Montemurro Nicola, Herbet Guillaume, Duffau Hugues
Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
Brain Topogr. 2016 Jul;29(4):561-71. doi: 10.1007/s10548-016-0490-6. Epub 2016 Apr 11.
To investigate the neural network underpinning eye movements, a cortical and subcortical intraoperative mapping using direct electrical stimulation (DES) was achieved in six awake patients during surgery for a right frontal low-grade glioma. We assessed the relationship between the occurrence of ocular deviation during both cortical and axonal DES and the anatomic location for each response. The corresponding stimulation sites were reported on a standard brain template for visual analysis and between-subjects comparisons. Our results showed that DES of the cortical frontal eye field (FEF) elicited horizontal (anterior FEF) or upward (posterior FEF) eye movements in 3 patients, supporting the fact that FEF comprises several distinct functional subregions. In addition, subcortical stimulation of the white matter tracts underneath the FEF evoked conjugate contraversive ocular deviation in 3 other patients. Interestingly, this region seems to be a crossroad between the fronto-striatal tract, the frontal aslant tract, the inferior fronto-occipital fascicle and the superior longitudinal fascicle. No deficits in eye movements were observed following surgery. To our knowledge, this is the first study reporting ocular deviation during axonal electrostimulation mapping of the white matter fibers in awake patients. Therefore, our original data issued from DES give new insights into the cortical and subcortical structures involved in the control of eye movements and their strong relationships with other functional pathways.
为了研究眼动背后的神经网络，在6例因右侧额叶低级别胶质瘤接受手术的清醒患者中，通过直接电刺激（DES）实现了皮质和皮质下术中映射。我们评估了皮质和轴突DES期间眼偏斜的发生与每个反应的解剖位置之间的关系。在标准脑模板上报告相应的刺激部位，用于视觉分析和受试者间比较。我们的结果显示，皮质额叶眼区（FEF）的DES在3例患者中引发了水平（前FEF）或向上（后FEF）眼动，支持FEF包含几个不同功能亚区这一事实。此外，FEF下方白质束的皮质下刺激在其他3例患者中诱发了共轭对侧眼偏斜。有趣的是，该区域似乎是额纹状体束、额斜束、额枕下束和上纵束之间的交叉点。术后未观察到眼动缺陷。据我们所知，这是第一项报告清醒患者白质纤维轴突电刺激映射期间眼偏斜的研究。因此，我们从DES获得的原始数据为参与眼动控制的皮质和皮质下结构及其与其他功能通路的紧密关系提供了新的见解。
