1
|
Castellucci GA, Kovach CK, Tabasi F, Christianson D, Greenlee JDW, Long MA. Stimulation of caudal inferior and middle frontal gyri disrupts planning during spoken interaction. Curr Biol 2024; 34:2719-2727.e5. [PMID: 38823382 PMCID: PMC11187660 DOI: 10.1016/j.cub.2024.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/06/2024] [Accepted: 04/30/2024] [Indexed: 06/03/2024]
Abstract
Turn-taking is a central feature of conversation across languages and cultures.1,2,3,4 This key social behavior requires numerous sensorimotor and cognitive operations1,5,6 that can be organized into three general phases: comprehension of a partner's turn, preparation of a speaker's own turn, and execution of that turn. Using intracranial electrocorticography, we recently demonstrated that neural activity related to these phases is functionally distinct during turn-taking.7 In particular, networks active during the perceptual and articulatory stages of turn-taking consisted of structures known to be important for speech-related sensory and motor processing,8,9,10,11,12,13,14,15,16,17 while putative planning dynamics were most regularly observed in the caudal inferior frontal gyrus (cIFG) and the middle frontal gyrus (cMFG). To test if these structures are necessary for planning during spoken interaction, we used direct electrical stimulation (DES) to transiently perturb cortical function in neurosurgical patient-volunteers performing a question-answer task.7,18,19 We found that stimulating the cIFG and cMFG led to various response errors9,13,20,21 but not gross articulatory deficits, which instead resulted from DES of structures involved in motor control8,13,20,22 (e.g., the precentral gyrus). Furthermore, perturbation of the cIFG and cMFG delayed inter-speaker timing-consistent with slowed planning-while faster responses could result from stimulation of sites located in other areas. Taken together, our findings suggest that the cIFG and cMFG contain critical preparatory circuits that are relevant for interactive language use.
Collapse
Affiliation(s)
- Gregg A Castellucci
- NYU Neuroscience Institute and Department of Otolaryngology, New York University Langone Medical Center, New York, NY 10016, USA; Center for Neural Science, New York University, New York, NY 10003, USA
| | - Christopher K Kovach
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Farhad Tabasi
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - David Christianson
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; Iowa Neuroscience Institute, Iowa City, IA 52242, USA
| | - Michael A Long
- NYU Neuroscience Institute and Department of Otolaryngology, New York University Langone Medical Center, New York, NY 10016, USA; Center for Neural Science, New York University, New York, NY 10003, USA.
| |
Collapse
|
2
|
Roelofs A. Wernicke's functional neuroanatomy model of language turns 150: what became of its psychological reflex arcs? Brain Struct Funct 2024:10.1007/s00429-024-02785-5. [PMID: 38581582 DOI: 10.1007/s00429-024-02785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
Wernicke (Der aphasische Symptomencomplex: Eine psychologische Studie auf anatomischer Basis. Cohn und Weigert, Breslau. https://wellcomecollection.org/works/dwv5w9rw , 1874) proposed a model of the functional neuroanatomy of spoken word repetition, production, and comprehension. At the heart of this epoch-making model are psychological reflex arcs underpinned by fiber tracts connecting sensory to motor areas. Here, I evaluate the central assumption of psychological reflex arcs in light of what we have learned about language in the brain during the past 150 years. I first describe Wernicke's 1874 model and the evidence he presented for it. Next, I discuss his updates of the model published in 1886 and posthumously in 1906. Although the model had an enormous immediate impact, it lost influence after the First World War. Unresolved issues included the anatomical underpinnings of the psychological reflex arcs, the role of auditory images in word production, and the sufficiency of psychological reflex arcs, which was questioned by Wundt (Grundzüge der physiologischen Psychologie. Engelmann, Leipzig. http://vlp.mpiwg-berlin.mpg.de/references?id=lit46 , 1874; Grundzüge der physiologischen Psychologie (Vol. 1, 5th ed.). Engelmann, Leipzig. http://vlp.mpiwg-berlin.mpg.de/references?id=lit806 , 1902). After a long dormant period, Wernicke's model was revived by Geschwind (Science 170:940-944. https://doi.org/10.1126/science.170.3961.940 , 1970; Selected papers on language and the brain. Reidel, Dordrecht, 1974), who proposed a version of it that differed in several important respects from Wernicke's original. Finally, I describe how new evidence from modern research has led to a novel view on language in the brain, supplementing contemporary equivalents of psychological reflex arcs by other mechanisms such as attentional control and assuming different neuroanatomical underpinnings. In support of this novel view, I report new analyses of patient data and computer simulations using the WEAVER++/ARC model (Roelofs 2014, 2022) that incorporates attentional control and integrates the new evidence.
Collapse
Affiliation(s)
- Ardi Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, The Netherlands.
| |
Collapse
|
3
|
Castellucci GA, Kovach CK, Tabasi F, Christianson D, Greenlee JD, Long MA. A frontal cortical network is critical for language planning during spoken interaction. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.26.554639. [PMID: 37693383 PMCID: PMC10491113 DOI: 10.1101/2023.08.26.554639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Many brain areas exhibit activity correlated with language planning, but the impact of these dynamics on spoken interaction remains unclear. Here we use direct electrical stimulation to transiently perturb cortical function in neurosurgical patient-volunteers performing a question-answer task. Stimulating structures involved in speech motor function evoked diverse articulatory deficits, while perturbations of caudal inferior and middle frontal gyri - which exhibit preparatory activity during conversational turn-taking - led to response errors. Perturbation of the same planning-related frontal regions slowed inter-speaker timing, while faster responses could result from stimulation of sites located in other areas. Taken together, these findings further indicate that caudal inferior and middle frontal gyri constitute a critical planning network essential for interactive language use.
Collapse
|
4
|
De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
Collapse
Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | | |
Collapse
|
5
|
Facchini S, Favaretto C, Castellaro M, Zangrossi A, Zannin M, Bisogno AL, Baro V, Anglani MG, Vallesi A, Baracchini C, D'Avella D, Della Puppa A, Semenza C, Corbetta M. A common low dimensional structure of cognitive impairment in stroke and brain tumors. Neuroimage Clin 2023; 40:103518. [PMID: 37778195 PMCID: PMC10562193 DOI: 10.1016/j.nicl.2023.103518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Neuropsychological studies infer brain-behavior relationships from focal lesions like stroke and tumors. However, these pathologies impair brain function through different mechanisms even when they occur at the same brain's location. The aim of this study was to compare the profile of cognitive impairment in patients with brain tumors vs. stroke and examine the correlation with lesion location in each pathology. METHODS Patients with first time stroke (n = 77) or newly diagnosed brain tumors (n = 76) were assessed with a neuropsychological battery. Their lesions were mapped with MRI scans. Test scores were analyzed using principal component analysis (PCA) to measure their correlation, and logistic regression to examine differences between pathologies. Next, with ridge regression we examined whether lesion features (location, volume) were associated with behavioral performance. RESULTS The PCA showed a similar cognitive impairment profile in tumors and strokes with three principal components (PCs) accounting for about half of the individual variance. PC1 loaded on language, verbal memory, and executive/working memory; PC2 loaded on general performance, visuo-spatial attention and memory, and executive functions; and, PC3 loaded on calculation, reading and visuo-spatial attention. The average lesion distribution was different, and lesion location was correlated with cognitive deficits only in stroke. Logistic regression found language and calculation more affected in stroke, and verbal memory and verbal fluency more affected in tumors. CONCLUSIONS A similar low dimensional set of behavioral impairments was found both in stroke and brain tumors, even though each pathology caused some specific deficits in different domains. The lesion distribution was different for stroke and tumors and correlated with behavioral impairment only in stroke.
Collapse
Affiliation(s)
- Silvia Facchini
- Clinica Neurologica, Azienda Ospedale Università Padova, and Department of Neuroscience, University of Padua, Italy
| | | | - Marco Castellaro
- Department of Information Engineering, University of Padua, Italy
| | | | - Margherita Zannin
- Clinica Neurologica, Azienda Ospedale Università Padova, and Department of Neuroscience, University of Padua, Italy
| | - Antonio Luigi Bisogno
- Clinica Neurologica, Azienda Ospedale Università Padova, and Department of Neuroscience, University of Padua, Italy
| | - Valentina Baro
- Paediatric and Functional Neurosurgery Unit, Azienda Ospedale Università Padova, and Department of Neuroscience, University of Padua, Italy
| | | | - Antonio Vallesi
- Clinica Neurologica, Azienda Ospedale Università Padova, and Department of Neuroscience, University of Padua, Italy; Padova Neuroscience Center (PNC), University of Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Azienda Ospedale Università Padova, Padua, Italy
| | - Domenico D'Avella
- Paediatric and Functional Neurosurgery Unit, Azienda Ospedale Università Padova, and Department of Neuroscience, University of Padua, Italy
| | - Alessandro Della Puppa
- Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Italy
| | - Carlo Semenza
- Clinica Neurologica, Azienda Ospedale Università Padova, and Department of Neuroscience, University of Padua, Italy; Padova Neuroscience Center (PNC), University of Padua, Italy
| | - Maurizio Corbetta
- Clinica Neurologica, Azienda Ospedale Università Padova, and Department of Neuroscience, University of Padua, Italy; Padova Neuroscience Center (PNC), University of Padua, Italy; Venetian Institute of Molecular Medicine, VIMM, Padua, Italy.
