Postoperative speech disorder after medial frontal surgery

Krainik, Alexandre; Lehericy, Stéphane; Duffau, Hugues; Laurent, Césari; Chainay, Hanna; Cornu, Philippe; Cohen, Laurent; Boch, Anne‐Laure; Mangin, Jean François; Bihan, Denis Le; Marsault, C.

doi:10.1212/01.wnl.0000048206.07837.59

Cited by 195 publications

(128 citation statements)

References 44 publications

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“…Furthermore the speech arrest track was less than 1 mm posterior to the coronal plane passing through the anterior commissure (VCA), while the tracks from the mouth motor and jaw/mouth sites in the SMA were 5 mm posterior to the VCA plane. This arrangement is consistent with studies suggesting somatotopy of the SMA proper (Fontaine et al, 2002;Krainik et al, 2003) with the most anterior region directly posterior to the VCA implicated in language and face/mouth motor aspects directly posterior to this language area.…”

Section: Discussionsupporting

confidence: 91%

“…The supplementary motor area has been previously shown to result in speech arrest and/or anomia when stimulated (Baumgartner et al, 1996;Berger, 1995;Berger andOjemann, 1992, 1994;Fried et al, 1991;Ojemann et al, 1989;Penfield and Rasmussen, 1950;Skirboll et al, 1996), resected (Fontaine et al, 2002;Krainik et al, 2003;Laplane et al, 1977;Rostomily et al, 1991;Zentner et al, 1996), or activated in functional imaging speech experiments (Alexander et al, 1986;Blank et al, 2002;Bookheimer et al, 2000;Corson et al, 2001;Etard et al, 2000;Fiez and Petersen, 1998;Fontaine et al, 2002;Krainik et al, 2003;Petersen et al, 1989;Rosen et al, 2000;Wildgruber et al, 2001;Xiong et al, 2000). Hence the existence of white matter connectivity between the supplementary motor area and the anomia and speech arrest sites in the inferior precentral gyrus is expected.…”

Section: Discussionmentioning

confidence: 97%

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Subcortical pathways serving cortical language sites: initial experience with diffusion tensor imaging fiber tracking combined with intraoperative language mapping

et al. 2004

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The combination of mapping functional cortical neurons by intraoperative cortical stimulation and axonal architecture by diffusion tensor MRI fiber tracking can be used to delineate the pathways between functional regions. In this study the authors investigated the feasibility of combining these techniques to yield connectivity associated with motor speech and naming. Diffusion tensor MRI fiber tracking provides maps of axonal bundles and was combined with intraoperative mapping of eloquent cortex for a patient undergoing brain tumor surgery. Tracks from eight stimulated sites in the inferior frontal cortex including mouth motor, speech arrest, and anomia were generated from the diffusion tensor MRI data. The regions connected by the fiber tracking were compared to foci from previous functional imaging reports on language tasks. Connections were found between speech arrest, mouth motor, and anomia sites and the SMA proper and cerebral peduncle. The speech arrest and a mouth motor site were also seen to connect to the putamen via the external capsule. This is the first demonstration of delineation of subcortical pathways using diffusion tensor MRI fiber tracking with intraoperative cortical stimulation. The combined techniques may provide improved preservation of eloquent regions during neurological surgery, and may provide access to direct connectivity information between functional regions of the brain.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Subcortical pathways serving cortical language sites: initial experience with diffusion tensor imaging fiber tracking combined with intraoperative language mapping

et al. 2004

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“…The role of the clinician in defining the results is of particular importance given clinicians' current focus on Broca's and Wernicke's but not other known language-critical regions (e.g., BTLA, Exner's area, SMA) [Anderson et al, 1990; Benjamin et al, 2017; Krainik et al, 2003; Krauss et al, 1996; Roux et al, 2009]. More sophisticated models of language have been suggested for well over a century in the clinical literature [e.g., see Benjamin et al, 2017 for a review] and have been a recent focus in the cognitive literature [e.g.…”

Section: 1 Discussionmentioning

confidence: 99%

Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning

Benjamin

Blumenfeld

et al. 2018

Human Brain Mapping

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The goal of this study was to document current clinical practice and report patient outcomes in presurgical language functional MRI (fMRI) for epilepsy surgery. Epilepsy surgical programs worldwide were surveyed as to the utility, implementation, and efficacy of language fMRI in the clinic; 82 programs responded. Respondents were predominantly from the US (61%) academic programs (85%), and evaluated adults (44%), adults and children (40%), or children only (16%). Nearly all (96%) reported using language fMRI. Surprisingly, fMRI is used to guide surgical margins (44% of programs) as well as language lateralization (100%). Sites using fMRI for localization most often use a distance margin around activation of 10mm. While considered useful, 56% of programs reported at least one instance of disagreement with other measures. Direct brain stimulation typically confirmed fMRI findings (74%) when guiding margins, but instances of unpredicted decline were reported by 17% of programs and unexpected preservation of function by 54%. Programs reporting unexpected decline did not clearly differ from those which did not. Clinicians using fMRI to guide surgical margins do not typically map known language-critical areas beyond Broca’s and Wernicke’s. This initial data shows many clinical teams are confident using fMRI not only for language lateralization but also to guide surgical margins. Reported cases of unexpected language preservation when fMRI activation is resected, and cases of language decline when it is not, emphasize a critical need for further validation. Comprehensive studies comparing commonly-used fMRI paradigms to predict stimulation mapping and post-surgical language decline remain of high importance.

