Mandonnet E
Department of Neurosurgery, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Université Diderot Paris 7, 75010 Paris, France; IMNC, UMR165, 91405 Orsay, France.
Neurochirurgie. 2017 Jun;63(3):122-128. doi: 10.1016/j.neuchi.2016.10.004. Epub 2017 May 12.
Language is the most widely mapped cognitive function during brain surgery. Intraoperative language functional mapping using direct electrical stimulation under awake conditions is currently the gold standard technique for establishing the causal link between an area and a deficit that would be caused by its resection. It is also a powerful tool to investigate the anatomical correlates of current neuropsychological models of language.
The aim of this article is to reexamine the anatomo-functional structure of language that could be inferred from data obtained in direct electrical stimulation studies during awake surgery.
Concomitantly with the development of new neuropsychological models of language, major advances have been made in our understanding of error patterns elicited by language network stimulation, both cortically and axonally. Following the recognition of visual information, the language network of picture naming is organized in parallel into two main dorsal phonological and ventral semantic subsystems that are sustained anatomically by two systems (arcuate fasciculus and inferior fronto-occipital/inferior longitudinal/uncinate fasciculus respectively). Networks of articulatory and motor aspects of speech are now better depicted (aslant tract, third branch of longitudinal fasciculus). Finally, the links between the core language networks and the cognitive control networks are also emerging.
Mastering the language map and its dynamical properties should be a basic prerequisite for any neurosurgeon who wishes to operate on the brain with the aim of optimizing the extent of resection while preserving language abilities.
语言是脑外科手术中映射最为广泛的认知功能。在清醒状态下使用直接电刺激进行术中语言功能映射，是目前建立脑区与其切除后可能导致的功能缺陷之间因果关系的金标准技术。它也是研究当前语言神经心理学模型解剖学关联的有力工具。
本文旨在重新审视从清醒手术期间直接电刺激研究获得的数据中推断出的语言解剖功能结构。
随着新的语言神经心理学模型的发展，我们对语言网络刺激在皮层和轴突水平引发的错误模式的理解取得了重大进展。在识别视觉信息之后，图片命名的语言网络并行组织为两个主要的背侧语音子系统和腹侧语义子系统，它们在解剖学上分别由两个系统（弓状束和额枕下束/下纵束/钩束）维持。现在对言语的发音和运动方面的网络有了更好的描绘（斜束，纵束的第三分支）。最后，核心语言网络与认知控制网络之间的联系也逐渐显现。
对于任何希望通过手术切除脑区同时保留语言能力以优化切除范围的神经外科医生来说，掌握语言图谱及其动态特性应是一项基本前提。
