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Intraoperative functional mapping of calculation in parietal surgery. New insights and clinical implications

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Parietal areas play a crucial role in calculation processing. The purpose of this study is to report our experience in the assessment of calculation processing during awake surgery in parietal areas, focusing on clinical implications and new insights provided by this approach.

Methods

We retrospectively reviewed clinical and surgical data of 13 patients who underwent parietal surgery with calculation mapping. Cortical and sub-cortical areas (in 13 and five patients, respectively) involved in single-digit multiplications and additions were identified using bipolar electro-stimulation.

Results

Cortical stimulation data showed that the inferior parietal lobule and the intraparietal sulcus were specifically related to calculation in all cases, regardless of the side (100 % of cases, in both sides). Conversely, the superior parietal lobule was inconstantly involved in calculation processing (40 % of cases in the left and 75 % in the right side), whereas the somatosensory area was never involved. Sub-cortical stimulation was able to detect functional areas for calculation in all patients: in 90 % of cases the sub-cortical sites positive for calculation were in close anatomical connection with the cortical sites mapping for the same function. The intraoperative preservation (−or damaging-) of functional sites correlated with the absence (− or occurrence-) of post-operative calculation processing impairment.

Conclusions

Our findings support the specificity of the reported technique in the intraoperative identification of sites functional for calculation. Our data show the bilateral involvement of parietal cortex, especially of the inferior lobule, in calculation processing. Furthermore, our study suggests the existence of a sub-cortical pathway specific for calculation, whose better understanding might be crucial for the clinical outcome of patients.

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References

  1. Andres M, Pelgrims B, Michaux N, Olivier E, Pesenti M (2011) Role of distinct parietal areas in arithmetic: an fMRI-guided TMS study. NeuroImage 54(4):3048–3056

    Article  PubMed  Google Scholar 

  2. Arsalidou M, Taylor MJ (2011) Is 2 + 2 = 4? Meta-analyses of brain areas needed for numbers and calculations. NeuroImage 54(3):2382–2393

    Article  PubMed  Google Scholar 

  3. Butterworth B (1999) The Mathematical Brain. Macmillan, London

    Google Scholar 

  4. Dehaene S, Cohen L, Changeux JP (1998) Neuronal network models of acalculia and prefrontal deficits. In: Parks RW, Levine DS (eds) Fundamentals of neural network modeling for neuropsychology. MIT Press, 233–256

  5. Dehaene S, Piazza M, Pinel P, Cohen L (2003) Three parietal circuits for number processing. Cogn Neuropsychol 20:487–506

    Article  PubMed  Google Scholar 

  6. Delazer M, Girelli L, Granà A, Domahs F (2003) Number processing and calculation-normative data from healthy adults. Clin Neuropsychol 17:331–350

    Article  CAS  PubMed  Google Scholar 

  7. Della Puppa A, De Pellegrin S, d’Avella E, Gioffrè G, Munari M, Saladini M, Salillas E, Scienza R, Semenza C (2013) Right parietal cortex and calculation processing: intraoperative functional mapping of multiplication and addition in patients affected by a brain tumor. J Neurosurg 119(5):1107–1111

    Article  PubMed  Google Scholar 

  8. Della Puppa A, De Pellegrin S, Lazzarini A, Gioffrè G, Rustemi O, Cagnin A, Scienza R, Semenza C (2014) Subcortical mapping of calculation processing in the right parietal lobe. J Neurosurg. doi:10.3171/2014.10.JNS14261

    Google Scholar 

  9. Della Puppa A, De Pellegrin S, Salillas E, Grego A, Lazzarini A, Vallesi A, Saladini M, Semenza C (2014) Functional mapping of left parietal areas involved in simple addition and multiplication. A single-case study of qualitative analysis of errors. J Neuropsychol. doi:10.1111/jnp.12043

    PubMed  Google Scholar 

  10. Duffau H, Denvil D, Lopes M, Gasparini F, Cohen L, Capelle L, Van Effenterre R (2002) Intraoperative mapping of the cortical areas involved in multiplication and subtraction: an electrostimulation study in a patient with a left parietal gliomas. J Neurol Neurosurg Psychiatry 73:733–738

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Fayers P, Aaronson NK, Bjordal K, Curran D, Groenvold M, on behalf of the EORTC Quality of Life Group (2001) QLQ EORTC-C30, the EORTC QLQ-C30 scoring manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels

    Google Scholar 

  12. Kurimoto M, Asahi T, Shibata T, Takahashi C, Nagai S, Hayashi N, Matsui M, Endo S (2006) Safe removal of glioblastoma near the angular gyrus by awake surgery preserving calculation ability. Neurol Med Chir (Tokyo) 46:46–50

    Article  Google Scholar 

  13. Luzzatti C, Willmes K, De Blaser R (1994) Aachener Aphasie test (AAT), Italian version, Firenze, Organizzazioni Speciali. http://www.giuntios.it/catalogo/test/?alpha. Accessed 27 Mar 2015

