Acta Neurochirurgica

, Volume 156, Issue 4, pp 661–670

The persistent crucial role of the left hemisphere for language in left-handers with a left low grade glioma: a stimulation mapping study

  • Ryosuke Matsuda
  • Sylvie Moritz-Gasser
  • Sophie Duvaux
  • Alejandro Fernández Coello
  • Matteo Martinoni
  • Hugues Duffau
Clinical Article - Brain Tumors

DOI: 10.1007/s00701-014-2003-2

Cite this article as:
Matsuda, R., Moritz-Gasser, S., Duvaux, S. et al. Acta Neurochir (2014) 156: 661. doi:10.1007/s00701-014-2003-2

Abstract

Background

Left-handers have a more bilateral language representation than right-handers. Therefore, in left-handers with a low-grade glioma (LGG) in the left hemisphere (LH), one could hypothesize that the right hemisphere (RH) might allow language compensation, at least partly, with no or only a minor persistent role of the LH in speech. However, although LGG induces language reorganization in right-handed patients, little is known in left-handers. Here, we report the first series of left-handers who underwent awake surgery for a left LGG using intraoperative mapping, in order to investigate whether there was still an involvement of LH in language.

Method

Ten consecutive left-handed patients were operated for a left LGG (three frontal, four paralimbic, one parietal, one temporal, one parieto-temporal tumor) using an awake procedure with intraoperative electrical language mapping.

Results

Intraoperative language disorders were elicited in all cases but one by electrostimulation in the LH. Cortical language sites were detected in nine cases. Subcortical stimulation also demonstrated the crucial role of left white matter pathways in language, including the inferior occipital-frontal fascicle, arcuate fascicle, lateral segment of the superior longitudinal fascicle and fibers from the ventral premotor cortex. Moreover, stimulation of deep gray nuclei generated language disturbances in four patients. These nine patients experienced transient postoperative language worsening, supporting the persistent critical role of LH in speech. In only one patient, no language deficit was evoked intraoperatively and postoperatively. The ten patients returned to a normal life. Total or subtotal resection was achieved in all cases but one.

Conclusions

Our results suggest that, even though the RH may participate in language compensation, the LH in left-handers still plays a crucial role, despite a left slow-growing LGG. Thus, we propose to routinely consider awake surgery for left LGG removal in left-handers patients, to optimize the extent of resection while preserving language.

Keywords

Left-handers Left hemisphere Brain mapping Language Electrostimulation Brain connectivity 

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Ryosuke Matsuda
    • 1
  • Sylvie Moritz-Gasser
    • 2
    • 3
  • Sophie Duvaux
    • 2
    • 3
  • Alejandro Fernández Coello
    • 4
  • Matteo Martinoni
    • 5
  • Hugues Duffau
    • 3
    • 6
    • 7
  1. 1.Department of NeurosurgeryNara Medical UniversityKashiharaJapan
  2. 2.Department of NeurologyHôpital Gui de Chauliac, Montpellier University Medical CenterMontpellierFrance
  3. 3.Department of NeurosurgeryHôpital Gui de Chauliac, Montpellier University Medical CenterMontpellierFrance
  4. 4.Department of Neurology, NeurosurgeryHospital Universitario de Bellvitge, L’Hospitalet de LlobregatBarcelonaSpain
  5. 5.Department of NeurosurgeryIRCCS, Bellaria HospitalBolognaItaly
  6. 6.INSERM U1051, Team “Plasticity of the central nervous system, human stem cells and glial tumors”, Institute for Neurosciences of MontpellierMontpellier University Medical CenterMontpellierFrance
  7. 7.Department of NeurosurgeryGui de Chauliac Hospital, CHU MontpellierMontpellierFrance

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