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<p><b>OBJECTIVE</b>To discuss the distribution characteristics of language areas in Chinese-English non-fluent late bilinguals.</p><p><b>METHODS</b>Six Chinese-English bilinguals with eloquent tumors underwent awake-surgeries. The activated areas of BOLD-fMRI were obtained as the patients performed pure naming, verb generation, and abstract/concrete judgment tasks. Direct cortical stimulation(DCS) as the golden standard of language mapping were performed during awake-surgeries on the exposed cortical areas. BOLD-fMRI results of 3 language tasks were compared with DCS results. The statistical method was McNemer.</p><p><b>RESULTS</b>Sixteen positive sites(22.5%) were comfirmed out of 71 stimulations. There were 3 specific language sites, in which 2 sites were specific English sites and 1 site was specific Chinese site. When activated areas of BOLD-fMRI were compared with the DCS results, verb generation task had the highest concordance rate 40.9% (95%CI:30.2%-52.5%) . There were significant differences between the results of BOLD-fMRI and DCS of all 3 bilingual tasks(P < 0.017).</p><p><b>CONCLUSIONS</b>There are specific language areas in Chinese-English non-fluent late bilinguals. The BOLD-fMRI language mapping could not substitute DCS in the context of mapping language areas in bilinguals.</p>
Subject(s)
Adult , Female , Humans , Male , Young Adult , Brain Mapping , Brain Neoplasms , General Surgery , Cerebral Cortex , Physiology , Magnetic Resonance Imaging , MultilingualismABSTRACT
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.
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<p><b>BACKGROUND</b>The goal of surgery in the treatment of intrinsic cerebral tumors is to resect the maximum tumor volume, and to spare the eloquent areas. However, it is difficult to discover the eloquent areas intraoperatively due to individual anatomo-functional variability both for sensori-motor and language functions. Consequently, the surgery of intrinsic cerebral tumors frequently results in poor extent of resection or permanent postoperative deficits, or both, and remains a difficult problem for neurosurgeons.</p><p><b>METHODS</b>From January 2003 to January 2010, 112 patients with neuroepithelial tumors in/close to the eloquent areas were operated on under awake anesthesia with the intraoperative direct electrical stimulation for functional mapping of the eloquent areas. The extent of the tumors was verified by intraoperative ultrasonography. The maximal resection of the tumors and minimal damage of the eloquent areas were the surgical goal of all patients.</p><p><b>RESULTS</b>Totally 356 cortical sites in 99 patients were detected for motor response by intraoperative direct electrical stimulation, 50 sites in 16 patients for sensory, 72 sites in 48 patients for language. Sixty-six patients (58.9%) achieved total resection, 34 (30.4%) subtotal and 12 (10.7%) partial. Fifty-eight patients (51.8%) had no postoperative deficit, while 37 patients (33.0%) had transitory postoperative paralysis, 26 patients (23.2%) with transitory postoperative language disturbance and 3 patients (2.7%) with permanent neurological deficits. No patient complained of pain recollection following operation.</p><p><b>CONCLUSIONS</b>Awake anesthesia, intraoperative direct electrical stimulation and ultrasonography are three core techniques for the resection of intrinsic cerebral tumors near the eloquent areas. This new concept allows an improvement in the quality of surgery for neuroepithelial tumors in/adjacent to eloquent areas.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Anesthesia , Methods , Brain Mapping , Methods , Brain Neoplasms , Diagnostic Imaging , General Surgery , Deep Brain Stimulation , Methods , Neoplasms, Neuroepithelial , Diagnostic Imaging , General Surgery , UltrasonographyABSTRACT
Objective To analyze the clinical characteristics of pituitary stalk interruption syndrome (PSIS) for its better understanding. Methods The clinical manifestations and endocrine alterations were analyzed retrospectively in 2 PSIS cases, and the literatures concerning this disease were reviewed. Results Both of the 2 adult patients had definite history of head injuries, and one of them exhibited nervous system sequelae. The diagnoses remained erroneous for 15 and 2 years, respectively. This disease was characterized by gradual clinical hypopituitarism, and both of the 2 patients were admitted for pituitary crisis, which occurred for several times in 1 case;neither of the patients had diabetes insipidus. Endocrine examination suggested hypofunction of the thyroid gland, sexual gland and adrenal glands due to hypopituitarism. Magnetic resonance imaging revealed pituitary atrophy, pituitary stalk interruption and posterior lobe hyperintensity in the infundibular recess. So far only 2 juvenile cases of traumatic PSIS were reported, which had distinct differences from early-onset PSlS and from simple traumatic hypopituitarism without pituitary stalk interruption. Conclusion Traumatic PSIS is a rare clinical entity. In cases of endocrine alterations following head injury, traumatic PSIS might be suspected and appropriate treatment should be administered.
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Objective To evaluate and discuss the usage of T2 reversed magnetic resonance (MR) image in neurosurgical operations. Methods T2 MR image was integrated in neuronavigation and then it was reversed. The T2 reversed image was used in image-guided neurosurgical operations in 36 cases to localize central sulcus and precentral gyrus. In 13 cases of a brain functional area tumor, the results of localization of central sulcus by somatosensory evoked potential (SEP) and precentral gyrus hand-knob by direct electrical stimulation (DES) were compared with those of reversed T2 guided navigation. Results The sulcus, gyms, brain surface vein, suture, pacchionian corpuscles, sinus, and brain edema were conspicuous in T2 reversed image. The reversed T2 image-guided navigation results of the central sulcus and the hand-knob were consistent with those of electrical examination completely. Conclusion The T2 reversed image is reliable in localizing sulcus and gyrus. It could substitute for SEP in localizing the central sulcus and provide more image information in neuronavigation.
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<p><b>OBJECTIVE</b>To examine the changes in the expression of mGluR4 after diffuse brain injury (DBI) and to determine the role of its specific agonist L-2-amino-4-phosphonobutyrate (L-AP4) in vivo.</p><p><b>METHODS</b>A total of 161 male SD rats were randomized into the following groups. Group A included normal control, sham-operated control and DBI group. DBI was produced according to Marmarou's diffuse head injury model. mRNA expression of mGluR4 was detected by hybridization in situ. Group B included DBI alone, DBI treated with normal saline and DBI treated with L-AP4. All DBI rats were trained in a series of performance tests, following which they were subjected to DBI. At 1 and 12 hours, animals were injected intraventricularly with L-AP4 (100 mmol/L, 10 microl) or normal saline. Motor and cognitive performances were tested at 1, 3, 7, 14 days after injury and the damaged neurons were also detected.</p><p><b>RESULTS</b>There was no significant difference between normal control group and sham-operated group in the expression of mGluR4 (P>0.05). The animals exposed to DBI showed significantly increased expression of mRNA of mGluR4 compared with the sham-operated animals 1 h after injury (P<0.05). At 6 hours, the evolution of neuronal expression of mGluR4 in the trauma alone group was relatively static. Compared with saline-treated control animals, rats treated with L-AP4 showed an effective result of decreased number of damaged neurons and better motor and cognitive performances.</p><p><b>CONCLUSIONS</b>Increased expression of mGluR4 is important in the pathophysiological process of DBI and its specific agonist L-AP4 can provide remarkable neuroprotection against DBI not only at the histopathological level but also in the motor and cognitive performance.</p>