汉-英-法多语者脑功能区手术定位的探讨

目的 探讨中国人汉-英-法多语者的脑功能区定位,应用唤醒手术及直接皮层电刺激技术,探讨多语者脑功能区肿瘤的手术方法.方法 对一例浙江籍汉语普通话-英语-法语多语者,同时也是左额叶低级别胶质瘤患者进行手术,术前完成汉、英、法语言试验任务,经功能磁共振定位汉语、英语、法语皮质区;术中采用超声探测肿瘤,全麻唤醒下应用皮层直接电刺激技术确定多语言的功能区,依据功能区边界切除肿瘤.评价术前、术后语言功能.结果 通过fMRI检出汉、英、法3种语言激活区,且3种语言区基本重合,位于左额中、上回的后部及颞上回.切除肿瘤过程中,应用皮层直接电刺激技术发现了汉、英、法3种语言的功能区,其中英、法语言区基本重合,但与汉语语言区并不完全重合,颞上回后部存在特异性的语言区.肿瘤次全切除,术后出现短暂运动性失语,3种语言均受损,但于半年内恢复,其中汉语的恢复较快,英语、法语恢复慢.术后1年随访,患者恢复正常生活和工作,3种语青功能均恢复至术前水平,未发现语言转换障碍,术前癫痫症状消失.结论 采用多语方式进行扫描定位和术中清醒状态下多语监测使得多语脑功能区病变患者的手术治疗成为可能.

Surgical strategy of a Chinese-English-French multilingual patient with tumor in eloquent area

Objective To explore the localization of brain functional area in a Chinese-English-French multilingual patient with low-grade glioma and study the surgical method of low-grade glioma in the eloquent area using awake craniotomy and direct cortical electrical stimulation. Methods A cerebral operation was performed in a Chinese multilingual patient with low-grade glioma in the eloquent region, who spoke Mandarin, English and French. Based on semantic, speech and reading test of Chinese, English and French, functional MRI (fMRI) was conducted to map the Chinese-English-French eloquent cerebral cortex before operation. The patient received microsurgery for tumor resection with monitoring of Chinese, English and French multilingual eloquent areas under awake anesthesia, and the surgical program was guided by cortical-subcortical direct electrical stimulation, with tumor locating by B-mode ultrasound in the operation. Results Chinese, English and French eloquent cerebral cortexes were found by fMRI. All eloquent areas were located in the inferior-anterior region near the tumor, namely the posterior part of left middle-inferior frontal gyrus and superior temperal gyrus. But cortical direct electrical stimulation identified that Chinese eloquent cerebral cortex was not totally coincided with English and French eloquent cerebral cortexes, which were in the unique cortical area in the posterior part of the upper temporal gyrus; these results were different from those of fMRI. Transient supplementary motor area syndrome in the left middle-frontal gyrus was observed by subcortical direct stimulation; subtotal resection of the tumor was achieved. The patient suffered from multilingual motor aphasia of all 3 languages for 3 months. Then his Chinese recovered first, followed by English and French. After 1 year follow-up, the patient went back to his work free of aphasia of all 3 languages and had normal life with free of epilepsy. Conclusion Mapping eloquent areas using fMRI based on multilingual mission and multilingual monitoring under a waking state of the patient makes it possibe to remove the tumor in the multilingual eloquent area. Protection of mother tongue is the precondition of this kind of surgery. Linguistic function may be recovered after the maximal resection of the tumor.