MAPPING ELOQUENT CORTEX USING RESTING STATE CORTICAL PHYSIOLOGY

使用静息态皮质生理学绘制雄辩皮质图

• 批准号: 8256952
• 负责人: Eric CLAUDE Leuthardt
• 金额: $ 30.85万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-26 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8256952
• 关键词: Adult; Anatomy; Anesthesia procedures; Architecture; Area; Biological Preservation; Brain; Brain Mapping; Brain Neoplasms; Brain Part; Child; Clinical; Cognitive; Conscious; Craniotomy; Data; Diagnosis; Enrollment; Evaluation; Excision; Functional Magnetic Resonance Imaging; Future; General Anesthesia; Glioma; Goals; Gold; Individual; Language; Lesion; Location; Magnetic Resonance Imaging; Maps; Methodology; Methods; Mission; Motor; National Cancer Institute; Neurosurgeon; Newly Diagnosed; Operative Surgical Procedures; Outcome; Outcome Study; Patient Participation; Patients; Physiology; Public Health; Research; Rest; Seeds; Signal Transduction; Site; Speech; Staging; Sum; Techniques; Testing; Work; awake; base; compliance behavior; improved; innovation; novel strategies; patient population; response; tumor

DESCRIPTION (provided by applicant): A challenge in the surgical treatment of brain tumors is to preserve eloquent areas of brain function while maximizing extent of resection. To do so, current pre-operative and intra- operative brain mapping techniques require active patient participation, which limits their use in a significant number of patients (e.g. children). This limitation prohibits an optimal resection. There is an urgent need to develop brain mapping methodologies that can be used in all patients, can be performed both pre- and intra-operatively, and can be used in the setting of general anesthesia. New approaches based on resting state cortical physiology, such as functional connectivity MRI (fcMRI) and slow cortical potential mapping (SCPM), are emerging as techniques to identify motor and speech networks. The long-term goal of our research is to achieve more effective resections in a broader patient population with brain tumors near eloquent cortex by improving pre- and intra-operative mapping. The overall objective of this application is to define within patients with gliomas the correspondence between functional sites identified with resting state approaches to those areas identified by more established methods of pre-operative and intra-operative localization. The central hypothesis is that pre-operative fcMRI and intra-operative SCPM while under anesthesia will identify anatomic locations of eloquent cortex that are consistent with sites using the gold standard methods of pre-operative (task-based fMRI) and intra-operative (direct electrocortical stimulation, DECS) functional localization and with each other. The rationale that underlies this proposal is that this project wll provide a validated method of pre- and intra-operative brain mapping that can be done under anesthesia and in the absence of patient participation which will set the stage for more definitive clinical outcome studies in the future. We will test our central hypotheses with the following three specific aims: 1) Identify motor and language cortex in proximity to brain tumors using pre- operative resting state functional connectivity magnetic resonance imaging (fcMRI), 2) Identify motor and language cortex in proximity to brain tumors under anesthesia using intra-operative slow cortical potential mapping (SCPM), and 3) Define concordance between functional regions identified with fcMRI and SCPM in identifying DECS positive sites. We will implement these aims by enrolling 20 adults subjects with newly diagnosed primary gliomas that are to undergo surgical resection with intra-operative DECS. Using methods developed by our labs, each patient will get pre-operative fcfMRI and intra-operative SCPM and these findings will then be used to predict sites defined by current gold standard techniques. This project is innovative because these findings will provide a wholly new approach that is independent of patient state, does not require DECS, and can potentially be used to identify networks not currently mapped. Thus, this project is significant because resting-state mapping will obviate the need for patient participation/consciousness to successfully identify critical functional sites in the context of a brain tumor. In sum, such capabilities will make a larger patient population amenable to more effective resections and reduce individual and collective burden of brain tumors. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because when brain tumors are diagnosed in critical parts of the brain, such as the motor or language areas, it is important for the neurosurgeon to know exactly where these areas are located in order to avoid damaging them during the tumor resection. Current methods for mapping these regions are limited to patients than can cooperate with the exam and cannot be performed in children or in patients that are confused or sedated. Consistent with the National Cancer Institute's mission, by developing brain mapping techniques that use resting state brain signals alone which do not require patient participation or consciousness, this project will greatly enhance the ability for more effective surgical treatments of brain tumors and be applicable to a broader patient population.

