Neural bases of semantic processing : a new highlight : studies based on direct brain electrostimulations

Le traitement sémantique est le processus mental par lequel nous accédons au sens. Il occupe donc une place centrale dans la compréhension et la production du langage, mais également dans le fonctionnement humain en général, puisqu'il permet de conceptualiser le monde qui nous entoure et de lui donner un sens, en le confrontant en pleine conscience aux connaissances que nous emmagasinons au fil de nos expériences. Si les bases neurales corticales du traitement sémantique sont bien documentées par de nombreuses études basées sur les données de l'imagerie fonctionnelle notamment, l'analyse de la connectivité sous-corticale impliquée dans ce traitement a jusqu'ici reçu moins d'attention. Les auteurs s'accordent néanmoins sur l'existence d'une voie ventrale sémantique, parallèle à une voie dorsale dédiée au traitement phonologique. Le présent ouvrage se propose d'apporter un nouvel éclairage à la connaissance des bases neurales du traitement sémantique du mot isolé, en lien avec le cadre plus large du traitement sémantique non-verbal, par l'étude des habiletés sémantiques de patients présentant un gliome de grade 2 OMS et pour lequel ils bénéficient d'une prise en charge chirurgicale en condition éveillée, avec cartographie cortico-sous-corticale peropératoire. Il met ainsi en évidence l'importance cruciale du faisceau fronto-occipital inférieur gauche dans cette voie ventrale sémantique, au sein d'une organisation cérébrale fonctionnelle en réseaux parallèles et distribués de zones corticales interconnectées par des faisceaux d'association de substance blanche. Il souligne également le caractère interactif du fonctionnement cognitif, ainsi que l'importance des mécanismes de contrôle dans le traitement du langage, et de la mesure de la chronométrie mentale lors son évaluation. Ces différentes considérations nous amènent à proposer un modèle hodotopique général d'organisation anatomo-fonctionnelle du langage. Les résultats présentés dans cet ouvrage peuvent donc avoir des implications cliniques et scientifiques majeures, quant à la compréhension de l'organisation cérébrale fonctionnelle du langage, de ses dysfonctionnements, des mécanismes de réorganisation fonctionnelle en cas de lésion et à l'élaboration de programmes de réhabilitation.Semantic processing is the mental process by which we access to meaning. Therefore, it takes a central place in language comprehension and production, but also in the whole human functioning, since it allows conceptualizing and giving a meaning to the world, by confronting it consciously with the knowledge we store over our experiences. If the neural bases of semantic processing are well known at the cortical level, thanks to numerous studies based particularly on functional neuroimaging data, the analysis of the subcortical connectivity underlying this processing received so far less attention. Nevertheless, the authors agree on the existence of a semantic ventral stream, parallel to a phonological dorsal stream.The present work mean to bring a new highlight on the knowledge of the neural bases of semantic processing at the level of the single word, in connection with the wider setting of non verbal semantic processing, by the study of semantic skills in patients presenting with WHO grade 2 glioma, and for which they undergo a surgery in awaken conditions, with cortico-subcortical intraoperative mapping. Thus, this work highlights the crucial role of the inferior fronto-occipital fascicle, in this ventral semantic route, within a functional brain organization in parallel and distributed networks of cortical areas interconnected by white matter association fibers.it underlines also the interactive feature of cognitive functioning, and the significance of control mechanisms in language processing, as well as the measuring of mental chronometry when assessing it. These considerations lead us to propose a general hodotopical model of language anatomo-functional organization.The results presented in this work may thus have important clinical and scientific implications, regarding the comprehension of language brain functional organization, of its dysfunctioning, of functional reorganization mechanisms in case of brain lesion, and the elaboration of rehabilitation programs

Les bases neurales du traitement sémantique (un nouvel éclairage)

