Geschwind’s区损伤后语言功能障碍及恢复的脑网络机制研究

At present, functional imaging studies have suggested that the Geschwind's territory (the inferior parietal lobe) is an important language area. It is the hub for semantics and phonetic language processing. However, the type and mechanism of aphasia after injury of Geschwind’s territory and the subsequent recovery of language are still unclear. In our study based on brain injury model of brain arteriovenous malformation (BAVMs) resection, we found that the incidence of aphasia was higher after the injury of Geschwind's territory than after injury of the classical language area, and the type of aphasia was complicated, while the recovery rate of language disorder was high during follow-up. We hypothesized that the type of aphasia may be associated with the type of brain connectivity damaged, and that reorganization of brain connections and brain network promote the recovery of language function. In this study, we aim to investigate the types of aphasia and their corresponding brain network changes after the resection of BAVMs located in the Geschwind's territory. We will evaluate language function and collect multimodality images of the patients before resection of the lesions, as well as 7 days, 3 months and 6 months afterwards. In addition, the anatomical brain connectivity and brain network will also be analyzed. Our research will not only be a meaningful exploration for mechanisms of human language function damage and reorganization, but will also provide an important basis for the protection of brain function in neurosurgery.

近年来脑功能影像学研究提示脑Geschwind’s区（左脑顶下小叶,以下简称G区）是处理语义、语音等语言功能的重要枢纽。但其损伤后出现的失语类型、其后语言功能恢复规律及内在机制尚不明确。我们在脑血管畸形切除手术形成的脑损伤模型研究中发现：相比经典语言区，G区损伤后患者失语发生率高，失语类型复杂，而随访中语言障碍恢复比例高。我们假设可能是由于G区损伤造成特定的脑连接受损产生相应类型的失语；在恢复过程中G区局部脑连接以及全脑语言网络重塑促进了语言恢复。我们拟通过G区脑血管畸形患者手术切除前、后的语言功能测评及脑弥散张量成像数据，采用脑网络分析方法探究G区损伤后患者失语类型及其对应的脑网络变化机制；通过损伤后1周、3月和6月的语言评估和脑网络影像数据，探究G区语言功能恢复的变化规律及脑网络重塑机制。项目实施不仅是人语言功能损伤及重塑机制的重要探索，也将为神经外科手术脑功能保护提供重要依据。

背景：目前，功能影像学研究表明，Geschwind’s区是重要的语言中枢。它是语义和语音语言处理的中枢。然而，Geschwind’s区损伤后失语的类型和机制以及的语言区的重构机制仍不清楚。.主要研究内容：本研究基于Geschwind’s区BAVM的损伤模型，通过多模态磁共振成像对比研究Geschwind’s区损伤前后及损伤后不同阶段功能重塑过程中脑白质连接、脑网络变化机制。研究Geschwind’s皮层损伤后各语言区之间的白质连接损伤机制、脑网络参数变化，揭示Geschwind’s区损伤后失语的脑结构网络拓扑学机制，以及Geschwind’s区损伤后语言康复过程中发生重塑的机制。.重要结果及数据：Geschwind’s区BAVM术前患者在 Broca’s区和 Wernicke’s 区具有右侧半球的 BOLD 信号激活同源重组。手术后6个月，患者右半球弓状束的纤维数量显着增加。患者术后左侧下额枕束的纤维数量显着增加。此外，Wernicke’s区右半球优势增加。此外，本研究通过对长期语言障碍的风险因素分析提出了预测语言重构潜力的分级系统；其预测准确率为 0.921。.科学意义：我们的研究表明，Geschwind’s区损伤后后通过募集 Broca’s 区和 Wernicke’s区的右半球同源区域、右半球弓状束和左半球下额枕束进行功能重组。结合对弓状束分段的分级系统对长期语言预后具有良好的预测准确性。为神外术前评估、脑语言功能保护提供重要依据和脑网络影像学标记，也是语言功能损伤及重塑内在的机制探索。.