| |
Collapse
|
6
|
Vavassori L, Venturini M, Zigiotto L, Annicchiarico L, Corsini F, Avesani P, Petit L, De Benedictis A, Sarubbo S. The arcuate fasciculus: Combining structure and function into surgical considerations. Brain Behav 2023; 13:e3107. [PMID: 37280786 PMCID: PMC10454270 DOI: 10.1002/brb3.3107] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/19/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Two Centuries from today, Karl Friedrich Burdach attributed the nomenclature "arcuate fasciculus" to a white matter (WM) pathway connecting the frontal to the temporal cortices by arching around the Sylvian fissure. Although this label remained essentially unvaried, the concepts related to it and the characterization of the structural properties of this bundle evolved along with the methodological progress of the past years. Concurrently, the functional relevance of the arcuate fasciculus (AF) classically restricted to the linguistic domain has extended to further cognitive abilities. These features make it a relevant structure to consider in a large variety of neurosurgical procedures. OBJECTIVE Herein, we build on our previous review uncovering the connectivity provided by the Superior Longitudinal System, including the AF, and provide a handy representation of the structural organization of the AF by considering the frequency of defined reports in the literature. By adopting the same approach, we implement an account of which functions are mediated by this WM bundle. We highlight how this information can be transferred to the neurosurgical field by presenting four surgical cases of glioma resection requiring the evaluation of the relationship between the AF and the nearby structures, and the safest approaches to adopt. CONCLUSIONS Our cumulative overview reports the most common wiring patterns and functional implications to be expected when approaching the study of the AF, while still considering seldom descriptions as an account of interindividual variability. Given its extension and the variety of cortical territories it reaches, the AF is a pivotal structure for different cognitive functions, and thorough understanding of its structural wiring and the functions it mediates is necessary for preserving the patient's cognitive abilities during glioma resection.
Collapse
Affiliation(s)
- Laura Vavassori
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
- Center for Mind and Brain Sciences (CIMeC)University of TrentoTrento Provincia Autonoma di TrentoItaly
| | - Martina Venturini
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Luca Zigiotto
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Luciano Annicchiarico
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Francesco Corsini
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Paolo Avesani
- Center for Mind and Brain Sciences (CIMeC)University of TrentoTrento Provincia Autonoma di TrentoItaly
- Neuroinfrmatics Laboratory (NiLab)Bruno Kessler FoundationPovo Provincia Autonoma di TrentoItaly
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives (GIN‐IMN), UMR5293, CNRS, CEAUniversity of BordeauxBordeauxFrance
| | | | - Silvio Sarubbo
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| |
Collapse
|
7
|
Bonosi L, Musso S, Cusimano LM, Porzio M, Giovannini EA, Benigno UE, Giammalva GR, Gerardi RM, Brunasso L, Costanzo R, Paolini F, Sciortino A, Campisi BM, Giardina K, Scalia G, Iacopino DG, Maugeri R. The role of neuronal plasticity in cervical spondylotic myelopathy surgery: functional assessment and prognostic implication. Neurosurg Rev 2023; 46:149. [PMID: 37358655 PMCID: PMC10293440 DOI: 10.1007/s10143-023-02062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Cervical spondylotic myelopathy (CSM) is a degenerative disease representing the most common spinal cord disorder in the adult population. It is characterized by chronic compression leading to neurological dysfunction due to static and dynamic injury of the spinal cord in cervical spine. These insidious damage mechanisms can result in the reorganization of cortical and subcortical areas. The cerebral cortex can reorganize due to spinal cord injury and may play a role in preserving neurological function. To date, the gold standard treatment of cervical myelopathy is surgery, comprising anterior, posterior, and combined approaches. However, the complex physiologic recovery processes involving cortical and subcortical neural reorganization following surgery are still inadequately understood. It has been demonstrated that diffusion MRI and functional imaging and techniques, such as transcranial magnetic stimulation (TMS) or functional magnetic resonance imaging (fMRI), can provide new insights into the diagnosis and prognosis of CSM. This review aims to shed light on the state-of-the-art regarding the pattern of cortical and subcortical areas reorganization and recovery before and after surgery in CSM patients, underlighting the critical role of neuroplasticity.
Collapse
Affiliation(s)
- Lapo Bonosi
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy.
| | - Sofia Musso
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Luigi Maria Cusimano
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Massimiliano Porzio
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Evier Andrea Giovannini
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Umberto Emanuele Benigno
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Giuseppe Roberto Giammalva
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Rosa Maria Gerardi
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Federica Paolini
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Andrea Sciortino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Benedetta Maria Campisi
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Kevin Giardina
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, ARNAS Garibaldi, P.O. Garibaldi Nesima, 95122, Catania, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| |
Collapse
|
8
|
Sarubbo S, Venturini M, Avesani P, Duffau H. In Reply: Planning Brain Tumor Resection Using a Probabilistic Atlas of Cortical and Subcortical Structures Critical for Functional Processing: A Proof of Concept. Oper Neurosurg (Hagerstown) 2023; 24:e246-e247. [PMID: 36716037 DOI: 10.1227/ons.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 01/31/2023] Open
Affiliation(s)
- Silvio Sarubbo
- Department of Neurosurgery, Azienda Provinciale peri Servizi Sanitari (APSS), "S. Chiara" Hospital, Trento, Italy
| | - Martina Venturini
- Department of Neurosurgery, Azienda Provinciale peri Servizi Sanitari (APSS), "S. Chiara" Hospital, Trento, Italy
| | - Paolo Avesani
- Neuroinformatic Laboratory, Bruno Kessler Foundation, Trento Italy
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, University of Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Montpellier, France
| |
Collapse
|
9
|
Sleurs C, Zegers CML, Compter I, Dijkstra J, Anten MHME, Postma AA, Schijns OEMG, Hoeben A, Sitskoorn MM, De Baene W, De Roeck L, Sunaert S, Van Elmpt W, Lambrecht M, Eekers DBP. Neurocognition in adults with intracranial tumors: does location really matter? J Neurooncol 2022; 160:619-629. [PMID: 36346497 PMCID: PMC9758085 DOI: 10.1007/s11060-022-04181-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/22/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE As preservation of cognitive functioning increasingly becomes important in the light of ameliorated survival after intracranial tumor treatments, identification of eloquent brain areas would enable optimization of these treatments. METHODS This cohort study enrolled adult intracranial tumor patients who received neuropsychological assessments pre-irradiation, estimating processing speed, verbal fluency and memory. Anatomical magnetic resonance imaging scans were used for multivariate voxel-wise lesion-symptom predictions of the test scores (corrected for age, gender, educational level, histological subtype, surgery, and tumor volume). Potential effects of histological and molecular subtype and corresponding WHO grades on the risk of cognitive impairment were investigated using Chi square tests. P-values were adjusted for multiple comparisons (p < .001 and p < .05 for voxel- and cluster-level, resp.). RESULTS A cohort of 179 intracranial tumor patients was included [aged 19-85 years, median age (SD) = 58.46 (14.62), 50% females]. In this cohort, test-specific impairment was detected in 20-30% of patients. Higher WHO grade was associated with lower processing speed, cognitive flexibility and delayed memory in gliomas, while no acute surgery-effects were found. No grading, nor surgery effects were found in meningiomas. The voxel-wise analyses showed that tumor locations in left temporal areas and right temporo-parietal areas were related to verbal memory and processing speed, respectively. INTERPRETATION Patients with intracranial tumors affecting the left temporal areas and right temporo-parietal areas might specifically be vulnerable for lower verbal memory and processing speed. These specific patients at-risk might benefit from early-stage interventions. Furthermore, based on future validation studies, imaging-informed surgical and radiotherapy planning could further be improved.
Collapse
Affiliation(s)
- Charlotte Sleurs
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands.
- Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Catharina M L Zegers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Inge Compter
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jeanette Dijkstra
- Department of Medical Psychology, Maastricht University Medical Center+, MHeNs School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Monique H M E Anten
- Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, MHeNs School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Olaf E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center+, MHeNs School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Ann Hoeben
- Division of Medical Oncology, Department of Internal Medicine, GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Margriet M Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Wouter De Baene
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | | | - Stefan Sunaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Wouter Van Elmpt
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Daniëlle B P Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
10
|
Suarez-Meade P, Marenco-Hillembrand L, Sabsevitz D, Okromelidze L, Blake Perdikis B, Sherman WJ, Quinones-Hinojosa A, Middlebrooks EH, Chaichana KL. Surgical Resection of Gliomas in the Dominant Inferior Frontal Gyrus: Consecutive Case Series and Anatomy Review of Broca’s Area. Clin Neurol Neurosurg 2022; 223:107512. [DOI: 10.1016/j.clineuro.2022.107512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
|
11
|
Massot-Tarrús A, Mirsattari SM. Roles of fMRI and Wada tests in the presurgical evaluation of language functions in temporal lobe epilepsy. Front Neurol 2022; 13:884730. [PMID: 36247757 PMCID: PMC9562037 DOI: 10.3389/fneur.2022.884730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
Surgical treatment of pharmacoresistant temporal lobe epilepsy (TLE) carries risks for language function that can significantly affect the quality of life. Predicting the risks of decline in language functions before surgery is, consequently, just as important as predicting the chances of becoming seizure-free. The intracarotid amobarbital test, generally known as the Wada test (WT), has been traditionally used to determine language lateralization and to estimate their potential decline after surgery. However, the test is invasive and it does not localize the language functions. Therefore, other noninvasive methods have been proposed, of which functional magnetic resonance (fMRI) has the greatest potential. Functional MRI allows localization of language areas. It has good concordance with the WT for language lateralization, and it is of predictive value for postsurgical naming outcomes. Consequently, fMRI has progressively replaced WT for presurgical language evaluation. The objective of this manuscript is to review the most relevant aspects of language functions in TLE and the current role of fMRI and WT in the presurgical evaluation of language. First, we will provide context by revising the language network distribution and the effects of TLE on them. Then, we will assess the functional outcomes following various forms of TLE surgery and measures to reduce postoperative language decline. Finally, we will discuss the current indications for WT and fMRI and the potential usefulness of the resting-state fMRI technique.
