Scarone Pietro, Gatignol Peggy, Guillaume Sophie, Denvil Dominique, Capelle Laurent, Duffau Hugues
Department of Neurosurgery, Hôpital Foch, Suresnes, France 92150.
Surg Neurol. 2009 Sep;72(3):223-41; discussion 241. doi: 10.1016/j.surneu.2008.10.074. Epub 2009 Jul 23.
Controversy still exists about neural basis underlying writing and its relation with the sites subserving oral language. Our objective is to study functional areas involved in writing network, based on the observations of different postoperative writing disorders in a population of patients without preoperative agraphia.
We analyzed the postoperative agraphia profiles in 15 patients who underwent surgery for cerebral LGGs in functional language areas, using electrical mapping under local anesthesia. These profiles were then correlated to the sites of the lesions, shown by preoperative cerebral imaging.
Our findings showed that (1) spoken language and writing functions could be dissociated, and that (2) writing is subserved, at least partially, by a network of 5 areas located in the dominant hemisphere for language: the superior parietal region, the supramarginalis gyrus, the second and third frontal convolutions, the supplementary motor area, and the insula. Each of these areas seems to have a different role in writing, which will be detailed in this article. However, among the patients, only those with lesions of the supplementary motor area did not recover from agraphia in the postoperative period (in 50% of cases).
On the basis of these results, and in the light of the recent literature, we discuss the relevance of each area in this anatomo-functional network as well as the clinical implications of such better knowledge of the neural basis of writing, especially for brain surgery and functional rehabilitation.
关于书写的神经基础及其与口语相关脑区的关系仍存在争议。我们的目标是基于对一组术前无失写症患者术后不同书写障碍的观察，研究参与书写网络的功能区。
我们分析了15例在功能语言区接受大脑低级别胶质瘤手术的患者术后的失写症情况，采用局部麻醉下的电刺激图谱。然后将这些情况与术前脑成像显示的病变部位相关联。
我们的研究结果表明：（1）口语和书写功能可以分离；（2）书写至少部分由位于语言优势半球的5个区域组成的网络支持，即顶上叶区域、缘上回、额中回和额下回、辅助运动区和脑岛。这些区域在书写中似乎各自发挥着不同的作用，本文将详细阐述。然而，在这些患者中，只有辅助运动区受损的患者在术后失写症没有恢复（50%的病例）。
基于这些结果，并结合近期文献，我们讨论了这个解剖功能网络中每个区域的相关性，以及更好地了解书写神经基础的临床意义，特别是对脑外科手术和功能康复的意义。
