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

  • Clinical Article - Brain Tumors
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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.

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Conflict of Interest

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan

    Ryosuke Matsuda

  2. Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France

    Sylvie Moritz-Gasser & Sophie Duvaux

  3. Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France

    Sylvie Moritz-Gasser, Sophie Duvaux & Hugues Duffau

  4. Department of Neurology, Neurosurgery, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Alejandro Fernández Coello

  5. Department of Neurosurgery, IRCCS, Bellaria Hospital, Bologna, Italy

    Matteo Martinoni

  6. INSERM U1051, Team “Plasticity of the central nervous system, human stem cells and glial tumors”, Institute for Neurosciences of Montpellier, Montpellier University Medical Center, Montpellier, France

    Hugues Duffau

  7. Department of Neurosurgery, Gui de Chauliac Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, Montpellier, 34295, France

    Hugues Duffau

Authors
  1. Ryosuke Matsuda
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  2. Sylvie Moritz-Gasser
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  3. Sophie Duvaux
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  4. Alejandro Fernández Coello
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  5. Matteo Martinoni
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  6. Hugues Duffau
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Corresponding author

Correspondence to Hugues Duffau.

Additional information

Comment

This is a well written retrospective report stressing the need of language mapping in patients with left hemisphere tumours even if they are left handed. The idea behind the report is very attractive, with a shift from a localizationistic view to a connectionistic approach: language function is not located at the right or left hemisphere, rather both hemispheres work together and the left hemisphere has still an important function even in left handers or after functional plastic rearrangement.

However, nothing is known about the language distribution between both hemispheres, or about the laterality index in these patients, because fMRI or Wada's tests were not used. The clinical uselessness of these tests is justified by the authors because intraoperative electrical stimulation is a far superior tool to detect language function. However, as the authors note, most left handers (70-78%) have a left dominant hemisphere. So it is likely that these nine patients out of ten with language function detected with intraoperative stimulation at the left hemisphere have had activation in the fMRI at the left side or a positive Wada test for language at the left hemisphere.

The series of the authors is impressive and ten left handers with left LGG may be difficult to collect. Still, it is not possible to generalize about the structure of language function with only those cases and no other functional imaging studies.

Juan A. Barcia

Madrid, Spain

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Matsuda, R., Moritz-Gasser, S., Duvaux, S. et al. The persistent crucial role of the left hemisphere for language in left-handers with a left low grade glioma: a stimulation mapping study. Acta Neurochir 156, 661–670 (2014). https://doi.org/10.1007/s00701-014-2003-2

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  • DOI: https://doi.org/10.1007/s00701-014-2003-2

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