Collapse
Affiliation(s)
| | - Seyed M. Mirsattari
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| |
Collapse
|
12
|
Structural Brain Asymmetries for Language: A Comparative Approach across Primates. Symmetry (Basel) 2022. [DOI: 10.3390/sym14050876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Humans are the only species that can speak. Nonhuman primates, however, share some ‘domain-general’ cognitive properties that are essential to language processes. Whether these shared cognitive properties between humans and nonhuman primates are the results of a continuous evolution [homologies] or of a convergent evolution [analogies] remain difficult to demonstrate. However, comparing their respective underlying structure—the brain—to determinate their similarity or their divergence across species is critical to help increase the probability of either of the two hypotheses, respectively. Key areas associated with language processes are the Planum Temporale, Broca’s Area, the Arcuate Fasciculus, Cingulate Sulcus, The Insula, Superior Temporal Sulcus, the Inferior Parietal lobe, and the Central Sulcus. These structures share a fundamental feature: They are functionally and structurally specialised to one hemisphere. Interestingly, several nonhuman primate species, such as chimpanzees and baboons, show human-like structural brain asymmetries for areas homologous to key language regions. The question then arises: for what function did these asymmetries arise in non-linguistic primates, if not for language per se? In an attempt to provide some answers, we review the literature on the lateralisation of the gestural communication system, which may represent the missing behavioural link to brain asymmetries for language area’s homologues in our common ancestor.
Collapse
|
13
|
Le Lann F, Cristante J, De Schlichting E, Quehan R, Réhault E, Lotterie JA, Roux FE. Variability of Intraoperative Electrostimulation Parameters in Conscious Individuals: Language Fasciculi. World Neurosurg 2022; 164:e194-e202. [PMID: 35472645 DOI: 10.1016/j.wneu.2022.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The authors analyzed the current-intensity thresholds for electrostimulation of language fasciculi and the possible consequences of threshold variability on brain mapping. METHODS A prospective protocol of subcortical electrostimulation was used in 50 patients undergoing brain mapping, directly stimulating presumed language fasciculi identified by diffusion tensor imaging. RESULTS The stimulation-intensity thresholds for identification of language fasciculi varied among patients (mean minimum current intensity of 4.4 mA, range = 1.5-10 mA, standard deviation = 1.1 mA), and 23% of fascicular interferences were detected only above 5 mA. Repeated stimulation of the same site with the same intensity led to different types of interferences in 20% of patients, and a higher current intensity led to changes in the type of response in 27%. The mean minimum stimulation intensities did not differ significantly between different fasciculi, between the different types of interference obtained, or with age, sex, or type of tumor. Positive results on cortical mapping were significantly associated with positive results on subcortical mapping (P < 0.001). Subcortical intensity thresholds were slightly lower than cortical ones (mean = 4.43 vs. 5.25 mA, P = 0.034). In 23 of 50 subcortical mappings, fascicular stimulation produced no language interference. CONCLUSIONS Individual variability of minimum stimulation-intensity thresholds for identification of language fasciculi is frequent. Nevertheless, even when a high current intensity was used, many stimulations on language fasciculi remained negative for various hypothetic reasons. Finding the optimal current intensity for identifying language fasciculi is of paramount importance to refine the clinical results and scientific data derived from brain mapping.
Collapse
Affiliation(s)
- Florian Le Lann
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France.
| | | | - Emmanuel De Schlichting
- Université Grenoble Alpes, Faculté de Médecine, Grenoble, France; Neurochirurgie, Centre Hospitalo-Universitaire de Grenoble, Toulouse, France
| | - Romain Quehan
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France
| | - Emilie Réhault
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Jean-Albert Lotterie
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France
| | - Franck-Emmanuel Roux
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France; Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France
| |
Collapse
|
14
|
Current Status of Neuromodulation-Induced Cortical Prehabilitation and Considerations for Treatment Pathways in Lower-Grade Glioma Surgery. LIFE (BASEL, SWITZERLAND) 2022; 12:life12040466. [PMID: 35454957 PMCID: PMC9024440 DOI: 10.3390/life12040466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/19/2022] [Accepted: 03/19/2022] [Indexed: 12/15/2022]
Abstract
The infiltrative character of supratentorial lower grade glioma makes it possible for eloquent neural pathways to remain within tumoural tissue, which renders complete surgical resection challenging. Neuromodulation-Induced Cortical Prehabilitation (NICP) is intended to reduce the likelihood of premeditated neurologic sequelae that otherwise would have resulted in extensive rehabilitation or permanent injury following surgery. This review aims to conceptualise current approaches involving Repetitive Transcranial Magnetic Stimulation (rTMS-NICP) and extraoperative Direct Cortical Stimulation (eDCS-NICP) for the purposes of inducing cortical reorganisation prior to surgery, with considerations derived from psychiatric, rehabilitative and electrophysiologic findings related to previous reports of prehabilitation. Despite the promise of reduced risk and incidence of neurologic injury in glioma surgery, the current data indicates a broad but compelling possibility of effective cortical prehabilitation relating to perisylvian cortex, though it remains an under-explored investigational tool. Preliminary findings may prove sufficient for the continued investigation of prehabilitation in small-volume lower-grade tumour or epilepsy patients. However, considering the very low number of peer-reviewed case reports, optimal stimulation parameters and duration of therapy necessary to catalyse functional reorganisation remain equivocal. The non-invasive nature and low risk profile of rTMS-NICP may permit larger sample sizes and control groups until such time that eDCS-NICP protocols can be further elucidated.
Collapse
|
15
|
TMS Seeded Diffusion Tensor Imaging Tractography Predicts Permanent Neurological Deficits. Cancers (Basel) 2022; 14:cancers14020340. [PMID: 35053503 PMCID: PMC8774180 DOI: 10.3390/cancers14020340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/01/2022] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary For brain tumor patients, surgeons must resect as much of the tumor as possible while preserving the patient’s function and quality of life. This requires preoperative imaging that accurately identifies important parts of the brain. Transcranial magnetic stimulation is a way of preoperatively finding the areas of the brain connected to motor function. However, few studies have investigated the accuracy and clinical relevance of the data. In this study, we examine the functional outcomes of patients who had TMS points resected and patients who did not. We aim to address key technical barriers to performing this analysis. We also aim to discern the appropriate role of TMS tractography in preoperative diagnostic imaging. Insights gained from this study can be used to select the right patients and plan for the optimal surgeries. Abstract Surgeons must optimize the onco-functional balance by maximizing the extent of resection and minimizing postoperative neurological morbidity. Optimal patient selection and surgical planning requires preoperative identification of nonresectable structures. Transcranial magnetic stimulation is a method of noninvasively mapping the cortical representations of the speech and motor systems. Despite recent promising data, its clinical relevance and appropriate role in a comprehensive mapping approach remains unknown. In this study, we aim to provide direct evidence regarding the clinical utility of transcranial magnetic stimulation by interrogating the eloquence of TMS points. Forty-two glioma patients were included in this retrospective study. We collected motor function outcomes 3 months postoperatively. We overlayed the postoperative MRI onto the preoperative MRI to visualize preoperative TMS points in the context of the surgical cavity. We then generated diffusion tensor imaging tractography to identify meaningful subsets of TMS points. We correlated the resection of preoperative imaging features with clinical outcomes. The resection of TMS-positive points was significantly predictive of permanent deficits (p = 0.05). However, four out of eight patients had TMS-positive points resected without a permanent deficit. DTI tractography at a 75% FA threshold identified which TMS points are essential and which are amenable to surgical resection. TMS combined with DTI tractography shows a significant prediction of postoperative neurological deficits with both a high positive predictive value and negative predictive value.
