Crossed aphasia (aphasia resulting from a right hemispheric lesion among right-handed patients) is rare. The authors describe for the first time transient crossed aphasia elicited by intraoperative electrostimulation of both cortex and white matter pathways in awake patients.
Three right-handed adults underwent surgery for a right-sided glioma. Because slight language disorders occurred during partial seizures or were identified on preoperative cognitive assessment, with right activations detected on language functional MR imaging in 1 patient, awake craniotomy was performed using intraoperative cortico-subcortical electrical functional mapping.
Transient language disturbances were elicited by stimulating discrete cortical areas (inferior frontal gyrus and posterior part of the superior temporal gyrus) and white matter pathways (inferior frontooccipital fasciculus and arcuate fasciculus). A subtotal resection was achieved in all cases, according to functional boundaries. Postoperatively, 1 patient experienced a transient dysphasia, which resolved after speech rehabilitation, with no permanent deficit.
These original findings highlight the possibility of finding crucial cortico-subcortical language networks in the right hemisphere in a subgroup of atypical right-handed patients. These findings provide new insights into the neural basis of language, by underlining the role of the right inferior occipitofrontal fasciculus in semantics and that of the right arcuate fasciculus in phonology, and by supporting the hypothesis of a mirror organization between the right and left hemispheres. The authors suggest that, in right-handed patients, if language disturbances are detected during seizures or on presurgical neuropsychological assessment, especially when right activations are observed on language functional MR imaging, awake craniotomy with intraoperative language mapping should be considered.
"Knowledge on the organization of propositional language in the right hemisphere comes from the analysis of aphasic patients with damage to the right hemisphere (see Alexander et al., 1989a; Mariën et al., 2004) and from a case series study of intraoperative cortical-subcortical stimulation (Vassal et al., 2010). Vassal coworkers (2010) performed intraoperative cortical-subcortical electrical functional mapping in three right-handed adults who had right-sided low-grade gliomas. "
[Show abstract][Hide abstract] ABSTRACT: Knowledge on the patterns of repetition amongst individuals who develop language deficits in association with right hemisphere lesions (crossed aphasia) is very limited. Available data indicate that repetition in some crossed aphasics experiencing phonological processing deficits is not heavily influenced by lexical-semantic variables (lexicality, imageability, and frequency) as is regularly reported in phonologically-impaired cases with left hemisphere damage. Moreover, in view of the fact that crossed aphasia is rare, information on the role of right cortical areas and white matter tracts underpinning language repetition deficits is scarce. In this study, repetition performance was assessed in two patients with crossed conduction aphasia and striatal/capsular vascular lesions encompassing the right arcuate fasciculus (AF) and inferior frontal-occipital fasciculus (IFOF), the temporal stem and the white matter underneath the supramarginal gyrus. Both patients showed lexicality effects repeating better words than non-words, but manipulation of other lexical-semantic variables exerted less influence on repetition performance. Imageability and frequency effects, production of meaning-based paraphrases during sentence repetition, or better performance on repeating novel sentences than overlearned clichés were hardly ever observed in these two patients. In one patient, diffusion tensor imaging disclosed damage to the right long direct segment of the AF and IFOF with relative sparing of the anterior indirect and posterior segments of the AF, together with fully developed left perisylvian white matter pathways. These findings suggest that striatal/capsular lesions extending into the right AF and IFOF in some individuals with right hemisphere language dominance are associated with atypical repetition patterns which might reflect reduced interactions between phonological and lexical-semantic processes.
Frontiers in Human Neuroscience 10/2013; 7:675. DOI:10.3389/fnhum.2013.00675 · 3.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite the report of recent experiences of insular surgery in the past decade, there has been no series specifically dedicated to studying functional outcome following resection of insular WHO Grade II gliomas involving the dominant hemisphere, in patients with no or only mild preoperative language deficit. In this article, the authors analyze the contribution of awake mapping for preservation of brain function, especially language, in a homogeneous series of 24 patients who underwent surgery for insular Grade II gliomas within the dominant insular lobe.
Twenty-four patients underwent surgery for an insular Grade II glioma involving the dominant hemisphere (22 left, 2 right), revealed by seizures in all but 1 case. The preoperative neurological examination result was normal in 17 patients (71%), whereas 7 patients presented with language disorders detected using an accurate language assessment performed by a speech therapist. All surgeries were performed on awake patients utilizing intra-operative language mapping involving cortical and subcortical stimulation.
There were no intrasurgical complications or postsurgical sensorimotor deficits. Despite an immediate postoperative language worsening in 12 cases (50%), all patients recovered to a normal status within 3 months, and 6 cases even improved in comparison with their preoperative examination results. The 24 patients returned to normal social and professional lives. Moreover, the surgery had a favorable impact on epilepsy in all but 4 cases (83%). On control MR imaging, 62.5% of resections were total or subtotal. Three patients underwent a second or third awake surgery, with no additional deficit. All but 2 patients (92%) are alive after a mean follow-up of 3 years (range 3-133 months).
Although insular surgery was long believed to be too risky, the present results show that the rate of permanent deficit, especially dysphasia, following resection of Grade II gliomas involving the dominant insula has been dramatically reduced (none in this patient series), thanks to the systematic use of intraoperative awake mapping, even in cases of repeated operations. Furthermore, patient quality of life may be improved due to a decrease of epilepsy after surgery. Thus, the authors suggest systematically considering resection when an insular Grade II glioma is diagnosed after seizures in a patient with no or mild deficit, even a glioma invading the dominant hemisphere.
[Show abstract][Hide abstract] ABSTRACT: For a long time, in a localizationist view of brain functioning, a combination of symptoms called "frontal syndrome" has been interpreted as the direct result of damages involving the frontal lobe(s). The goal of this review is to challenge this view, that is, to move to a hodotopical approach to lesion mapping, on the basis of new insights provided by intraoperative electrostimulation mapping investigations in patients who underwent awake surgery for cerebral tumors. These original data reported in the last decade break with the traditional dogma of a modular and fixed organization of the central nervous system, by switching to the concepts of cerebral connectivity and plasticity - i.e., a brain organization based on dynamic interrelationships between parallel distributed networks. According to this revisited model, "frontal symptoms" can be generated by tumor or electrostimulation not only of the frontal lobes, but also of cortical and subcortical (white matter pathways/deep gray nuclei) structures outside the frontal lobes: especially, stimulation of the superior longitudinal fascicle may elicit speech production disorders, syntactic disturbances, involuntary language switching or phonemic paraphasia (arcuate fascicle), stimulation of the inferior fronto-occipital fascicle can generate semantic paraphasia or deficit of cross-modal judgment, stimulation of the subcallosal fasciculus may elicit transcortical motor aphasia, while stimulation of the striatum induces preservations. On the other hand, it is also possible to perform extensive right or left frontal lobectomy in patients who continue to have a normal familial, social and professional life, without "frontal syndrome". Therefore, this provocative approach may open the door to a renewal in the modeling of brain processing as well as in its clinical applications, especially in the fields of cerebral surgery and functional rehabilitation. These findings illustrate well the need to reinforce links between cognitive neuroscience and clinical neurology/neurosurgery.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.