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“…Lesions or pathologyespecially slow-growing low-grade gliomas-can induce cortical reorganization and plasticity with redistribution of eloquent areas into the tumor itself, adjacent parenchyma, or even in the contralateral hemisphere. 6,56,57,70 This makes operative localization even more variable, requiring the use of functional boundaries for resection. Second, essential cortical sites are usually found in a spatially confined (approximately 1 cm 2 ) cortical area and often are directly adjacent to sites that do not have any apparent effect from stimulation.…”

Section: Intraoperative Cortical Mappingmentioning

confidence: 99%

“…With this in mind, it is important to note that resection of tumors in the SMA is safe as speech does return to normal within 1 year, as long as functional mapping is used to determine the posterior and lateral resection boundaries; in particular, resection of the subcallosal fasciculus and the middle third of the PVWM should be avoided. 28,56,57 Of note, a subcortical pathway connecting the superior, middle, and inferior frontal gyri, named the "frontal aslant tract," has also been recently described. 13,105 A system of fibers connects these 3 cortical regions and then projects inferiorly to the striatum in a manner similar to that previously attributed to the subcallosal fasciculus.…”

Section: Subcortical Fiber Mappingmentioning

confidence: 99%

Contemporary model of language organization: an overview for neurosurgeons

Chang¹,

Raygor²,

Berger³

2015

JNS

337

285

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T he pursuit of defining how the human brain processes language is one of the greatest challenges in neuroscience. Pierre Broca and Karl Wernicke made fundamental contributions at a time when the practice of localization by phrenology was pervasive. Their careful studies were some of the first to define functional localization in the brain by studying patients with defined brain injuries and lesions. Over time, their names have become synonymous with two key brain areas for language function: the inferior frontal gyrus and superior posterior temporal area, respectively. The brain regions that bear their names are now universal in every medical student's education. However, the dichotomy of language production based in the frontal lobe and language comprehension based in the temporal lobe is a commonly oversimplified interpretation of their work. For example, injuries to Wernicke's area result in abnormal speech production in addition to deficits in comprehension. Frontal lesions can also result in higherorder comprehension deficits. Thus, the language network is more complicated and integrated than commonly appreciated. In the last 15 years, an exponential increase in the number of studies on the neurobiology of language has improved our understanding of potential mechanisms, but many fundamental questions remain unresolved.Our goal in this overview is to provide an update to neurosurgeons by comparing classic with more recent models of language organization. It is not meant to be an exhaustive review of language research, which is beyond our intended scope, but rather to introduce contemporary theories and briefly review selected neurosurgical experience with stimulation-based language mapping. This will abbreviatioNs DTI = diffusion tensor imaging; fMRI = functional MRI; IFOF = inferior fronto-occipital fasciculus; MTG = middle temporal gyrus; PVWM = periventricular white matter; SLF = superior longitudinal fasciculus; SMA = supplementary motor area; STG = superior temporal gyrus; STS = superior temporal sulcus. Classic models of language organization posited that separate motor and sensory language foci existed in the inferior frontal gyrus (Broca's area) and superior temporal gyrus (Wernicke's area), respectively, and that connections between these sites (arcuate fasciculus) allowed for auditory-motor interaction. These theories have predominated for more than a century, but advances in neuroimaging and stimulation mapping have provided a more detailed description of the functional neuroanatomy of language. New insights have shaped modern network-based models of speech processing composed of parallel and interconnected streams involving both cortical and subcortical areas. Recent models emphasize processing in "dorsal" and "ventral" pathways, mediating phonological and semantic processing, respectively. Phonological processing occurs along a dorsal pathway, from the posterosuperior temporal to the inferior frontal cortices. On the other hand, semantic information is carried in a ventral pathway that runs fro...

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Postoperative speech disorder after medial frontal surgery

Abstract: fMRI is able to identify the area at risk in the SMA, of which resection is related to the occurrence of characteristic transient postoperative speech disorders. Increased SMA activation in the healthy hemisphere suggested that a plastic change of SMA function occurred in these patients.

Cited by 195 publications

References 44 publications

Subcortical pathways serving cortical language sites: initial experience with diffusion tensor imaging fiber tracking combined with intraoperative language mapping

Subcortical pathways serving cortical language sites: initial experience with diffusion tensor imaging fiber tracking combined with intraoperative language mapping

Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning

Contemporary model of language organization: an overview for neurosurgeons

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