Collapse
|
16
|
Giampiccolo D, Nunes S, Cattaneo L, Sala F. Functional Approaches to the Surgery of Brain Gliomas. Adv Tech Stand Neurosurg 2022; 45:35-96. [PMID: 35976447 DOI: 10.1007/978-3-030-99166-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the surgery of gliomas, recent years have witnessed unprecedented theoretical and technical development, which extensively increased indication to surgery. On one hand, it has been solidly demonstrated the impact of gross total resection on life expectancy. On the other hand, the paradigm shift from classical cortical localization of brain function towards connectomics caused by the resurgence of awake surgery and the advent of tractography has permitted safer surgeries focused on subcortical white matter tracts preservation and allowed for surgical resections within regions, such as Broca's area or the primary motor cortex, which were previously deemed inoperable. Furthermore, new asleep electrophysiological techniques have been developed whenever awake surgery is not an option, such as operating in situations of poor compliance (including paediatric patients) or pre-existing neurological deficits. One such strategy is the use of intraoperative neurophysiological monitoring (IONM), enabling the identification and preservation of functionally defined, but anatomically ambiguous, cortico-subcortical structures through mapping and monitoring techniques. These advances tie in with novel challenges, specifically risk prediction and the impact of neuroplasticity, the indication for tumour resection beyond visible borders, or supratotal resection, and most of all, a reappraisal of the importance of the right hemisphere from early psychosurgery to mapping and preservation of social behaviour, executive control, and decision making.Here we review current advances and future perspectives in a functional approach to glioma surgery.
Collapse
Affiliation(s)
- Davide Giampiccolo
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, University of Verona, Verona, Italy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Institute of Neurosciences, Cleveland Clinic London, London, UK
| | - Sonia Nunes
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, University of Verona, Verona, Italy
| | - Luigi Cattaneo
- Center for Mind and Brain Sciences (CIMeC) and Center for Medical Sciences (CISMed), University of Trento, Trento, Italy
| | - Francesco Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, University of Verona, Verona, Italy.
| |
Collapse
|
17
|
Alves J, Cardoso M, Morgado M, De Witte E, Satoer D, Hall A, Jesus LMT. Language assessment in awake brain surgery: the Portuguese adaptation of the Dutch linguistic intraoperative protocol (DuLIP). CLINICAL LINGUISTICS & PHONETICS 2021; 35:1113-1131. [PMID: 33412951 DOI: 10.1080/02699206.2020.1868022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 06/12/2023]
Abstract
Awake brain surgery, combined with neurophysiological evaluation and intraoperative mapping, is one of the preferential lines of treatment when approaching low-grade gliomas. Speech and language assessment is used while applying Direct Electrical Stimulation (DES) and during the resection of a lesion/tumour, as it allows to establish related eloquent areas and optimise the extent of the resection and avoid impairments. Patients need to be assessed pre, intra and post-surgery, but in under resourced countries such as Portugal, there are still no standardised and validated tools to conduct this type of evaluation. To address this need, the tasks of the Dutch Linguistic Intraoperative Protocol (DuLIP) were adapted to European Portuguese, and the resulting materials were standardised for a group of 144 Portuguese participants. For each task, the impact of age, gender and schooling were measured. The resulting Portuguese version of the DuLIP (DuLIP-EP) consists of 17 tasks, including phonological, syntactic, semantic, naming and articulatory tests. No significant differences were found between male and female participants. However, schooling influenced phonological and syntactic fluency, object naming and verb generation. Schooling and age had a significant impact on semantic fluency and reading with semantic odd word out tasks. This is the first contribution to the standardisation of a tool that can be used during an awake brain surgery in Portugal, which includes a new phonological odd word out task that is not currently available in the Dutch version.
Collapse
Affiliation(s)
- Joana Alves
- Hospital das Forças Armadas - Pólo Porto, Porto, Portugal
| | - Mafalda Cardoso
- Unidade de Cuidados Continuados Solar Billadonnes, Penacova, Portugal
| | | | - Elke De Witte
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Djaina Satoer
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andreia Hall
- Department of Mathematics (DMat) and Center for Research and Development in Mathematics and Applications (CIDMA), University of Aveiro, Aveiro, Portugal
| | - Luis M T Jesus
- School of Health Sciences (ESSUA) and Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| |
Collapse
|
18
|
Fekonja LS, Wang Z, Doppelbauer L, Vajkoczy P, Picht T, Pulvermüller F, Dreyer FR. Lesion-symptom mapping of language impairments in patients suffering from left perisylvian gliomas. Cortex 2021; 144:1-14. [PMID: 34537591 DOI: 10.1016/j.cortex.2021.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/10/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
Brain tumors cause local structural impairments of the cerebral network. Moreover, brain tumors can also affect functional brain networks more distant from the lesion. In this study, we analyzed the impact of glioma WHO grade II-IV tumors on grey and white matter in relation to impaired language function. In a retrospective analysis of 60 patients, 14 aphasic and 46 non-aphasic, voxel-based lesion-symptom mapping (VLSM) was used to identify tumor induced lesions in grey (GM) and white matter (WM) related to patients' performance in subtests of the Aachen Aphasia Test (AAT). Significant clusters were analyzed for atlas-based grey and white matter involvements in relation to different linguistic modalities. VLSM analysis indicated significant contribution of a posterior perisylvian cluster covering WM and GM to AAT performance averaged across subtests. When considering individual AAT subtests, a substantial overlap between significant clusters for analysis of the token test, picture naming and language comprehension results could be observed. The WM-cluster intersections reflect the overall importance of the perisylvian area in language function, similarly to GM participations. Especially the constant high percentages of Heschl's gyrus, superior temporal gyrus, inferior longitudinal and middle longitudinal fascicles, but also arcuate and inferior fronto-occipital fascicles highlight the importance of the posterior perisylvian area for language function.
Collapse
Affiliation(s)
- Lucius S Fekonja
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany; Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany.
| | - Ziqian Wang
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lea Doppelbauer
- Freie Universität Berlin, Brain Language Laboratory, Department of Philosophy and Humanities, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany; Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
| | - Friedemann Pulvermüller
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany; Freie Universität Berlin, Brain Language Laboratory, Department of Philosophy and Humanities, Berlin, Germany
| | - Felix R Dreyer
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany; Freie Universität Berlin, Brain Language Laboratory, Department of Philosophy and Humanities, Berlin, Germany; Medical School OWL, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
19
|
Hazem SR, Awan M, Lavrador JP, Patel S, Wren HM, Lucena O, Semedo C, Irzan H, Melbourne A, Ourselin S, Shapey J, Kailaya-Vasan A, Gullan R, Ashkan K, Bhangoo R, Vergani F. Middle Frontal Gyrus and Area 55b: Perioperative Mapping and Language Outcomes. Front Neurol 2021; 12:646075. [PMID: 33776898 PMCID: PMC7988187 DOI: 10.3389/fneur.2021.646075] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The simplistic approaches to language circuits are continuously challenged by new findings in brain structure and connectivity. The posterior middle frontal gyrus and area 55b (pFMG/area55b), in particular, has gained a renewed interest in the overall language network. Methods: This is a retrospective single-center cohort study of patients who have undergone awake craniotomy for tumor resection. Navigated transcranial magnetic simulation (nTMS), tractography, and intraoperative findings were correlated with language outcomes. Results: Sixty-five awake craniotomies were performed between 2012 and 2020, and 24 patients were included. nTMS elicited 42 positive responses, 76.2% in the inferior frontal gyrus (IFG), and hesitation was the most common error (71.4%). In the pMFG/area55b, there were seven positive errors (five hesitations and two phonemic errors). This area had the highest positive predictive value (43.0%), negative predictive value (98.3%), sensitivity (50.0%), and specificity (99.0%) among all the frontal gyri. Intraoperatively, there were 33 cortical positive responses—two (6.0%) in the superior frontal gyrus (SFG), 15 (45.5%) in the MFG, and 16 (48.5%) in the IFG. A total of 29 subcortical positive responses were elicited−21 in the deep IFG–MFG gyri and eight in the deep SFG–MFG gyri. The most common errors identified were speech arrest at the cortical level (20 responses−13 in the IFG and seven in the MFG) and anomia at the subcortical level (nine patients—eight in the deep IFG–MFG and one in the deep MFG–SFG). Moreover, 83.3% of patients had a transitory deterioration of language after surgery, mainly in the expressive component (p = 0.03). An increased number of gyri with intraoperative positive responses were related with better preoperative (p = 0.037) and worse postoperative (p = 0.029) outcomes. The involvement of the SFG–MFG subcortical area was related with worse language outcomes (p = 0.037). Positive nTMS mapping in the IFG was associated with a better preoperative language outcome (p = 0.017), relating to a better performance in the expressive component, while positive mapping in the MFG was related to a worse preoperative receptive component of language (p = 0.031). Conclusion: This case series suggests that the posterior middle frontal gyrus, including area 55b, is an important integration cortical hub for both dorsal and ventral streams of language.
