Impact of connectivity between the pars triangularis and orbitalis on identifying the frontal language area in patients with dominant frontal gliomas
- 20 Downloads
We have previously revealed that identification of the frontal language area (FLA) can be difficult in patients with dominant frontal glioma involving the pars triangularis (PT). The present study added new cases and performed additional analyses. We noticed a new finding that the presence of extension to the pars orbitalis (POr) was associated with negative response to the FLA. The aim of the present study was to evaluate the impact of PT involvement with extension to the POr on the failure to identify the FLA. From 2000 to 2017, awake craniotomy was performed on 470 patients. Of these patients, the present study included 148 consecutive patients with frontal glioma on the dominant side. We evaluated whether tumors involved the PT or extended to the POr. Thirty one of 148 patients showed involvement of the PT, and we examined the detailed characteristics of these 31 patients. The rate of negative response for the FLA was 61% in patients with involvement of the PT. In 31 patients with frontal glioma involving the PT, univariate analyses showed significant correlation between extension to the POr and failure to identify the FLA (P = 0.0070). Similarly, multivariate analysis showed only extension to the POr correlated significantly with failure to identify the FLA (P = 0.0129). We found new evidence that extension to the POr which impacts connectivity between the PT and POr correlated significantly with negative response to the FLA of patients with dominant frontal glioma.
KeywordsAwake craniotomy Language function Frontal glioma Pars triangularis Pars orbitalis
Special thanks are extended to Dr. Takashi Komori, Ms. Soko Ikuta, Satoko Fukuchi, Asuka Komori, and Mr. Takashi Sakayori for valuable help with clinical work and data analysis.
This study was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant No. 18K09006.
Compliance with ethical standards
Ethical approval was obtained from the ethics committee at the Tokyo Women’s Medical University (No. 3540).
Given the retrospective design, the institutional review board waived the requirement for informed consent. We took the opt-out method. To protect patient privacy, we removed all identifiers from our records upon completion of our analyses.
Conflict of interest
The authors declare that they have no potential conflicts of interest.
- 1.Ardila A, Bernal B, Rosselli M (2016) How localized are language brain areas? A review of Brodmann areas involvement in oral language. Archives of Clinical Neuropsychology: the Official Journal of the National Academy of Neuropsychologists 31:112–122. https://doi.org/10.1093/arclin/acv081 CrossRefGoogle Scholar
- 4.Damasio AR, Geschwind N (1984) The neural basis of language. Annu Rev Neurosci 7:127–147. https://doi.org/10.1146/annurev.ne.07.030184.001015 CrossRefPubMedGoogle Scholar
- 12.Friederici AD (2015) White-matter pathways for speech and language processing. Handb Clin Neurol 129:177–186. https://doi.org/10.1016/B978-0-444-62630-1.00010-X CrossRefPubMedGoogle Scholar
- 13.Giussani C, Roux FE, Ojemann J, Sganzerla EP, Pirillo D, Papagno C (2010) Is preoperative functional magnetic resonance imaging reliable for language areas mapping in brain tumor surgery? Review of language functional magnetic resonance imaging and direct cortical stimulation correlation studies. Neurosurgery 66:113–120. https://doi.org/10.1227/01.NEU.0000360392.15450.C9 CrossRefPubMedGoogle Scholar
- 15.Kim SS, McCutcheon IE, Suki D, Weinberg JS, Sawaya R, Lang FF, Ferson D, Heimberger AB, DeMonte F, Prabhu SS (2009) Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients. Neurosurgery 64:836–845; discussion 345-836. https://doi.org/10.1227/01.NEU.0000342405.80881.81 CrossRefPubMedGoogle Scholar
- 16.Lemaire JJ, Golby A, Wells WM 3rd, Pujol S, Tie Y, Rigolo L, Yarmarkovich A, Pieper S, Westin CF, Jolesz F, Kikinis R (2013) Extended Broca's area in the functional connectome of language in adults: combined cortical and subcortical single-subject analysis using fMRI and DTI tractography. Brain Topogr 26:428–441. https://doi.org/10.1007/s10548-012-0257-7 CrossRefPubMedGoogle Scholar
- 19.Muragaki Y, Iseki H, Maruyama T, Tanaka M, Shinohara C, Suzuki T, Yoshimitsu K, Ikuta S, Hayashi M, Chernov M, Hori T, Okada Y, Takakura K (2011) Information-guided surgical management of gliomas using low-field-strength intraoperative MRI. Acta Neurochir Suppl 109:67–72. https://doi.org/10.1007/978-3-211-99651-5_11 CrossRefPubMedGoogle Scholar
- 24.Saito T, Muragaki Y, Maruyama T, Tamura M, Nitta M, Tsuzuki S, Konishi Y, Kamata K, Kinno R, Sakai KL, Iseki H, Kawamata T (2016) Difficulty in identification of the frontal language area in patients with dominant frontal gliomas that involve the pars triangularis. J Neurosurg 125:803–811. https://doi.org/10.3171/2015.8.JNS151204 CrossRefPubMedGoogle Scholar
- 25.Saito T, Tamura M, Muragaki Y, Maruyama T, Kubota Y, Fukuchi S, Nitta M, Chernov M, Okamoto S, Sugiyama K, Kurisu K, Sakai KL, Okada Y, Iseki H (2014) Intraoperative cortico-cortical evoked potentials for the evaluation of language function during brain tumor resection: initial experience with 13 cases. J Neurosurg 121:827–838. https://doi.org/10.3171/2014.4.JNS131195 CrossRefPubMedGoogle Scholar
- 28.Szelenyi A, Bello L, Duffau H, Fava E, Feigl GC, Galanda M, Neuloh G, Signorelli F, Sala F, Workgroup for Intraoperative Management in Low-Grade Glioma Surgery Within the European Low-Grade Glioma N (2010) Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice. Neurosurg Focus 28:E7. https://doi.org/10.3171/2009.12.FOCUS09237 CrossRefPubMedGoogle Scholar
- 30.Yoshimitsu K, Suzuki T, Muragaki Y, Chernov M, Iseki H (2010) Development of modified intraoperative examination monitor for awake surgery (IEMAS) system for awake craniotomy during brain tumor resection. Conference Proceedings 2010:6050–6053. https://doi.org/10.1109/IEMBS.2010.5627616 CrossRefPubMedGoogle Scholar