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Прехирургическое картирование речевых зон коры головного мозга с помощью фМРТ: актуальное состояние и тенденции

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Прехирургическое картирование областей мозга, критически важных для осуществления речевых функций, направлено на минимизацию повреждения этих областей во время нейрохирургического вмешательства у пациентов с опухолями головного мозга и фармакорезистентной эпилепсией и тем самым на сохранение качества их жизни. Две основных задачи картирования речи - это определение локализации и латерализации речевых зон, “золотыми стандартами” для решения которых являются интраоперационное картирование (ИОК) и проба Вада соответственно. Однако ряд ограничений этих методов обусловливает целесообразность неинвазивного предварительного картирования речи, для которого в последние годы наиболее широко используется функциональная МРТ (фМРТ). Проведенный обзор литературы сосредоточен на нововведениях и актуальных тенденциях, которые получили распространение в области фМРТ-картирования речи за последнее десятилетие. В статье кратко изложено текущее состояние представлений о мозговой организации речевых функций, лежащих в основе картирования речи с применением фМРТ. Рассматриваются современные исследования валидности результатов фМРТ, касающихся локализации и латерализации речевых областей. Отдельно обсуждаются такие тактики прехирургического картирования речи, как дополнение фМРТ-данных результатами трактографии, комбинированный анализ фМРТ-проб и использование фМРТ покоя. Перечисляются и описываются устоявшиеся фМРТ-пробы для картирования зон, связанных с порождением и восприятием речи, и новые экспериментальные разработки в этой области.

Ключевые слова:
функционально значимые зоны, нейрохирургия, функциональное картирование мозга, речь, фМРТ, eloquent cortex, neurosurgery, functional brain mapping, language, fMRI

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Presurgical brain mapping of language processing with fMRI: state of the art and tendencies

Presurgical brain mapping of language-eloquent cortex aims to minimize its injury during neurosurgery in patients with brain tumors and drug-resistant epilepsy, and thereby, to preserve their quality of life. Two main goals of language mapping are to identify the localization and lateralization of brain regions involved in language. Gold standards for them are the intraoperative mapping and Wada test, respectively; however, due to some limitations of these techniques, non-invasive preliminary language mapping becomes reasonable. During the last years, fMRI has been widely applied for such purposes. Our literature review focuses on innovations and actual tendencies which spread in the field of language mapping via fMRI in the last decade. State-of-the-art knowledge on brain organization of language, which underpins brain mapping of language processing via fMRI, is briefly described in the article. Contemporary studies of fMRI validity in localization and lateralization of language brain regions are considered. Strategies of presurgical language mapping, such as application of tractography in addition to fMRI, combined analysis of fMRI tasks as well as resting-state fMRI are also discussed. Well-established fMRI tasks for brain mapping of language production and comprehension, as well as new experimental developments in this field, are listed and described.

Keywords:
функционально значимые зоны, нейрохирургия, функциональное картирование мозга, речь, фМРТ, eloquent cortex, neurosurgery, functional brain mapping, language, fMRI