The role of dominant striatum in language: a study using intraoperative electrical stimulations.
BACKGROUND
The role of the striatum in language remains poorly understood. Intraoperative electrical stimulation during surgery for tumours involving the caudate nucleus or putamen in the dominant hemisphere might be illuminating.


OBJECTIVE
To study the role of these structures in language, with the aim of avoiding postoperative definitive aphasia.


METHODS
11 patients with cortico-subcortical low grade gliomas were operated on while awake, and striatal functional mapping was done. Intraoperative direct electrical stimulation was used while the patients carried out motor and naming tasks during the resection.


RESULTS
In five cases of glioma involving the dominant putamen, stimulations induced anarthria, while in six cases of glioma involving the dominant caudate, stimulations elicited perseveration. There was no motor effect. The striatum was systematically preserved. Postoperatively, all patients except one had transient dysphasia which resolved within three months.


CONCLUSIONS
There appear to be two separate basal ganglia systems in language, one mediated by the putamen which might have a motor role, and one by the caudate which might have a role in cognitive control. These findings could have implications for surgical strategy in lesions involving the dominant striatum.
Gil Robles
S
S
Department of Neurosurgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Spain.
Gatignol
P
P
Capelle
L
L
Mitchell
M-C
MC
Duffau
H
H
D000328:Adult; D000849:Anomia / Q000175:diagnosis / Q000503:physiopathology; D001037:Aphasia / Q000175:diagnosis / Q000503:physiopathology; D001480:Basal Ganglia Diseases / Q000503:physiopathology / Q000601:surgery*; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery*; D002421:Caudate Nucleus / Q000503:physiopathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000503:physiopathology; D003071:Cognition / Q000502:physiology; D003342:Corpus Striatum / Q000503:physiopathology*; D004292:Dominance, Cerebral / Q000502:physiology*; D004401:Dysarthria / Q000175:diagnosis / Q000503:physiopathology; D004558:Electric Stimulation; D005260:Female; D005910:Glioma / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007806:Language Disorders / Q000175:diagnosis / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009434:Neural Pathways / Q000503:physiopathology; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000502:physiology; D011699:Putamen / Q000503:physiopathology / Q000601:surgery*