Surgery for gliomas involving the left inferior parietal lobule: new insights into the functional anatomy provided by stimulation mapping in awake patients

Maldonado, Igor Lima; Moritz‐Gasser, Sylvie; Champfleur, Nicolas Menjot de; Bertram, Luc; Moulinié, Gérard; Duffau, Hugues

doi:10.3171/2011.5.jns112

Cited by 118 publications

(83 citation statements)

References 47 publications

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“…69,105 Lesions to this subcortical pathway have long been believed to cause conduction aphasias, although stimulation of cortical areas can also lead to the phonemic paraphasias and anomia characteristic of conduction aphasias. 1,28,64,65 Subcortical mapping studies have confirmed that the arcuate fasciculus can be accurately and reliably identified intraoperatively and that stimulation of that bundle leads to phonological errors. 28,58,64,65 Syntactical errors have also been ascribed to the arcuate fasciculus based on DTI tractography 35,38 and subcortical stimulation studies.…”

Section: Subcortical Fiber Mappingmentioning

confidence: 99%

“…1,28,64,65 Subcortical mapping studies have confirmed that the arcuate fasciculus can be accurately and reliably identified intraoperatively and that stimulation of that bundle leads to phonological errors. 28,58,64,65 Syntactical errors have also been ascribed to the arcuate fasciculus based on DTI tractography 35,38 and subcortical stimulation studies. 107 Some question exists regarding the nomenclature of the temporoparietal tract involved in phonological processing and repetition.…”

Section: Subcortical Fiber Mappingmentioning

confidence: 99%

“…SLF II connects the dorsal premotor and prefrontal cortices to the angular gyrus 39,88,100 whereas the operculo-opercular pathway known as the SLF III joins the ventral prefrontal areas to the supramarginal gyrus. 15,27,39,[63][64][65] Stimulation of these white matter tracts causes dysarthria and other impairments in articulatory processing. 38,39,58,63,65 The SLF-tp runs in a posterior direction from the inferior parietal lobe to the posterior temporal lobe.…”

Section: Subcortical Fiber Mappingmentioning

confidence: 99%

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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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Section: Subcortical Fiber Mappingmentioning

confidence: 99%

Section: Subcortical Fiber Mappingmentioning

confidence: 99%

Section: Subcortical Fiber Mappingmentioning

confidence: 99%

See 1 more Smart Citation

Contemporary model of language organization: an overview for neurosurgeons

Chang¹,

Raygor²,

Berger³

2015

JNS

337

285

View full text Add to dashboard Cite

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“…In particular, a crucial role in quantity processing has been proposed for the horizontal segment of the intraparietal sulcus. With regard to electrostimulation mapping of calculation, some experiences have been reported on left parietal lobe mapping, 7,[13][14][15]21,23 while data on right parietal mapping are anecdotal and discordant. 20,25 This difference may be due to the much greater attention given to language mapping so far; however, impairment of mathematical skills can be the cause of serious personal and social difficulties.…”

confidence: 99%

Right parietal cortex and calculation processing: intraoperative functional mapping of multiplication and addition in patients affected by a brain tumor

Puppa¹,

Pellegrin

d’Avella

et al. 2013

JNS

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C alCulation is based on distinct neural networks, which can be reproducibly identified in different subjects. 2,3,24 A pivotal role in calculation is played by the parietal lobe. In the past 2 decades, neuroimaging and neuropsychological evidence was collected about the innermost mechanisms of calculation, and 3 main parietal circuits 4 have been proposed as the basis of calculation processing. According to this model, intraparietal areas are bilaterally associated with core quantity organization, the left angular gyrus is associated with verbal processing of numbers, and the posterior superior parietal system is associated with spatial and nonspatial attention. In particular, a crucial role in quantity processing has been proposed for the horizontal segment of the intraparietal sulcus. With regard to electrostimulation mapping of calculation, some experiences have been reported on left parietal lobe mapping, 7,13-15,21,23 while data on right parietal mapping are anecdotal and discordant. 20,25 This difference may be due to the much greater attention given to language mapping so far; however, impairment of mathematical skills can be the cause of serious personal and social difficulties. For this reason, the ability to perform calculation tasks ought to be regarded as a fundamental function. The parietal lobe is not only a frequent location of different neurosurgical conditions (such as gliomas, arteriovenous malformations, and others) but it is also a key area for the surgical approach of deeply seated lesions such as intraventricular or periventricular lesions. 10,12,16 The potential clinical repercussions of new data providing evidence of the right parietal lobe as an eloquent area for calculation are therefore obvious in left-dominant patients, in whom the right, nondominant side is generally considered a reasonably safe surgical approach.In this report, we present the results of intraoperative Object. The role of parietal areas in number processing is well known. The significance of intraoperative functional mapping of these areas has been only partially explored, however, and only a few discordant data are available in the surgical literature with regard to the right parietal lobe. The purpose of this study was to evaluate the clinical impact of simple calculation in cortical electrostimulation of right-handed patients affected by a right parietal brain tumor.Methods. Calculation mapping in awake surgery was performed in 3 right-handed patients affected by highgrade gliomas located in the right parietal lobe. Preoperatively, none of the patients presented with calculation deficits. In all 3 cases, after sensorimotor and language mapping, cortical and intraparietal sulcus areas involved in singledigit multiplication and addition calculations were mapped using bipolar electrostimulation.Results. In all patients, different sites of the right parietal cortex, mainly in the inferior lobule, were detected as being specifically related to calculation (multiplication or addition). In 2 patients the intraparietal s...

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“…DES plays an important role in studies of such higher cognitive functions as hemispheric ignorance, perceptual awareness, music, calculation, memory and category-specific naming (12,(34)(35)(36)(37)(38)(39). In the present study, it was found that the Broca area of a Chinese population undergoing DES was mainly concentrated within a 1-cm range.…”

Section: Discussionmentioning

confidence: 55%

Glioma localization and excision using direct electrical stimulation for language mapping during awake surgery

Bai

Wang

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of this study was to investigate the method and significance of the application of direct electrical stimulation (DES) to the brain mapping of language functions during glioma surgery. A retrospective analysis of clinical data was performed for 91 cases of brain functional area glioma surgery under DES from January 2003 until January 2012. Following cortical electrical stimulation, 88 patients exhibited seizures involving facial or hand movements and 91 cases experienced language disorders such as counting interruption, naming errors or anomia. The most commonly observed areas of counting interruption were distributed on the posterior part of the left anterior central gyrus (47.7%), the operculum of the left inferior frontal gyrus (24.4%) and the triangular part of the left inferior frontal gyrus (12.8%). Postoperative magnetic resonance imaging demonstrated that overall excision was achieved in 53 cases and sub-overall excision was performed in 31 cases. A total of 42 cases (46.2%) exhibited no postoperative neurological dysfunction, 39 cases (42.9%) exhibited brief language dysfunction, 27 cases (29.7%) experienced brief limb movement disorder, and one case appeared to have permanent neurological dysfunction. DES was indicated to be a reliable and noninvasive method for the intraoperative positioning of language areas, and was able to resect gliomas in the language area with maximal safety.

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Surgery for gliomas involving the left inferior parietal lobule: new insights into the functional anatomy provided by stimulation mapping in awake patients

Cited by 118 publications

References 47 publications

Contemporary model of language organization: an overview for neurosurgeons

Contemporary model of language organization: an overview for neurosurgeons

Right parietal cortex and calculation processing: intraoperative functional mapping of multiplication and addition in patients affected by a brain tumor

Glioma localization and excision using direct electrical stimulation for language mapping during awake surgery

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