Collapse
Affiliation(s)
- Sally Rosario Hazem
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Mariam Awan
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Sabina Patel
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Hilary Margaret Wren
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Oeslle Lucena
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Carla Semedo
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Hassna Irzan
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Shapey
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ahilan Kailaya-Vasan
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom.,King's Neuro Lab, Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| |
Collapse
|
20
|
Di Cristofori A, Basso G, de Laurentis C, Mauri I, Sirtori MA, Ferrarese C, Isella V, Giussani C. Perspectives on (A)symmetry of Arcuate Fasciculus. A Short Review About Anatomy, Tractography and TMS for Arcuate Fasciculus Reconstruction in Planning Surgery for Gliomas in Language Areas. Front Neurol 2021; 12:639822. [PMID: 33643213 PMCID: PMC7902861 DOI: 10.3389/fneur.2021.639822] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
Gliomas are brain tumors that are treated with surgical resection. Prognosis is influenced by the extent of resection and postoperative neurological status. As consequence, given the extreme interindividual and interhemispheric variability of subcortical white matter (WM) surgical planning requires to be patient's tailored. According to the “connectionist model,” there is a huge variability among both cortical areas and subcortical WM in all human beings, and it is known that brain is able to reorganize itself and to adapt to WM lesions. Brain magnetic resonance imaging diffusion tensor imaging (DTI) tractography allows visualization of WM bundles. Nowadays DTI tractography is widely available in the clinical setting for presurgical planning. Arcuate fasciculus (AF) is a long WM bundle that connects the Broca's and Wernicke's regions with a complex anatomical architecture and important role in language functions. Thus, its preservation is important for the postoperative outcome, and DTI tractography is usually performed for planning surgery within the language-dominant hemisphere. High variability among individuals and an asymmetrical pattern has been reported for this WM bundle. However, the functional relevance of AF in the contralateral non-dominant hemisphere in case of tumoral or surgical lesion of the language-dominant AF is unclear. This review focuses on AF anatomy with special attention to its asymmetry in both normal and pathological conditions and how it may be explored with preoperative tools for planning surgery on gliomas in language areas. Based on the findings available in literature, we finally speculate about the potential role of preoperative evaluation of the WM contralateral to the surgical site.
Collapse
Affiliation(s)
| | - Gianpaolo Basso
- Neurosurgery Unit, San Gerardo Hospital, ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neuroradiology Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Camilla de Laurentis
- Neurosurgery Unit, San Gerardo Hospital, ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ilaria Mauri
- Neurology Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurology Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Valeria Isella
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurology Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Carlo Giussani
- Neurosurgery Unit, San Gerardo Hospital, ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
21
|
Haddad AF, Young JS, Berger MS, Tarapore PE. Preoperative Applications of Navigated Transcranial Magnetic Stimulation. Front Neurol 2021; 11:628903. [PMID: 33551983 PMCID: PMC7862711 DOI: 10.3389/fneur.2020.628903] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/29/2020] [Indexed: 12/18/2022] Open
Abstract
Preoperative mapping of cortical structures prior to neurosurgical intervention can provide a roadmap of the brain with which neurosurgeons can navigate critical cortical structures. In patients undergoing surgery for brain tumors, preoperative mapping allows for improved operative planning, patient risk stratification, and personalized preoperative patient counseling. Navigated transcranial magnetic stimulation (nTMS) is one modality that allows for highly accurate, image-guided, non-invasive stimulation of the brain, thus allowing for differentiation between eloquent and non-eloquent cortical regions. Motor mapping is the best validated application of nTMS, yielding reliable maps with an accuracy similar to intraoperative cortical mapping. Language mapping is also commonly performed, although nTMS language maps are not as highly concordant with direct intraoperative cortical stimulation maps as nTMS motor maps. Additionally, nTMS has been used to localize cortical regions involved in other functions such as facial recognition, calculation, higher-order motor processing, and visuospatial orientation. In this review, we evaluate the growing literature on the applications of nTMS in the preoperative setting. First, we analyze the evidence in support of the most common clinical applications. Then we identify usages that show promise but require further validation. We also discuss developing nTMS techniques that are still in the experimental stage, such as the use of nTMS to enhance postoperative recovery. Finally, we highlight practical considerations when utilizing nTMS and, importantly, its safety profile in neurosurgical patients. In so doing, we aim to provide a comprehensive review of the role of nTMS in the neurosurgical management of a patient with a brain tumor.
Collapse
Affiliation(s)
- Alexander F Haddad
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
22
|
Kherif F, Muller S. Neuro-Clinical Signatures of Language Impairments: A Theoretical Framework for Function-to-structure Mapping in Clinics. Curr Top Med Chem 2021; 20:800-811. [PMID: 32116193 DOI: 10.2174/1568026620666200302111130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/10/2019] [Accepted: 01/12/2020] [Indexed: 12/26/2022]
Abstract
In the past decades, neuroscientists and clinicians have collected a considerable amount of data and drastically increased our knowledge about the mapping of language in the brain. The emerging picture from the accumulated knowledge is that there are complex and combinatorial relationships between language functions and anatomical brain regions. Understanding the underlying principles of this complex mapping is of paramount importance for the identification of the brain signature of language and Neuro-Clinical signatures that explain language impairments and predict language recovery after stroke. We review recent attempts to addresses this question of language-brain mapping. We introduce the different concepts of mapping (from diffeomorphic one-to-one mapping to many-to-many mapping). We build those different forms of mapping to derive a theoretical framework where the current principles of brain architectures including redundancy, degeneracy, pluri-potentiality and bow-tie network are described.
Collapse
Affiliation(s)
- Ferath Kherif
- Laboratory for Research in Neuroimaging, Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sandrine Muller
- 1Laboratory for Research in Neuroimaging, Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
23
|
Michon M, Boncompte G, López V. Electrophysiological Dynamics of Visual Speech Processing and the Role of Orofacial Effectors for Cross-Modal Predictions. Front Hum Neurosci 2020; 14:538619. [PMID: 33192386 PMCID: PMC7653187 DOI: 10.3389/fnhum.2020.538619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
The human brain generates predictions about future events. During face-to-face conversations, visemic information is used to predict upcoming auditory input. Recent studies suggest that the speech motor system plays a role in these cross-modal predictions, however, usually only audio-visual paradigms are employed. Here we tested whether speech sounds can be predicted on the basis of visemic information only, and to what extent interfering with orofacial articulatory effectors can affect these predictions. We registered EEG and employed N400 as an index of such predictions. Our results show that N400's amplitude was strongly modulated by visemic salience, coherent with cross-modal speech predictions. Additionally, N400 ceased to be evoked when syllables' visemes were presented backwards, suggesting that predictions occur only when the observed viseme matched an existing articuleme in the observer's speech motor system (i.e., the articulatory neural sequence required to produce a particular phoneme/viseme). Importantly, we found that interfering with the motor articulatory system strongly disrupted cross-modal predictions. We also observed a late P1000 that was evoked only for syllable-related visual stimuli, but whose amplitude was not modulated by interfering with the motor system. The present study provides further evidence of the importance of the speech production system for speech sounds predictions based on visemic information at the pre-lexical level. The implications of these results are discussed in the context of a hypothesized trimodal repertoire for speech, in which speech perception is conceived as a highly interactive process that involves not only your ears but also your eyes, lips and tongue.
Collapse
Affiliation(s)
- Maëva Michon
- Laboratorio de Neurociencia Cognitiva y Evolutiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Laboratorio de Neurociencia Cognitiva y Social, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Gonzalo Boncompte
- Laboratorio de Neurodinámicas de la Cognición, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vladimir López
- Laboratorio de Psicología Experimental, Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
24
|
Arantes ME, Cendes F. In Search of a New Paradigm for Functional Magnetic Resonance Experimentation With Language. Front Neurol 2020; 11:588. [PMID: 32670188 PMCID: PMC7326770 DOI: 10.3389/fneur.2020.00588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/22/2020] [Indexed: 11/23/2022] Open
Abstract
Human language can convey a broad range of entities and relationships through processes that are highly complex and structured. All of these processes are happening somewhere inside our brains, and one way of precising these locations is through the usage of the functional magnetic resonance imaging. The great obstacle when experimenting with complex processes, however, is the need to control them while still having data that are representative of reality. When it comes to language, an interactional phenomenon in its nature, and that integrates a wide range of processes, a question emerges concerning how compatible it is with the current experimental methodology, and how much of it is lost in order to fit the controlled experimental environment. Because of its particularities, the fMRI technique imposes several limitations to the expression of language during experimentation. This paper discusses the different conceptions of language as a research object, the hardships of combining this object with the requirements of fMRI, and what are the current perspectives for this field of research.
Collapse
Affiliation(s)
| | - Fernando Cendes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas—UNICAMP, Campinas, Brazil
| |
Collapse
|
25
|
Martín-Monzón I, Rivero Ballagas Y, Arias-Sánchez S. Language mapping: A systematic review of protocols that evaluate linguistic functions in awake surgery. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:845-854. [PMID: 32543924 DOI: 10.1080/23279095.2020.1776287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Nowadays, numerous neuropsychological tests are available for multidisciplinary teams to perform awake brain surgery but none-or very few-of them constitutes a mandatory prerequisite. No consensus has been reached about the choice of intraoperative tests, which can be relatively simple for certain primary functions, but can be much more difficult for high-level cognitive functions. This review aims to give an overview about the assessment of language during awake brain surgery in adults and focus on the analysis of the different language protocols that have been published, to compile the most used standardized tests that evaluate different linguistic cognitive processes. We performed a systematic review about awake brain surgery studies that mentioned a specific test or protocol for assessing language in adults from the last 15 years. The search yielded 3,504 articles. 120 studies reported a linguistic protocol or test. This review allowed to obtain a defined neuropsychological picture of the essential tasks that a linguistic protocol in awake surgery should compile. This review will help clinicians in selecting tasks for monitoring cognition during awake brain surgery as well as contributes to enlighten the efficacy of linguistics protocols in order to minimize language deficits in awake surgery.
