Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milan, Italy.
Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy.
Brain. 2019 Aug 1;142(8):2451-2465. doi: 10.1093/brain/awz178.
A key aspect of cognitive control is the management of conflicting incoming information to achieve a goal, termed 'interference control'. Although the role of the right frontal lobe in interference control is evident, the white matter tracts subserving this cognitive process remain unclear. To investigate this, we studied the effect of transient network disruption (by means of direct electrical stimulation) and permanent disconnection (resulting from neurosurgical resection) on interference control processes, using the Stroop test in the intraoperative and extraoperative neurosurgical setting. We evaluated the sites at which errors could be produced by direct electrical stimulation during an intraoperative Stroop test in 34 patients with frontal right hemisphere glioma. Lesion-symptom mapping was used to evaluate the relationship between the resection cavities and postoperative performance on the Stroop test of this group compared with an additional 29 control patients who did not perform the intraoperative test (63 patients in total aged 17-77 years; 28 female). We then examined tract disruption and disconnection in a subset of eight patients who underwent both the intraoperative Stroop test and high angular resolution diffusion imaging (HARDI) tractography. The results showed that, intraoperatively, the majority of sites associated with errors during Stroop test performance and concurrent subcortical stimulation clustered in a region of white matter medial to the right inferior frontal gyrus, lateral and superior to the striatum. Patients who underwent the intraoperative test maintained cognitive control ability at the 1-month follow-up (P = 0.003). Lesion-symptom analysis showed resection of the right inferior frontal gyrus was associated with slower postoperative Stroop test ability (corrected for multiple comparisons, 5000 permutations). The stimulation sites associated with intraoperative errors most commonly corresponded with the inferior fronto-striatal tracts and anterior thalamic radiation (over 75% of patients), although the latter was commonly resected without postoperative deficits on the Stroop test (in 60% of patients). Our results show converging evidence to support a critical role for the inferior frontal gyrus in interference control processes. The intraoperative data combined with tractography suggests that cortico-subcortical tracts, over cortico-cortical connections, may be vital in maintaining efficiency of cognitive control processes. This suggests the importance of their preservation during resection of right frontal tumours.
认知控制的一个关键方面是管理冲突的传入信息以实现目标，称为“干扰控制”。尽管右额叶在干扰控制中的作用是显而易见的，但支持这一认知过程的白质束仍不清楚。为了研究这一点，我们使用 Stroop 测试在术中及神经外科手术环境中研究了短暂网络中断（通过直接电刺激）和永久性断开（由神经外科切除引起）对干扰控制过程的影响。我们评估了在 34 名右额叶胶质瘤患者的术中 Stroop 测试中，直接电刺激时可能产生错误的部位。通过对该组患者的手术切除腔与术后 Stroop 测试结果的关系进行损伤症状映射，与另外 29 名未进行术中测试的对照组患者（共 63 名年龄 17-77 岁的患者，28 名女性）进行比较。然后，我们检查了在接受术中 Stroop 测试和高角度分辨率扩散成像（HARDI）束成像的 8 名患者的一组患者中束的中断和断开。结果表明，术中与 Stroop 测试表现和并发皮质下刺激相关的大多数错误部位聚集在右额下回内侧的白质区，位于纹状体的外侧和上方。接受术中测试的患者在 1 个月的随访中保持了认知控制能力（P = 0.003）。损伤症状分析表明，右额下回切除术与术后 Stroop 测试能力较慢有关（经多次比较校正，5000 次置换）。与术中错误相关的刺激部位最常见于额下回-纹状体束和前丘脑辐射（超过 75%的患者），尽管后者在没有术后 Stroop 测试缺陷的情况下经常被切除（60%的患者）。我们的结果提供了一致的证据，支持额下回在干扰控制过程中的关键作用。术中数据与束追踪相结合表明，皮质下束可能比皮质内连接更重要，对于维持认知控制过程的效率至关重要。这表明在切除右额叶肿瘤时，保护这些束是很重要的。
