在第一阶段前手术检查期间进行儿科功能语言和记忆映射的临床建议
Alyssa Ailion1,2, Priscilla Duong3, Moshe Maiman1
1Department of Psychiatry, Boston Children's Hospital, Harvard Medical School.
The Clinical neuropsychologist
|November 21, 2023
概括
儿童手术可能会导致认知能力下降,特别是在左叶切除后. 一个新的决策树有助于指导使用内麻醉程序 (IAP) 和前手术评估的其他映射技术.
科学领域:
- 神经科学是一个神经科学.
- 发病学 (Epileptology) 是一个专业的学科.
- 认知科学 认知科学
背景情况:
- 儿科手术可以控制发作,但会带来认知,语言和记忆缺陷的风险.
- 在历史上,内麻醉程序 (IAP) 或 Wada 测试对于评估语言和记忆功能至关重要.
- 像功能磁共振成像 (fMRI) 等非侵入性技术的进步已经减少了在术前评估中对IAP的依赖.
研究的目的:
- 批判性地审查用于小儿手术前评估的映射技术.
- 探索导致不同绘图方法之间不一致的因素.
- 引入一个决策树,以帮助IAP用于前手术.
主要方法:
- 进行了关于神经成像和功能映射技术的现有文献的批判性叙事审查.
- 分析了与后手术认知和语言结果相关的神经心理学发现.
- 开发了一个决策树,以解决手术前规划IAP决策中的不一致问题.
主要成果:
- 如果手术前功能完好无损,手术目标是雄辩的皮质,特别是在左前叶切除后,认知能力下降的可能性很大.
- 儿科患者的异常大脑组织可能导致不清楚的功能衰退风险和不一致的映射结果.
- 关于IAP和用于儿科的横向化/局部化新技术的联合使用的研究有限.
结论:
- 未来的研究必须专注于儿科患者群体,以提高功能映射精度和预测术后缺陷.
- 需要基于证据的指导方针来标准化映射程序,并解决新的和已建立的临床措施之间的冲突.
- 拟议的IAP决策树提供了一个标准化的方法,用于在多学科手术团队中整合IAP和侵入性映射.
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