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左弓状束颞皮质终末之争:再评价。

Controversy over the temporal cortical terminations of the left arcuate fasciculus: a reappraisal.

机构信息

Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy.

Institute of Neuroscience, Cleveland Clinic London, Grosvenor Place, London, UK.

出版信息

Brain. 2022 May 24;145(4):1242-1256. doi: 10.1093/brain/awac057.

Abstract

The arcuate fasciculus has been considered a major dorsal fronto-temporal white matter pathway linking frontal language production regions with auditory perception in the superior temporal gyrus, the so-called Wernicke's area. In line with this tradition, both historical and contemporary models of language function have assigned primacy to superior temporal projections of the arcuate fasciculus. However, classical anatomical descriptions and emerging behavioural data are at odds with this assumption. On one hand, fronto-temporal projections to Wernicke's area may not be unique to the arcuate fasciculus. On the other hand, dorsal stream language deficits have been reported also for damage to middle, inferior and basal temporal gyri that may be linked to arcuate disconnection. These findings point to a reappraisal of arcuate projections in the temporal lobe. Here, we review anatomical and functional evidence regarding the temporal cortical terminations of the left arcuate fasciculus by incorporating dissection and tractography findings with stimulation data using cortico-cortical evoked potentials and direct electrical stimulation mapping in awake patients. First, we discuss the fibres of the arcuate fasciculus projecting to the superior temporal gyrus and the functional rostro-caudal gradient in this region where both phonological encoding and auditory-motor transformation may be performed. Caudal regions within the temporoparietal junction may be involved in articulation and associated with temporoparietal projections of the third branch of the superior longitudinal fasciculus, while more rostral regions may support encoding of acoustic phonetic features, supported by arcuate fibres. We then move to examine clinical data showing that multimodal phonological encoding is facilitated by projections of the arcuate fasciculus to superior, but also middle, inferior and basal temporal regions. Hence, we discuss how projections of the arcuate fasciculus may contribute to acoustic (middle-posterior superior and middle temporal gyri), visual (posterior inferior temporal/fusiform gyri comprising the visual word form area) and lexical (anterior-middle inferior temporal/fusiform gyri in the basal temporal language area) information in the temporal lobe to be processed, encoded and translated into a dorsal phonological route to the frontal lobe. Finally, we point out surgical implications for this model in terms of the prediction and avoidance of neurological deficit.

摘要

弓状束被认为是连接额部语言产生区与上颞回(即所谓的韦尼克区)听觉感知的主要额颞背侧白质通路。与这一传统一致,语言功能的历史和当代模型都赋予了弓状束的上颞回投射以首要地位。然而,经典的解剖描述和新兴的行为数据与这一假设并不一致。一方面,到韦尼克区的额颞部投射可能并非弓状束所特有。另一方面,也有报道称,中颞叶、下颞叶和基底颞叶的损伤也会导致语言障碍,这可能与弓状束的断开有关。这些发现表明,需要重新评估颞叶中的弓状束投射。在这里,我们通过整合解剖和功能证据,包括在清醒患者中使用皮质-皮质诱发电位和直接电刺激映射进行的刺激数据,回顾了左侧弓状束的颞叶皮质末端的解剖和功能证据。首先,我们讨论了投射到上颞回的弓状束纤维,以及该区域的功能前后梯度,其中可能进行语音编码和听觉-运动转换。颞顶联合区的尾侧区域可能与第三分支上纵束的颞顶叶投射有关,涉及发音,而更头侧的区域可能支持声学语音特征的编码,这由弓状束纤维支持。然后,我们研究了临床数据,这些数据表明,弓状束的投射不仅促进了上颞回的多模态语音编码,也促进了中颞回、下颞回和基底颞回的多模态语音编码。因此,我们讨论了弓状束的投射如何有助于颞叶中的声学(中后部上颞回和中颞回)、视觉(包括视觉词形区的后下部颞回/梭状回)和词汇(基底颞叶语言区的前中部颞回/梭状回)信息的处理、编码和转化为到额叶的背侧语音通路。最后,我们指出了该模型在预测和避免神经功能缺损方面的手术意义。

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