描述（由申请人提供）： 手术治疗脑肿瘤的挑战是保持雄性大脑功能区域，同时最大程度地切除范围。为此，当前的术前和手术内脑图技术需要积极的患者参与，这限制了他们在大量患者（例如儿童）中的使用。这种限制禁止最佳切除。迫切需要开发可以在所有患者中使用的大脑映射方法，可以术前和术中进行，并且可以在全身麻醉的情况下使用。基于静止状态皮质生理学的新方法，例如功能连通性MRI（FCMRI）和慢速皮质势映射（SCPM），正在作为识别运动和语音网络的技术出现。我们研究的长期目标是通过改善术前和术中映射，在更广泛的患者人群中实现更有效的切除率。该应用的总体目的是定义胶质瘤患者的对应位置之间的对应关系，该功能位点与静止状态方法鉴定出通过更确定的术前和术中定位方法确定的那些区域。中心假设是，在麻醉下进行术前的FCMRI和术中SCPM，将确定具有雄辩皮层的解剖位置，这些位置与使用术前（基于任务的FMRI）的金标准方法一致的位点是一致的，并且是术中（直接术内）（直接触电刺激，DECS，DECS）的功能定位和其他相同的定位。该提案基于该建议的基本原理是，该项目提供了一种经过验证的术前和术中大脑映射的方法，可以在麻醉下进行，并且在没有患者参与的情况下可以为更明确的阶段奠定阶段 未来的临床结果研究。我们将使用以下三个特定目的测试中心假设：1）使用前手术静止状态功能连通性磁共振成像（FCMRI），确定与脑瘤的运动和语言皮质相对于脑肿瘤的接近（FCMRI），2）确定运动和语言皮质在脑部和语言皮质中，在麻醉下使用缓慢的细胞和3个脑部的脑部肿瘤（Scpm）consection（Scpm）（Scpm），Scpm（Scpm）（Scpm），Scpm conseptional neastione nectiage nike nike nightition noute Complative Image Imake night intagitive磁共振成像（FCMRI）（用FCMRI和SCPM鉴定在识别DECS阳性位点时识别。我们将通过招募有20名具有新诊断的原发性神经膜瘤的成年受试者来实现这些目标，这些受试者将接受手术切除术，并进行手术内部的DEC。使用我们实验室开发的方法，每个患者将获得术前的FCFMRI和术中SCPM，然后这些发现将用于预测由当前金标准技术定义的位点。该项目具有创新性，因为这些发现将提供一种完全独立于患者状态的新方法，不需要DEC，并且有可能用于识别目前尚未映射的网络。因此，该项目很重要，因为静止状态映射将消除患者参与/意识的需求，以便在脑肿瘤的背景下成功识别关键功能部位。总而言之，这种能力将使更大的患者人群适合更有效的切除术，并减轻脑肿瘤的个体和集体负担。 公共卫生相关性：拟议的研究与公共卫生有关，因为当在大脑的关键部位（例如运动或语言领域）诊断出脑肿瘤时，对于神经外科医生来说，确切知道这些区域的位置很重要，以避免在肿瘤切除期间损害它们。当前的映射这些区域的方法仅限于患者，而不是可以与考试合作，在儿童或混淆或镇静的患者中不能进行。与国家癌症研究所的使命一致，通过开发仅使用静止状态脑信号的大脑映射技术，这些技术不需要患者参与或意识，该项目将大大增强对脑肿瘤更有效的手术治疗的能力，并适用于更广泛的患者人群。