儿童额部皮层造瘘术后脑认知功能损伤与修复机制的研究

Brain surgery in children usually causes cognitive impairment, and serious cases may bring heavy burden to family and society. Therefore, it is an important issue faced by pediatric neurosurgeons, brain cognition experts and parents to accurately evaluate children’s cognitive impairment after brain surgery, give them timely intervention and promote the repair of cognitive function. However, few relevant reports are available at present. Our previous studies found that children’s perceptual reasoning, processing speed and working memory abilities significantly declined after resection of lateral ventricular tumor by frontal transcortical approach. Since frontal transcortical approach is relatively fixed, children’s cognitive impairment may be specific. Moreover, the brain plasticity of children is better than that of adults. Therefore, early cognitive intervention may compensate and repair the cognitive impairment in children. This project intends to investigate and identify what kinds of specific cognitive impairment will be caused by frontal transcortical surgery, establish effective intervention methods accordingly, and then make quantitative evaluation based on neuroimaging parameters, so as to preliminarily establish an evaluation system for cognitive impairment and rehabilitation after frontal transcortical surgery in children. Successful implementation of this project will provide theoretical implications for surgeons in choosing surgical approach and predicting surgical risk. In addition, this project has importantly scientific value for understanding the plasticity of prefrontal cortex cognitive function. More importantly, for children after brain surgery, early recovery of cognitive function has great social significance.

儿童颅脑手术后通常会产生认知功能障碍，严重者给家庭和社会造成沉重的负担。因此，准确评估儿童颅脑手术后认知功能损伤并及时干预、促进修复，成为小儿神经外科医生、脑认知专家及患儿家长共同面临的重大问题，但目前相关研究未见报道。我们之前研究发现，经前额叶皮层造瘘入路切除侧脑室肿瘤，使患儿在知觉推理、加工速度与工作记忆等能力明显降低。鉴于该术式路径相对固定，可能会造成患儿特异性的认知损伤，而儿童脑功能的可塑性较成年人更强，此类损伤有可能通过早期认知干预得到补偿与修复。本项目拟研究额部皮层造瘘术引起哪些特异性认知损伤，建立有效的干预方法，并通过影像学指标进行定量评估，初步建立儿童额部皮层造瘘术后认知功能损伤及康复的评价体系。项目顺利实施，不仅为外科医生选择手术入路、预估手术风险提供理论依据，而且对理解前额叶皮层认知功能的可塑性具有重要科学意义，更需强调，颅脑术后患儿认知功能损伤的尽早康复，社会意义重大

儿童颅脑手术后通常会产生认知功能障碍，明显影响患儿的生存质量，给家庭和社会造成沉重的负担。因此，准确评估儿童颅脑手术围手术期的认知障碍并及时干预、促进修复，成为小儿神经外科医生、脑认知专家及患儿家长共同面临的重大问题。本项目的主要研究内容包括额叶肿瘤患儿的手术前认知评估、手术后脑网络自修复、认知预后预测及康复三方面。（1）手术前认知评估：本项目在颅内病变患儿的认知研究中发现，患儿的流体智力下降明显，以记忆力受损为主。根据研究结果，本项目研发了《儿童颅内病变认知测试集（天坛版）》。《测试集》包括以下五个认知领域：感知能力、注意能力、记忆能力、执行功能、情绪识别。《测试集》在颅内病变患儿中具有较高的敏感性，且重测效应较低，可用于围手术期的快速评估。（2）手术后脑网络自修复：本项目对额叶病变患儿进行术后的纵向追踪随访发现，术后0-3个月内认知功能和脑网络的变化可能类似于衰老，在此期间患儿的精神运动速度明显受损，感觉运动网络和枕叶网络激活降低；术后3-6个月，额叶肿瘤患儿术后运动速度可以显著恢复，脑网络分析提示临近脑组织的“板块扩张”显示代偿了额叶功能的缺失。本项目的研究结果提示额叶肿瘤患儿围手术期的脑重塑与额顶网络-感觉运动网络-基底节的功能连接改变相关。（3）认知预后预测及康复：本项目对额叶肿瘤患儿与正常儿童进行横向比较发现，额叶肿瘤患儿的记忆功能明显受损，但注意力与正常儿童相似。功能磁共振显示，额叶肿瘤患儿默认网络-感觉运动网络存在“旁路代偿”的脑重塑现象。默认网络的功能连接可能是额叶肿瘤患儿认知功能重塑的重要预测指标之一。为了解决脑肿瘤患儿术后记忆力缺损的问题，我们研发了适合6-16岁患儿的《儿童颅脑术后记忆力康复训练集（天坛版）》。本项目成果为外科医生选择手术入路、预估手术风险、术后认知康复提供理论依据，而且对理解额叶认知功能的可塑性具有重要科学意义。