Collapse
Affiliation(s)
- Isabel Martín-Monzón
- Laboratory of Psychobiology, Faculty of Psychology, Campus Santiago Ramón y Cajal, University of Sevilla, Sevilla, Spain
| | - Yudania Rivero Ballagas
- Department of Experimental Psychology, Faculty of Psychology, Campus, Santiago Ramón y Cajal, University of Sevilla, Sevilla, Spain
| | - Samuel Arias-Sánchez
- Department of Experimental Psychology, Faculty of Psychology, Campus, Santiago Ramón y Cajal, University of Sevilla, Sevilla, Spain
| |
Collapse
|
26
|
Dimou J, Kelly J. The biological and clinical basis for early referral of low grade glioma patients to a surgical neuro-oncologist. J Clin Neurosci 2020; 78:20-29. [PMID: 32381393 DOI: 10.1016/j.jocn.2020.04.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/24/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022]
Abstract
The discovery of IDH1/2 (isocitrate dehydrogenase) mutation in large scale, genomewide mutational analyses of gliomas has led to profound developments in understanding tumourigenesis, and restructuring of the classification of both high and low grade gliomas. Owing to this progress made in the recognition of molecular markers which predict tumour behavior and treatment response, the increasing importance of adjuvant treatments such as chemo- and radiotherapy, and the tremendous advances in surgical technique and intraoperative monitoring which have facilitated superior extents of resection whilst preserving neurological functioning and quality of life, contemporary management of low grade glioma (LGG) has switched from a passive, observant approach to a more active, interventional one. Furthermore, this has implications for the manner in which patients with incidentally discovered and/or asymptomatic LGG are managed, and this review of the biological behaviour of LGG, as well as its clinical investigation and management, should act as a timely reminder to all clinicians of the importance of referring LGG patients early to a surgical neuro-oncologist who is not only familiar and acquainted with the vagaries of this disease process, but who, in addition, is devoted to delivering care to these patients with the support of a multi-disciplinary clinical decision-making unit, comprising medical neuro-oncologists, radiation oncologists and allied health professionals.
Collapse
Affiliation(s)
- James Dimou
- Department of Neurosurgery, University of Calgary, Alberta, Canada.
| | - John Kelly
- Department of Neurosurgery, University of Calgary, Alberta, Canada
| |
Collapse
|
27
|
Aydinlar EI, Dikmen PY, Kocak M, Sahillioğlu E, Pamir MN. Intraoperative motor speech mapping under general anesthesia using long-latency response from laryngeal muscles. Clin Neurol Neurosurg 2020; 190:105672. [DOI: 10.1016/j.clineuro.2020.105672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/06/2019] [Accepted: 01/05/2020] [Indexed: 11/30/2022]
|
28
|
Catalino MP, Yao S, Green D, Laws ER, Golby AJ, Tie Y. Mapping cognitive and emotional networks in neurosurgical patients using resting-state functional magnetic resonance imaging. Neurosurg Focus 2020; 48:E9. [PMID: 32006946 PMCID: PMC7712886 DOI: 10.3171/2019.11.focus19773] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/13/2019] [Indexed: 01/15/2023]
Abstract
Neurosurgery has been at the forefront of a paradigm shift from a localizationist perspective to a network-based approach to brain mapping. Over the last 2 decades, we have seen dramatic improvements in the way we can image the human brain and noninvasively estimate the location of critical functional networks. In certain patients with brain tumors and epilepsy, intraoperative electrical stimulation has revealed direct links between these networks and their function. The focus of these techniques has rightfully been identification and preservation of so-called "eloquent" brain functions (i.e., motor and language), but there is building momentum for more extensive mapping of cognitive and emotional networks. In addition, there is growing interest in mapping these functions in patients with a broad range of neurosurgical diseases. Resting-state functional MRI (rs-fMRI) is a noninvasive imaging modality that is able to measure spontaneous low-frequency blood oxygen level-dependent signal fluctuations at rest to infer neuronal activity. Rs-fMRI may be able to map cognitive and emotional networks for individual patients. In this review, the authors give an overview of the rs-fMRI technique and associated cognitive and emotional resting-state networks, discuss the potential applications of rs-fMRI, and propose future directions for the mapping of cognition and emotion in neurosurgical patients.
Collapse
Affiliation(s)
- Michael P Catalino
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, NC
| | - Shun Yao
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deborah Green
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Corresponding Author: Yanmei Tie, Ph.D., Assistant Professor, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 8016G, 60 Fenwood Road, Boston, MA 02115, USA, , Tel: 617-732-8249
| |
Collapse
|
29
|
Klaus J, Schutter DJLG, Piai V. Transient perturbation of the left temporal cortex evokes plasticity-related reconfiguration of the lexical network. Hum Brain Mapp 2019; 41:1061-1071. [PMID: 31705740 PMCID: PMC7267941 DOI: 10.1002/hbm.24860] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/30/2019] [Accepted: 10/28/2019] [Indexed: 12/28/2022] Open
Abstract
While much progress has been made in how brain organization supports language function, the language network's ability to adapt to immediate disturbances by means of reorganization remains unclear. The aim of this study was to examine acute reorganizational changes in brain activity related to conceptual and lexical retrieval in unimpaired language production following transient disruption of the left middle temporal gyrus (MTG). In a randomized single‐blind within‐subject experiment, we recorded the electroencephalogram from 16 healthy participants during a context‐driven picture‐naming task. Prior to the task, the left MTG was perturbed with real continuous theta‐burst stimulation (cTBS) or sham stimulation. During the task, participants read lead‐in sentences creating a constraining (e.g., “The farmer milks the”) or nonconstraining context (e.g., “The farmer buys the”). The last word was shown as a picture that participants had to name (e.g., “cow”). Replicating behavioral studies, participants were overall faster in naming pictures following a constraining relative to a nonconstraining context, but this effect did not differ between real and sham cTBS. In contrast, real cTBS increased overall error rates compared to sham cTBS. In line with previous studies, we observed a decrease in alpha‐beta (8–24 Hz) oscillatory power for constraining relative to nonconstraining contexts over left temporal–parietal cortex after participants received sham cTBS. However, following real cTBS, this decrease extended toward left prefrontal regions associated with both domain‐general and domain‐specific control mechanisms. Our findings provide evidence that immediately after perturbing the left MTG, the lexical‐semantic network is able to quickly reconfigure, also recruiting domain‐general regions.
Collapse
Affiliation(s)
- Jana Klaus
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Helmholtz Institute, Experimental Psychology, Utrecht University, Utrecht, Netherlands
| | - Dennis J L G Schutter
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.,Helmholtz Institute, Experimental Psychology, Utrecht University, Utrecht, Netherlands
| | - Vitória Piai
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.,Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
30
|
van Dokkum LEH, Moritz Gasser S, Deverdun J, Herbet G, Mura T, D'Agata B, Picot MC, Menjot de Champfleur N, Duffau H, Molino F, le Bars E. Resting state network plasticity related to picture naming in low-grade glioma patients before and after resection. NEUROIMAGE-CLINICAL 2019; 24:102010. [PMID: 31734532 PMCID: PMC6861733 DOI: 10.1016/j.nicl.2019.102010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 09/09/2019] [Accepted: 09/17/2019] [Indexed: 12/01/2022]
Abstract
Patients post DLGG surgery use attentional resources to compensate deficit. Functional plasticity occurs at secondary regions at distance from the lesion. Picture naming requires the integration of multiple resting-state networks. The right hemisphere plays also an important role in language processing. A whole brain approach with clinical input in case of lesion is the way forward.
The dynamic connectome perspective states that brain functions arise from the functional integration of distributed and/or partly overlapping networks. Diffuse low-grade gliomas (DLGG) have a slow infiltrating character. Here we addressed whether and how anatomical disconnection following DLGG growth and resection might interfere with functional resting-state connectivity, specifically in relation to picture naming. Thirty-nine native French persons with a left DLGG were included. All underwent awake surgical resection of the tumor using direct brain electrostimulation to preserve critical eloquent regions. The anatomical disconnectivity risk following the DLGG volume and the resection, and the functional connectivity of resting-state fMRI images in relation to picture naming were evaluated prior to and three months after surgery. Resting-state connectivity patterns were compared with nineteen healthy controls. It was demonstrated that picture naming was strongly dependent on the semantic network that emerged from the integration and interaction of regions within multiple resting-state brain networks, in which their specific role could be explained in the light of the broader resting-state network they take part in. It emphasized the importance of a whole brain approach with specific clinical data input, during resting-state analysis in case of lesion. Adaptive plasticity was found in secondary regions, functionally connected to regions close to the tumor and/or cavity, marked by an increased connectivity of the right and left inferior parietal lobule with the left inferior temporal gyrus. In addition, an important role was identified for the superior parietal lobe, connected with the frontal operculum, suggesting functional compensation by means of attentional resources in order to name a picture via recruitment of the frontoparietal attention network.
