多语言任务功能磁共振指导国人语言区动静脉畸形切除手术

目的 观察针对中国人主要汉语语言区的多语言任务功能磁共振（functional MRI，fMRI）指导语言区动静脉畸形（arteriovenous malformations，AVM）切除手术对术后语言功能的保护作用。方法 前瞻性纳入首都医科大学附属北京天坛医院神经外科2017年12月-2019年12月收治的语言区AVM患者31例，术前行多语言任务（包括同义字判断、单字朗读、听力理解）fMRI扫描。使用SPM12软件明确各个任务的激活区并分析病变与激活区关系（包括二者之间的距离以及是否存在激活区右侧半球重塑），借助Brainlab导航系统指导手术，术前、术后一周采用西方失语症语言量表（western aphasiabattery，WAB）评估患者语言功能。结果 所有患者均得到有效语言区定位。同义字判断任务主要激活左侧半球额中回（24/31，77.4%），其中1例（3.2%）患者出现语言区右侧半球优势；单字朗读任务主要激活左侧半球额下回后部（23/31，74.2%），7例（22.6%）患者出现语言区右侧半球优势；听力理解任务主要激活左侧半球颞上回后部（30/31，96.8%），6例（19.4%）患者出现语言区右侧半球优势。病变距离语言区平均距离为5.5±3.4 mm。术后WAB量表评分（38.51±2.84分）较术前（39.32±0.64分）无下降（P =0.135），仅2例（6.4%）患者术后出现语言功能障碍。结论 术前采用针对国人主要汉语语言区的多任务fMRI行语言功能定位可有效保护语言功能。

Multi-language-task Functional Magnetic Resonance Imaging Guides the Resection of Arteriovenous Malformations in Chinese Language Area

Objective To observe the protection effect of the multi-language-task functional MRI (fMRI)guided resection of arteriovenous malformations (AVM) involving the language (mainly Chinese)on language function.Methods From December 2017 to December 2019, the data of a total of 31 patients with AVMinvolving the language area who were admitted to Department of Neurosurgery, Beijing TiantanHospital, Capital Medical University were prospectively collected. Multi-language-task (includingsynonymous word judgment, single word reading, listening comprehension) fMRI was performedbefore surgery in all patients. SPM12 was used to map the activation areas of each task and therelationship between the lesions and activation areas was analyzed (including the distance betweenthem and the presence of lateralization functional remodeling in activation areas). The Brainlabsystem was used to guide the operation. Western aphasia battery (WAB) was used to evaluatelanguage function before and one week after surgery.Results All patients had effective language area mapping. Synonym judgment task mainly activatedthe left middle gyrus (24/31, 77.4%), and 1 patient (3.2%) showed right-hemisphere dominance in language area. single word reading task mainly activated the posterior part of left inferior frontalgyrus (23/31, 77.2%), and 7 patients (22.6%) showed right-hemisphere dominance in language area.listening comprehension task mainly activated the posterior part of left superior temporal gyrus (30/31,96.8%), and 6 patients (19.4%) showed right-hemisphere dominance in language area. The distancebetween lesions and language area was 5.5±3.4 mm. The overall WAB score (38.51±2.84) aftersurgery did not decrease significantly compared with that before surgery (39.32±0.64, P =0.135), andlanguage dysfunction after surgery occurred in only 2 patients (6.4%).Conclusions The multi-language-task fMRI can guide the resection of AVM with language area(mainly Chinese) involvement and effectively protect the language function.