Rofes Adrià, D'Agata Federico, Guerrini Francesco, Spena Giannantonio
1Center for Language and Cognition and.
2Research School of Behavioural and Cognitive Neurosciences, University of Groningen, The Netherlands.
J Neurosurg. 2024 Jan 12;140(6):1641-1659. doi: 10.3171/2023.10.JNS231493. Print 2024 Jun 1.
In this retrospective study, the authors aimed to establish the stereotactically defined probability distribution for speech (i.e., anarthria, speech arrest) and lexico-semantic errors (i.e., anomia) through direct cortical stimulation (DCS) by using two tasks: action naming and object naming. They also analyzed the patterns of interindividual variability in the localization of the language sites involved, and investigated whether any patient or lesion location factors were associated with greater variability.
Eighty-one Italian-speaking patients who underwent awake surgery between 2010 and 2021 for low- and high-grade gliomas in eloquent areas of the language-dominant hemisphere were entered in the analyses. The intraoperative DCS protocol included automatic speech tasks, object naming, and action naming. The position of the tags, as depicted on the intraoperative video or photograph, was transposed into Montreal Neurological Institute space. Subsequently, a 2D scatterplot and cluster analysis were performed. Associations between various clinical and radiological characteristics and the quantity of positive stimulated sites were determined by univariate analyses using binary logistic regression. Associated variables (p < 0.2) were included in stepwise multivariate logistic regression with backward elimination (p < 0.05).
A total of 1380 cortical sites were stimulated, with a positive response in 511 cases (37%). Most anarthric errors were triggered when stimulating the left precentral gyrus, and most speech arrest errors were elicited when stimulating the left posterior inferior frontal gyrus. Anomias were found in the left inferior frontal gyrus and in the posterior part of the left temporal lobe for object naming. DCS to the left dorsal premotor cortex elicited anomic errors for action naming. Anomias were also elicited during DCS to the left posterior temporal lobe, with both object and action naming.
The distribution of speech and lexico-semantic errors is in line with the current literature. The action-naming results are new and mostly involve the dorsal premotor cortex. These findings stress the importance of maximizing the use of different language tasks during surgery, because even when looking for the same type of errors, different tasks may be better suited to map specific brain regions. DCS with action and object naming identifies more positive sites than object naming alone.
在这项回顾性研究中，作者旨在通过使用动作命名和物体命名两项任务的直接皮质刺激（DCS），建立立体定向定义的言语（即构音障碍、言语停顿）和词汇语义错误（即命名性失语）的概率分布。他们还分析了所涉及语言区域定位的个体间变异性模式，并调查是否有任何患者或病变位置因素与更大的变异性相关。
对2010年至2021年间因语言优势半球明确区域的低级别和高级别胶质瘤而接受清醒手术的81名讲意大利语的患者进行分析。术中DCS方案包括自动言语任务、物体命名和动作命名。术中视频或照片上显示的标记位置被转换到蒙特利尔神经病学研究所空间。随后，进行二维散点图和聚类分析。使用二元逻辑回归的单变量分析确定各种临床和放射学特征与阳性刺激部位数量之间的关联。相关变量（p<0.2）被纳入逐步多元逻辑回归并进行向后消除（p<0.05）。
总共刺激了1380个皮质部位，511例（37%）有阳性反应。刺激左侧中央前回时引发的构音障碍错误最多，刺激左侧额下回后部时引发的言语停顿错误最多。在物体命名中，命名性失语出现在左侧额下回和左侧颞叶后部。对左侧背侧运动前皮质进行DCS会引发动作命名的命名性失语错误。在对左侧颞叶后部进行DCS时，物体命名和动作命名都会引发命名性失语错误。
言语和词汇语义错误的分布与当前文献一致。动作命名的结果是新的，主要涉及背侧运动前皮质。这些发现强调了在手术期间最大限度地使用不同语言任务的重要性，因为即使在寻找同一类型的错误时，不同的任务可能更适合映射特定的脑区。与仅进行物体命名相比，进行动作和物体命名的DCS能识别出更多的阳性部位。