Collapse
Affiliation(s)
- L E H van Dokkum
- I2FH, Institut d'Imagerie Fonctionelle Humaine, Montpellier University Hospital, Gui de Chauliac, 80 av. Augustin Fliche, 34295 Montpellier, France; Neuroradiology Department, Montpellier University Hospital, Gui de Chauliac, France.
| | - S Moritz Gasser
- Neurosurgery Department, Montpellier University Hospital, Gui de Chauliac, France; Team 'Plasticity of Central Nervous System, Stem Cells and Glial Tumors', INSERM U1051, Institute of Neuroscience Montpellier, France
| | - J Deverdun
- I2FH, Institut d'Imagerie Fonctionelle Humaine, Montpellier University Hospital, Gui de Chauliac, 80 av. Augustin Fliche, 34295 Montpellier, France; Neuroradiology Department, Montpellier University Hospital, Gui de Chauliac, France
| | - G Herbet
- Neurosurgery Department, Montpellier University Hospital, Gui de Chauliac, France; Team 'Plasticity of Central Nervous System, Stem Cells and Glial Tumors', INSERM U1051, Institute of Neuroscience Montpellier, France
| | - T Mura
- Epidemiology Department, Clinical Investigation Center, INSERM-CIC 1411, Montpellier University Hospital, France
| | - B D'Agata
- Epidemiology Department, Clinical Investigation Center, INSERM-CIC 1411, Montpellier University Hospital, France
| | - M C Picot
- Epidemiology Department, Clinical Investigation Center, INSERM-CIC 1411, Montpellier University Hospital, France
| | - N Menjot de Champfleur
- I2FH, Institut d'Imagerie Fonctionelle Humaine, Montpellier University Hospital, Gui de Chauliac, 80 av. Augustin Fliche, 34295 Montpellier, France; Neuroradiology Department, Montpellier University Hospital, Gui de Chauliac, France; Laboratoire Charles Coulomb, Montpellier University, France
| | - H Duffau
- Neurosurgery Department, Montpellier University Hospital, Gui de Chauliac, France; Team 'Plasticity of Central Nervous System, Stem Cells and Glial Tumors', INSERM U1051, Institute of Neuroscience Montpellier, France
| | - F Molino
- I2FH, Institut d'Imagerie Fonctionelle Humaine, Montpellier University Hospital, Gui de Chauliac, 80 av. Augustin Fliche, 34295 Montpellier, France; Laboratoire Charles Coulomb, Montpellier University, France
| | - E le Bars
- I2FH, Institut d'Imagerie Fonctionelle Humaine, Montpellier University Hospital, Gui de Chauliac, 80 av. Augustin Fliche, 34295 Montpellier, France; Neuroradiology Department, Montpellier University Hospital, Gui de Chauliac, France
| |
Collapse
|
31
|
Rutherford HJ, Xu J, Worhunsky PD, Zhang R, Yip SW, Morie KP, Calhoun VD, Kim S, Strathearn L, Mayes LC, Potenza MN. Gradient theories of brain activation: A novel application to studying the parental brain. Curr Behav Neurosci Rep 2019; 6:119-125. [PMID: 32154064 PMCID: PMC7062306 DOI: 10.1007/s40473-019-00182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Parental brain research primarily employs general-linear-model-based (GLM-based) analyses to assess blood-oxygenation-level-dependent responses to infant auditory and visual cues, reporting common responses in shared cortical and subcortical structures. However, this approach does not reveal intermixed neural substrates related to different sensory modalities. We consider this notion in studying the parental brain. RECENT FINDINGS Spatial independent component analysis (sICA) has been used to separate mixed source signals from overlapping functional networks. We explore relative differences between GLM-based analysis and sICA as applied to an fMRI dataset acquired from women while they listened to infant cries or viewed infant sad faces. SUMMARY There is growing appreciation for the value of moving beyond GLM-based analyses to consider brain functional organization as continuous, distributive, and overlapping gradients of neural substrates related to different sensory modalities. Preliminary findings suggest sICA can be applied to the study of the parental brain.
Collapse
Affiliation(s)
- Helena J.V. Rutherford
- Child Study Center, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Jiansong Xu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Patrick D. Worhunsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Rubin Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Sarah W. Yip
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Kristen P. Morie
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Vince D. Calhoun
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
- The Mind Research Network, Albuquerque, NM 87131, United States
- Dept of Electrical and Computer Engineering, The University of New Mexico, Albuquerque, NM, 87131, United States
| | - Sohye Kim
- Department of Obstetrics and Gynecology, Baylor College of Medicine
- Department of Pediatrics and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
- Center for Reproductive Psychiatry, Pavilion for Women, Texas Children’s Hospital
| | - Lane Strathearn
- Department of Pediatrics and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Linda C. Mayes
- Child Study Center, Yale University School of Medicine, New Haven, CT 06510, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Marc N. Potenza
- Child Study Center, Yale University School of Medicine, New Haven, CT 06510, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, United States
- The Connecticut Council on Problem Gambling, Wethersfield, CT 06109, United States
- The Connecticut Mental Health Center, New Haven, CT 06519, United States
| |
Collapse
|
32
|
Li Q, Dong JW, Del Ferraro G, Petrovich Brennan N, Peck KK, Tabar V, Makse HA, Holodny AI. Functional Translocation of Broca's Area in a Low-Grade Left Frontal Glioma: Graph Theory Reveals the Novel, Adaptive Network Connectivity. Front Neurol 2019; 10:702. [PMID: 31333562 PMCID: PMC6615260 DOI: 10.3389/fneur.2019.00702] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022] Open
Abstract
We describe frontal language reorganization in a 50–60 year-old right-handed patient with a low-grade left frontotemporal insular glioma. Pre-operative fMRI revealed robust activation in the left superior temporal gyrus (Wernicke Area, WA) and in the right inferior frontal gyrus (right anatomical homolog of Broca Area, BA). Intra-operative cortical stimulation of the left inferior frontal gyrus and adjacent cortices elicited no speech deficits, and gross total resection including the expected location of BA resulted in no speech impairment. We employed statistical inference methods to reconstruct the functional brain network and determined how different brain areas connect with one another. We found that the right homolog of the BA in this patient functionally connected to the same areas as the left BA in a typical healthy control. As opposed to the functional connection of the left BA in a healthy brain, the right BA did not connect directly with the left WA, but connected indirectly, mediated by the pre-Supplementary Motor Area and the Middle Frontal Gyrus. This case illustrates that pre-surgical fMRI may be used to identify atypical hemispheric language reorganization in the presence of brain tumor and that network theory opens the possibility for future insight into the neural mechanism underlying the language reorganization.
Collapse
Affiliation(s)
- Qiongge Li
- Levich Institute and Physics Department, City College of New York, New York, NY, United States
| | - Jian W Dong
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gino Del Ferraro
- Levich Institute and Physics Department, City College of New York, New York, NY, United States.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Kyung K Peck
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Viviane Tabar
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Hernán A Makse
- Levich Institute and Physics Department, City College of New York, New York, NY, United States
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States.,Neuroscience, Weill Medical College of Cornell University, New York, NY, United States
| |
Collapse
|
33
|
Jain S, Chan HM, Yeo TT, Teo K. Language Mapping of Hindi and English in a Bilingual Patient During Resection of a Right Frontal Glioma. World Neurosurg 2019; 125:106-110. [DOI: 10.1016/j.wneu.2019.01.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
|
34
|
de Souza Coelho D, Fernandes de Oliveira Santos B, Silva da Costa MD, Silva GS, Cavalheiro S, Santos FH, Chaddad-Neto F. Cognitive performance in patients with cerebral arteriovenous malformation. J Neurosurg 2019; 132:1548-1555. [PMID: 31465157 DOI: 10.3171/2018.12.jns181883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/31/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A cerebral arteriovenous malformation (cAVM) can change over time and cause symptoms, but clinical studies tend to define only the patients with ruptured cAVMs as symptomatic and do not consider neurocognitive aspects prior to neurosurgical intervention. The objective of this study was to describe the neurocognitive function of patients with ruptured and unruptured cAVMs according to the Spetzler-Martin (SM) grade, flow status, and anatomical topography. METHODS In this blinded cross-sectional study, 70 patients of both sexes and ages 18-60 years were evaluated using the Brazilian Brief Neuropsychological Assessment Battery Neupsilin. RESULTS Of the 70 patients with cAVMs, 50 (71.4%) demonstrated deficits in at least one of the eight neurocognitive domains surveyed, although they did not exhibit neurological deficits. cAVMs in the temporal lobe were associated with memory deficits compared with the general population. The SM grade was not significantly associated with the results of patients with unruptured cAVMs. However, among patients with ruptured cAVMs, there were deficits in working memory in those with high-grade (SM grade) cAVMs and deficits in executive function (verbal fluency) in those with low-grade cAVMs (p < 0.001). CONCLUSIONS This study indicates that patients with untreated cAVMs, either ruptured or unruptured, already exhibit neurocognitive deficits, even the patients without other neurological symptoms. However, the scales used to evaluate disability in the main clinical studies, such as A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA), do not assess neurocognitive alterations and therefore disregard any deficits that may affect quality of life. The authors' finding raises an important question about the effects of interventional treatment because it reinforces the hypothesis that cognitive alterations may be preexisting and not determined by interventions.
