Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, 08097, L'Hospitalet de Llobregat, Barcelona, Spain; Dept. of Cognition, Development and Education Psychology, University of Barcelona, Campus Bellvitge, 08097, L'Hospitalet de Llobregat, Barcelona, Spain; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Medical Psychology, Nijmegen, The Netherlands.
Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, 08097, L'Hospitalet de Llobregat, Barcelona, Spain; Hospital Universitari de Bellvitge (HUB), Neurosurgery Section, Campus Bellvitge, University of Barcelona - IDIBELL, 08097, L'Hospitalet de Llobregat, Barcelona, Spain.
Neuroimage Clin. 2019;22:101704. doi: 10.1016/j.nicl.2019.101704. Epub 2019 Jan 31.
In the present study, we aimed to test the association between the correct function of the left ventral white matter pathways and semantic processing (dual stream models for language processing, Hickok & Poeppel, 2004), using a new set of language tasks during intraoperative electrical stimulation at white matter level. Additionally, we evaluated brain regions needed for correct performance on the different semantic tasks using lesion-symptom analyses (voxel lesion-symptom mapping and track-wise lesion analysis) in a sample of 62 candidates for the awake brain surgery. We found that electrical stimulation in the vicinity of the inferior longitudinal and inferior fronto-occipital fasciculi disturbed performance on semantic processing tasks. Individuals presented with significantly more semantic paraphasias during brain tumor resection than during the electrical stimulation at the cortex level. Track-wise analyses confirmed the role of these left ventral pathways in semantic processing: a significant relationship was observed between the probability of inferior fronto-occipital fasciculus disconnection/damage and the semantic matching tasks, as well as the number of semantic paraphasias in naming. Importantly, the same analyses for the total score of the Boston Naming Test confirmed significant relationships between this test score and the integrity of the inferior fronto-occipital, inferior longitudinal and uncinate fasciculi. This was further supported by the results of VLSM analyses showing a significant relationship between BNT and the presence of lesion within left middle and inferior temporal gyri. The present findings provide new intraoperative evidence for the role of the white-matter ventral pathways in semantic processing, while at the same time emphasizing the need to include a broader assessment of semantic-conceptual aspects during the awake neurosurgical intervention. This approach will ensure better preservation of functional tissue in the tumoral vicinity and therefore substantially diminish post-surgical language impairments.
在本研究中，我们旨在通过在白质水平进行术中电刺激时使用一组新的语言任务，来测试左侧腹侧白质通路的正确功能与语义处理（语言处理的双加工流模型，Hickok & Poeppel，2004）之间的关联。此外，我们还在 62 名接受清醒脑手术的候选者的样本中进行了病变-症状分析（体素病变-症状映射和轨迹分析），评估了在不同语义任务中正确表现所需的大脑区域。我们发现，在接近下纵束和下额枕束附近进行电刺激会干扰语义处理任务的表现。与皮层水平的电刺激相比，个体在脑肿瘤切除过程中出现明显更多语义错误。轨迹分析证实了这些左侧腹侧通路在语义处理中的作用：在下额枕束断开/损伤与语义匹配任务之间观察到显著的关系，以及命名时语义错误的数量。重要的是，对波士顿命名测试总分的相同分析证实了该测试得分与下额枕束、下纵束和钩束完整性之间存在显著关系。VLSM 分析的结果进一步支持了这一点，该分析显示 BNT 与左侧颞中回和颞下回内病变的存在之间存在显著关系。这些发现为语义处理中白质腹侧通路的作用提供了新的术中证据，同时强调了在清醒神经外科干预过程中需要更广泛地评估语义概念方面。这种方法将确保在肿瘤附近更好地保留功能组织，从而大大减少术后语言障碍。