  14. Metz-Lutz M, Kremin H, Deloche G (1991) Standardisation d’un test de dénomination orale. Contrôle des effets de l’âge, du sexe et du niveau de scolarité chez les sujets adultes nor maux. Rev Neuropsychol 1:73–95

    Google Scholar 

  15. Mondini S, Mapelli D, Vestri A (2003) Esame Neuropsicologico Breve (ENB). Raffaello Cortina Editore, Milano

    Google Scholar 

  16. Pu S, Li YN, Wu CX, Wang YZ, Zhou XL, Jiang T (2011) Cortical areas involved in numerical processing: an intraoperative electrostimulation study. Stereotact Funct Neurosurg 89(1):42–47

    Article  PubMed  Google Scholar 

  17. Roux FE, Boetto S, Sacko O, Chollet F, Trémoulet M (2003) Writing, calculating, and finger recognition in the region of the angular gyrus: a cortical stimulation study of Gerstmann syndrome. J Neurosurg 99(4):716–727

    Article  PubMed  Google Scholar 

  18. Roux FE, Boukhatem L, Draper L, Sacko O, Démonet JF (2009) Cortical calculation localization using electrostimulation. J Neurosurg 110(6):1291–1299

    Article  PubMed  Google Scholar 

  19. Whalen J, McCloskey M, Lesser RP, Gordon B (1997) Localizing arithmetic processes in the brain: evidence from a transient deficit during cortical stimulation. J Cogn Neurosci 9(3):409–417

    Article  CAS  PubMed  Google Scholar 

  20. Yu X, Chen C, Pu S, Wu C, Li Y, Jiang T, Zhou X (2011) Dissociation of subtraction and multiplication in the right parietal cortex: evidence from intraoperative cortical electrostimulation. Neuropsychologia 49(10):2889–2895

    Article  PubMed  Google Scholar 

  21. Zigmond AS, Snaith RP (1983) Questionary HADS, the hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Padova, Via Giustiniani 2, Azienda Ospedaliera di Padova, 35128, Padova, Italy

    Alessandro Della Puppa, Marta Rossetto, Oriela Rustemi & Renato Scienza

  2. Department of Neuroscience, University Hospital of Padova, Padova, Italy

    Serena De Pellegrin & Marina Saladini

  3. Department of Anesthesiology and Intensive Care, University Hospital of Padova, Padova, Italy

    Marina Munari

Authors
  1. Alessandro Della Puppa
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  2. Serena De Pellegrin
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  3. Marta Rossetto
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  4. Oriela Rustemi
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  5. Marina Saladini
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  6. Marina Munari
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  7. Renato Scienza
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Corresponding author

Correspondence to Alessandro Della Puppa.

Additional information

Comment

This is a retrospective analysis of the author’s experience with awake surgery and mapping of calculus functions in 13 parietal lobe tumor patients.

The most important findings and messages are:

* Calculus functions are found in both language-dominant and non-dominant parietal lobes. Furthermore, the calculus functions were found both in the superior and inferior lobule as well as in the intraparietal sulcus. More positive sites were found in the inferior than in the superior lobule.

* In one patient with a tumor resection closer than 5 mm to a cortical site where stimulation affected calculation, the patient had a postoperative decline in calculus function. The other patients with resection at greater distances from sites positive for calculus functions did not have a postoperative decline in calculus function. This finding does suggest that mapping of calculus function may predict brain sites of integral functional importance for calculation.

* The authors demonstrate, in accordance with previous publications, that sites of integral importance for the calculus functions addition and multiplication are not identical.

* It is interesting that by testing just the two calculus functions addition and multiplication, at least in these 13 patients, was sufficient to spare all tested calculus functions in the postoperative tests.

The current study is a scientific extension of the small three-patient report by the same group reported in 2013, where they demonstrated the importance of the non-language dominant parietal lobe in the calculus functions addition and multiplication (Della Puppa A, De Pellegrin S, d’Avella E, Gioffrè G, Munari M, Saladini M,Salillas E, Scienza R, Semenza C (2013) Right parietal cortex intraoperative functional mapping of multiplication and addition in patients affected by a brain tumor. J Neurosurg 119(5):1107-11.).

The current study will be helpful for surgeons performing awake surgical procedures with mapping in parietal regions. It will help them expand their current technique to involve calculus functions. It will be interesting to follow future studies in this area, especially to which extent the relatively simple tests used by the authors are sufficient for sparing all calculus functions. The lengths of surgical procedures are of importance for a number of reasons, but especially because it is often difficult to maintain the vigilance and attention of the patient during long procedures. Therefore a simplification of testing procedures is more than welcome in the clinical setting, whereas in the scientific exploratory setting, more elaborate testing procedures will be important. The authors are to be applauded for their study, which helps broaden the usage of intraoperative mapping and the importance of calculus function in either parietal lobe.

Jannick Brennum

Copenhagen, Denmark

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Della Puppa, A., De Pellegrin, S., Rossetto, M. et al. Intraoperative functional mapping of calculation in parietal surgery. New insights and clinical implications. Acta Neurochir 157, 971–977 (2015). https://doi.org/10.1007/s00701-015-2426-4

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  • DOI: https://doi.org/10.1007/s00701-015-2426-4

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