Collapse
Affiliation(s)
- Daniela de Souza Coelho
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | | | | | - Gisele Sampaio Silva
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | - Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | | | - Feres Chaddad-Neto
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| |
Collapse
|
35
|
Origin and evolution of human speech: Emergence from a trimodal auditory, visual and vocal network. PROGRESS IN BRAIN RESEARCH 2019; 250:345-371. [PMID: 31703907 DOI: 10.1016/bs.pbr.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In recent years, there have been important additions to the classical model of speech processing as originally depicted by the Broca-Wernicke model consisting of an anterior, productive region and a posterior, perceptive region, both connected via the arcuate fasciculus. The modern view implies a separation into a dorsal and a ventral pathway conveying different kinds of linguistic information, which parallels the organization of the visual system. Furthermore, this organization is highly conserved in evolution and can be seen as the neural scaffolding from which the speech networks originated. In this chapter we emphasize that the speech networks are embedded in a multimodal system encompassing audio-vocal and visuo-vocal connections, which can be referred to an ancestral audio-visuo-motor pathway present in nonhuman primates. Likewise, we propose a trimodal repertoire for speech processing and acquisition involving auditory, visual and motor representations of the basic elements of speech: phoneme, observation of mouth movements, and articulatory processes. Finally, we discuss this proposal in the context of a scenario for early speech acquisition in infants and in human evolution.
Collapse
|
36
|
Breshears JD, Southwell DG, Chang EF. Inhibition of Manual Movements at Speech Arrest Sites in the Posterior Inferior Frontal Lobe. Neurosurgery 2018; 85:E496-E501. [DOI: 10.1093/neuros/nyy592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/11/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Intraoperative stimulation of the posterior inferior frontal lobe (IFL) induces speech arrest, which is often interpreted as demonstration of essential language function. However, prior reports have described “negative motor areas” in the IFL, sites where stimulation halts ongoing limb motor activity.
OBJECTIVE
To investigate the spatial and functional relationship between IFL speech arrest areas and negative motor areas (NMAs).
METHODS
In this retrospective cohort study, intraoperative stimulation mapping was performed to localize speech and motor function, as well as arrest of hand movement, hand posture, and guitar playing in a set of patients undergoing awake craniotomy for dominant hemisphere pathologies. The incidence and localization of speech arrest and motor inhibition was analyzed.
RESULTS
Eleven patients underwent intraoperative localization of speech arrest sites and inhibitory motor areas. A total of 17 speech arrest sites were identified in the dominant frontal lobe, and, of these, 5 sites (29.4%) were also identified as NMAs. Speech arrest and arrest of guitar playing was also evoked by a single IFL site in 1 subject.
CONCLUSION
Inferior frontal gyrus speech arrest sites do not function solely in speech production. These findings provide further evidence for the complexity of language organization, and suggest the need for refined mapping strategies that discern between language-specific sites and inhibitory motor areas.
Collapse
Affiliation(s)
- Jonathan D Breshears
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Derek G Southwell
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Edward F Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| |
Collapse
|
37
|
Albuquerque LAF, Pessoa FC, Diógenes GS, Borges FS, Araújo Filho SC. Awake craniotomy for a cavernous angioma in the Broca’s area. Neurosurg Focus 2018; 45:V4. [DOI: 10.3171/2018.10.focusvid.18240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cavernous angiomas constitute 5%–10% of cerebrovascular malformations and may cause seizure and neurological deficits from bleeding.4 The authors present a case of a 44-year-old man with a 3.5-year history of epilepsy without complete seizure control despite anticonvulsants. Brain MRI showed a 2.8 cm cavernous angioma at the left pars opercularis, also known as the Broca’s area.3 The patient underwent an awake craniotomy for intraoperative cortical–subcortical language and sensory-motor mapping for a complete resection of the cavernous angioma and the hemosiderin rim.1–6 The procedure was uneventful, and the patient evolved seizure free and with no deficits.The video can be found here: https://youtu.be/QajbLIsr_vg.
Collapse
|
38
|
Picart T, Herbet G, Moritz-Gasser S, Duffau H. Iterative Surgical Resections of Diffuse Glioma With Awake Mapping: How to Deal With Cortical Plasticity and Connectomal Constraints? Neurosurgery 2018; 85:105-116. [DOI: 10.1093/neuros/nyy218] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/28/2018] [Indexed: 01/17/2023] Open
Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors,” INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors,” INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors,” INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France
| |
Collapse
|
39
|
Leonard MK, Desai M, Hungate D, Cai R, Singhal NS, Knowlton RC, Chang EF. Direct cortical stimulation of inferior frontal cortex disrupts both speech and music production in highly trained musicians. Cogn Neuropsychol 2018; 36:158-166. [PMID: 29786470 DOI: 10.1080/02643294.2018.1472559] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Music and speech are human-specific behaviours that share numerous properties, including the fine motor skills required to produce them. Given these similarities, previous work has suggested that music and speech may at least partially share neural substrates. To date, much of this work has focused on perception, and has not investigated the neural basis of production, particularly in trained musicians. Here, we report two rare cases of musicians undergoing neurosurgical procedures, where it was possible to directly stimulate the left hemisphere cortex during speech and piano/guitar music production tasks. We found that stimulation to left inferior frontal cortex, including pars opercularis and ventral pre-central gyrus, caused slowing and arrest for both speech and music, and note sequence errors for music. Stimulation to posterior superior temporal cortex only caused production errors during speech. These results demonstrate partially dissociable networks underlying speech and music production, with a shared substrate in frontal regions.
Collapse
Affiliation(s)
- Matthew K Leonard
- Department of Neurological Surgery, University of California, San Francisco , San Francisco , CA , USA
| | - Maansi Desai
- Department of Neurological Surgery, University of California, San Francisco , San Francisco , CA , USA
| | - Dylan Hungate
- Department of Neurological Surgery, University of California, San Francisco , San Francisco , CA , USA
| | - Ruofan Cai
- Department of Neurological Surgery, University of California, San Francisco , San Francisco , CA , USA
| | - Nilika S Singhal
- Department of Neurology, University of California, San Francisco , San Francisco , CA , USA
| | - Robert C Knowlton
- Department of Neurology, University of California, San Francisco , San Francisco , CA , USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco , San Francisco , CA , USA
| |
Collapse
|
40
|
Ferpozzi V, Fornia L, Montagna M, Siodambro C, Castellano A, Borroni P, Riva M, Rossi M, Pessina F, Bello L, Cerri G. Broca's Area as a Pre-articulatory Phonetic Encoder: Gating the Motor Program. Front Hum Neurosci 2018. [PMID: 29520225 PMCID: PMC5826965 DOI: 10.3389/fnhum.2018.00064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The exact nature of the role of Broca’s area in control of speech and whether it is exerted at the cognitive or at the motor level is still debated. Intraoperative evidence of a lack of motor responses to direct electrical stimulation (DES) of Broca’s area and the observation that its stimulation induces a “speech arrest” without an apparent effect on the ongoing activity of phono-articulatory muscles, raises the argument. Essentially, attribution of direct involvement of Broca’s area in motor control of speech, requires evidence of a functional connection of this area with the phono-articulatory muscles’ motoneurons. With a quantitative approach we investigated, in 20 patients undergoing surgery for brain tumors, whether DES delivered on Broca’s area affects the recruitment of the phono-articulatory muscles’ motor units. The electromyography (EMG) of the muscles active during two speech tasks (object picture naming and counting) was recorded during and in absence of DES on Broca’s area. Offline, the EMG of each muscle was analyzed in frequency (power spectrum, PS) and time domain (root mean square, RMS) and the two conditions compared. Results show that DES on Broca’s area induces an intensity-dependent “speech arrest.” The intensity of DES needed to induce “speech arrest” when applied on Broca’s area was higher when compared to the intensity effective on the neighboring pre-motor/motor cortices. Notably, PS and RMS measured on the EMG recorded during “speech arrest” were superimposable to those recorded at baseline. Partial interruptions of speech were not observed. Speech arrest was an “all-or-none” effect: muscle activation started only by removing DES, as if DES prevented speech onset. The same effect was observed when stimulating directly the subcortical fibers running below Broca’s area. Intraoperative data point to Broca’s area as a functional gate authorizing the phonetic translation to be executed by the motor areas. Given the absence of a direct effect on motor units recruitment, a direct control of Broca’s area on the phono-articulatory apparatus seems unlikely. Moreover, the strict correlation between DES-intensity and speech prevention, might attribute this effect to the inactivation of the subcortical fibers rather than to Broca’s cortical neurons.
Collapse
Affiliation(s)
- Valentina Ferpozzi
- Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, University of Milan, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Luca Fornia
- Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, University of Milan, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Marcella Montagna
- Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, University of Milan, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Chiara Siodambro
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, University of Milan, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Borroni
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Marco Riva
- Neurosurgical Oncology Unit, Department of Medical Biotechnology and Translational Medicine, University of Milan, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Marco Rossi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, University of Milan, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Federico Pessina
- Cancer Neurosurgery Unit, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, University of Milan, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Gabriella Cerri
- Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, University of Milan, Humanitas Research Hospital, IRCCS, Milan, Italy
| |
Collapse
|