Le traitement sémantique est le processus mental par lequel nous accédons au sens. Il occupe donc une place centrale dans la compréhension et la production du langage, mais également dans le fonctionnement humain en général, puisqu'il permet de conceptualiser le monde qui nous entoure et de lui donner un sens, en le confrontant en pleine conscience aux connaissances que nous emmagasinons au fil de nos expériences. Si les bases neurales corticales du traitement sémantique sont bien documentées par de nombreuses études basées sur les données de l'imagerie fonctionnelle notamment, l'analyse de la connectivité sous-corticale impliquée dans ce traitement a jusqu'ici reçu moins d'attention. Les auteurs s'accordent néanmoins sur l'existence d'une voie ventrale sémantique, parallèle à une voie dorsale dédiée au traitement phonologique. Le présent ouvrage se propose d'apporter un nouvel éclairage à la connaissance des bases neurales du traitement sémantique du mot isolé, en lien avec le cadre plus large du traitement sémantique non-verbal, par l'étude des habiletés sémantiques de patients présentant un gliome de grade 2 OMS et pour lequel ils bénéficient d'une prise en charge chirurgicale en condition éveillée, avec cartographie cortico-sous-corticale peropératoire. Il met ainsi en évidence l'importance cruciale du faisceau fronto-occipital inférieur gauche dans cette voie ventrale sémantique, au sein d'une organisation cérébrale fonctionnelle en réseaux parallèles et distribués de zones corticales interconnectées par des faisceaux d'association de substance blanche. Il souligne également le caractère interactif du fonctionnement cognitif, ainsi que l'importance des mécanismes de contrôle dans le traitement du langage, et de la mesure de la chronométrie mentale lors son évaluation. Ces différentes considérations nous amènent à proposer un modèle hodotopique général d'organisation anatomo-fonctionnelle du langage. Les résultats présentés dans cet ouvrage peuvent donc avoir des implications cliniques et scientifiques majeures, quant à la compréhension de l'organisation cérébrale fonctionnelle du langage, de ses dysfonctionnements, des mécanismes de réorganisation fonctionnelle en cas de lésion et à l'élaboration de programmes de réhabilitation.Semantic processing is the mental process by which we access to meaning. Therefore, it takes a central place in language comprehension and production, but also in the whole human functioning, since it allows conceptualizing and giving a meaning to the world, by confronting it consciously with the knowledge we store over our experiences. If the neural bases of semantic processing are well known at the cortical level, thanks to numerous studies based particularly on functional neuroimaging data, the analysis of the subcortical connectivity underlying this processing received so far less attention. Nevertheless, the authors agree on the existence of a semantic ventral stream, parallel to a phonological dorsal stream.The present work mean to bring a new highlight on the knowledge of the neural bases of semantic processing at the level of the single word, in connection with the wider setting of non verbal semantic processing, by the study of semantic skills in patients presenting with WHO grade 2 glioma, and for which they undergo a surgery in awaken conditions, with cortico-subcortical intraoperative mapping. Thus, this work highlights the crucial role of the inferior fronto-occipital fascicle, in this ventral semantic route, within a functional brain organization in parallel and distributed networks of cortical areas interconnected by white matter association fibers.it underlines also the interactive feature of cognitive functioning, and the significance of control mechanisms in language processing, as well as the measuring of mental chronometry when assessing it. These considerations lead us to propose a general hodotopical model of language anatomo-functional organization.The results presented in this work may thus have important clinical and scientific implications, regarding the comprehension of language brain functional organization, of its dysfunctioning, of functional reorganization mechanisms in case of brain lesion, and the elaboration of rehabilitation programs.MONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF

Language recovery through a two-stage awake surgery in an aphasic patient with a voluminous left fronto-temporo-insular glioma: case report

International audienceAwake surgery is difficult in glioma patients with preoperative aphasia. A 29-year-old right-handed bilingual (Spanish/English) patient experienced intractable seizures with severe language disorders due to a voluminous left fronto-temporo-insular tumor. We performed awake procedure with initial laborious language mapping, but with real-time improvement throughout the debulking, allowing preservation of the connectivity. A substantial residue was left. Postoperative cognitive rehabilitation resulted in a dramatic functional improvement, in both languages, permitting a complementary awake surgery, this time with a perfect collaboration of the patient. This multistep strategy enabled 92% of resection while enhancing quality of life with language recovery and epilepsy control

Integrating emotional valence and semantics in the human ventral stream: a hodological account

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Direct evidence for the contributive role of the right inferior fronto-occipital fasciculus in non-verbal semantic cognition

International audienceThe neural foundations underlying semantic processing have been extensively investigated, highlighting a pivotal role of the ventral stream. However, although studies concerning the involvement of the left ventral route in verbal semantics are proficient, the potential implication of the right ventral pathway in non-verbal semantics has been to date unexplored. To gain insights on this matter, we used an intraoperative direct electrostimulation to map the structures mediating the non-verbal semantic system in the right hemisphere. Thirteen patients presenting with a right low-grade glioma located within or close to the ventral stream were included. During the 'awake' procedure, patients performed both a visual non-verbal semantic task and a verbal (control) task. At the cortical level, in the right hemisphere, we found non-verbal semantic-related sites (n = 7 in 6 patients) in structures commonly associated with verbal semantic processes in the left hemisphere, including the superior temporal gyrus, the pars triangularis, and the dorsolateral prefrontal cortex. At the subcortical level, we found non-verbal semantic-related sites in all but one patient (n = 15 sites in 12 patients). Importantly, all these responsive stimulation points were located on the spatial course of the right inferior fronto-occipital fasciculus (IFOF). These findings provide direct support for a critical role of the right IFOF in non-verbal semantic processing. Based upon these original data, and in connection with previous findings showing the involvement of the left IFOF in non-verbal semantic processing, we hypothesize the existence of a bilateral network underpinning the non-verbal semantic system, with a homotopic connectional architecture

Jargonaphasia as a disconnection syndrome: A study combining white matter electrical stimulation and disconnectome mapping

In jargonaphasia, speech is fluent but meaningless. While neuropsychological evaluation may distinguish a neologistic component characterised by non-word production and a semantic component where pronounced words are real but speech is senseless, how this relates to the underlying white matter anatomy is debated

