key-language brain regions have a relatively discrete distribution in the individual level, but there are the aggregation of the specific brain regions at the whole level, such as the ventral central frontal gyrus of the frontal lobe, the back of the upper back of the lower lobe, and the margin of the lower lobule. The reconstruction of the subcortical fiber of the second part (1) defines the cortical projection of different language-related fibers. (2) The function is carried by different language-related fibers. The key language site of the ventral central frontal gyrus is mainly responsible for the anterior segment and the long segment of the bow-shaped fiber; the key language site of the frontal lobe cover is mainly responsible for the amount of oblique line fibers; and the key language site of the frontal lobe triangle is mainly responsible for the lower beam of the frontal lobe. (3) The localization of the key language site in the end cortex of the arch-shaped fiber is of a certain feasibility only in the ventral central anterior region, and it is a certain risk in other brain regions to locate the key language area in the end of the arch-like fiber. Conclusion: (1) The navigation transcranial magnetic stimulation can be used to locate the Chinese language area, while the Chinese language functional area has a certain concentration tendency from the overall level. (2) The function of the language is to follow the principle of the nerve path-topology, and the key language functional area is carried by different language-related fibers in different areas. However, that position of the cortical position of the key language in the reverse position of the language-related fib is only feasible in some brain regions.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R739.41
本文編號：2509103
[Abstract]:Objective: Glioma is the most common tumor of central nervous system (CNS). The treatment of glioma includes operation, radiotherapy, chemotherapy, targeted drug treatment, etc. Surgical resection is one of the most important steps in the treatment of most glioma. At present, the surgical principle of glioma is the "maximum safety cut-off". The principle of ablation of the "maximum degree" can be realized with the support of the magnetic resonance system, the nerve navigation system, the micro-operating system and the like during the operation. However, the principle of ablation of the "safety" is limited by the current function of the function of the function area, and there are still a lot of defects on the individual positioning functional area, which needs to be further improved. The navigation transcranial magnetic stimulation (ntms) can generate time-varying magnetic field and non-invasively penetrate the skull. This study is to establish a method to locate the functional cortex of Chinese key language based on nTMS, and to study the distribution of the functional area of Chinese key language and its relationship with the subcortical fiber by using the technique of diffusion tensor tractography (DTT). To provide a reliable positioning method of the language functional area for the surgical treatment of glioma, and to improve the "safety" of surgical resection. The research method: This study is divided into two parts. The first part is to establish a Chinese language functional area positioning method based on nTMS technology. First, the stimulation pattern corresponding to the repeated transcranial magnetic stimulation (rTMS) technique used to locate the functional area of the language is explored. Using the rTMS of different intensity and frequency, the same subject was used to locate the same subject, and the result of the statistical localization was analyzed, and the stimulation pattern most suitable for the application of the Chinese language population was determined. Secondly, the author explores the optimal task applied to the positioning of the Chinese language functional area. Using different task modes and the same stimulation mode, the same subject is located in the language function area, and the positioning result is analyzed, and the optimal task of nTMS in the function of positioning Chinese language is determined. Finally, in the ideal stimulation mode and the task mode, the distribution pattern of the Chinese language functional area is studied by using the nTMS technology. The second part is to specify the cortical projection pattern of the language-related fibers and the relationship with the critical language cortex. First of all, the application of DTT technique to the reconstruction of the language-related fibers at the individual level and the analysis of its projection in the cerebral cortex. Secondly, based on the results of the localization of the language area of nTMS, the mechanism of the neural pathway-mechanism of the back of the function of the language is analyzed. Finally, by analyzing the relationship between the arcuate fasciculus (AF) and the key language site, it is clear that the feasibility of positioning the key language cortex by means of the terminal cortex of the fiber is determined, that is, the feasibility of using the anatomical landmarks of the white matter fiber to locate the functional language functional area. The results showed that the first part (1), with the increase of the intensity of the stimulation and the frequency, the rate of nTMS-induced speech error rate was also improved. In combination with the VAS score, the error rate, and the distribution of the error sites, we think the stimulation pattern of 110% RMT,5 Hz-10 pulses is the optimal stimulation mode. Because there is a certain difference between the individual, some subjects can fine-tune the stimulation pattern on this basis. (2) The result of the positioning in different task states indicates that the error rate induced by the picture naming task is the highest, and in the distributed mode it is more than the number of tasks, the Chinese reading task and the semantic judgment task are wide. So we think that for Chinese language people, the picture naming task is the ideal task for the positioning of the nTMS language functional area. (3) Through the use of the ideal stimulation mode and task, we have revealed the position of the brain language functional area of the healthy Chinese population. It is suggested that the Chinese key-language brain regions have a relatively discrete distribution in the individual level, but there are the aggregation of the specific brain regions at the whole level, such as the ventral central frontal gyrus of the frontal lobe, the back of the upper back of the lower lobe, and the margin of the lower lobule. The reconstruction of the subcortical fiber of the second part (1) defines the cortical projection of different language-related fibers. (2) The function is carried by different language-related fibers. The key language site of the ventral central frontal gyrus is mainly responsible for the anterior segment and the long segment of the bow-shaped fiber; the key language site of the frontal lobe cover is mainly responsible for the amount of oblique line fibers; and the key language site of the frontal lobe triangle is mainly responsible for the lower beam of the frontal lobe. (3) The localization of the key language site in the end cortex of the arch-shaped fiber is of a certain feasibility only in the ventral central anterior region, and it is a certain risk in other brain regions to locate the key language area in the end of the arch-like fiber. Conclusion: (1) The navigation transcranial magnetic stimulation can be used to locate the Chinese language area, while the Chinese language functional area has a certain concentration tendency from the overall level. (2) The function of the language is to follow the principle of the nerve path-topology, and the key language functional area is carried by different language-related fibers in different areas. However, that position of the cortical position of the key language in the reverse position of the language-related fib is only feasible in some brain regions.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R739.41
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