Somatotopic organization of the white matter tracts underpinning motor control in humans: an electrical stimulation study

International audienceThe somatotopic organization of the primary motor cortex is well documented. However, a possible somatotopy of the network involved in motor control, i.e., eliciting negative motor phenomena during electrostimulation, is unknown in humans, particularly at the subcortical level. Here, we performed electrical stimulation mapping in awake patients operated for gliomas, to study the distribution of the white matter tracts subserving movement control of the lower limb, upper limb(s), and speech. Eighteen patients underwent awake surgery for frontal low-grade gliomas, by using intraoperative subcortical electrostimulation mapping to search interference with movement of the leg, arm(s), and face. We assessed the negative motor responses and their distribution throughout the tracts located under premotor areas. The corresponding stimulation sites were reported on a standard brain template for visual analysis and between-subjects comparisons. During stimulation of the white matter underneath the dorsal premotor cortex and supplementary motor area, rostral to the corticospinal tracts, all patients experienced cessation of the movement of lower and upper limbs, of bimanual coordination, and/or speech. These subcortical sites were somatotopically distributed. Indeed, stimulation of the fibers from mesial to lateral directions and from posterior to anterior directions evoked arrest of movement of the lower limb (mesially and posteriorly), upper limb(s), and face/speech (laterally and anteriorly). There were no postoperative permanent deficits. This is the first evidence of a somatotopic organization of the white matter bundles underpinning movement control in humans. A better knowledge of the distribution of this motor control network may be helpful in neurosciences and neurosurgery

Iterative Surgical Resections of Diffuse Glioma With Awake Mapping: How to Deal With Cortical Plasticity and Connectomal Constraints?

International audienceBACKGROUND:In diffuse glioma, a multistage approach with iterative tailored surgical resections can be considered.OBJECTIVE:To compare results of iterative intrasurgical brain mappings to investigate the potential and limitation of neuroplasticity at the individual stage, and to highlight to what extent it can influence the therapeutic strategy.METHODS:Glioma patients who underwent 2 consecutive awake surgeries with cortical and subcortical stimulation were classified into group 1 (n = 23) if cortical mappings exhibited high level of plasticity (displacement of ≥2 sites) or into group 2 (n = 19) with low level of plasticity.RESULTS:Clinical characteristics did not differ significantly between both groups. The borders of the tumors were mostly sharp in group 1 (82.6%) and rather indistinct in group 2 (84.2%), (P = .00001). Tumor remnants were more often cortical (± subcortical) in group 1 (39.1%) and more often purely subcortical in group 2 (68.4%; P = .009). In group 1, the time needed to recover independence was significantly shorter at reoperation (37.6 h vs 78.3 h after the first surgery, P = .00003) while this difference was not significant in group 2. The iterative extents of resection (EOR) remain comparable in group 1 (94% vs 92%, P = .40) but were significantly smaller in group 2 at reoperation (94% vs 88%, P = .05).CONCLUSION:More efficient plasticity mechanisms are facilitated by cortical tumors with sharp borders, are associated with an increase of EOR at reoperation and with earlier functional recovery. Tumoral invasion of the white matter tracts represents the main limitation of neuroplasticity: this connectomal constraint limits EOR during second surgery

Return to Work Following Surgery for Incidental Diffuse Low-Grade Glioma: A Prospective Series With 74 Patients

International audienceBACKGROUND:Therapeutic strategy concerning incidental low-grade glioma (ILGG) is still debated. Early "prophylactic" surgery has been proposed in asymptomatic patients with favorable neurological and oncological outcomes.OBJECTIVE:To assess postoperative ability to resume employment following awake surgery in asymptomatic ILGG patients. To assess extent of resection (EOR), timeline for adjuvant oncological treatment, and survival.METHODS:A total of 74 patients with ILGG who underwent awake surgery with intraoperative mapping were prospectively included, with a minimum follow-up of 12 mo. All clinicoradiological data were collected, and statistical correlations with return to work (RTW) were performed.RESULTS:A total of 66 patients (97.1%) among 68 patients with preoperative professional activities resumed their employment including 62 (91.2%) within 12 mo. Mean time before RTW was 6.8 mo (median: 6 mo, range: 1-36). Two patients experienced seizure-related legal issues impacting their RTW. Clinicoradiological features did not correlate with RTW apart from postoperative seizures (P = .02). Mean EOR was 95.7%. A total of 43 patients (58.1%) underwent supratotal/total resections. All patients recovered from transient deficits at 3 mo. No patients received consecutive adjuvant treatment. A total of 24 patients (32.4%) were reoperated, 24 patients received chemotherapy, and 7 patients (9.5%) received radiotherapy, on average 73.1 mo after surgery. Mean follow-up was 67 mo (range 12-240). Four patients (5.4%) died during the follow-up.CONCLUSION:We observed a high rate of RTW (97.1%, including 91.2% within 12 mo) after awake surgery in ILGG patients. Delayed resumption of work was due to employer not clearing them for RTW, personal choice, and, in rare occasions, related to seizures