Mirror of the soul: a cortical stimulation study on recognition of facial emotions.
OBJECTIVE
The capability of recognizing the expressions of facial emotions has been hypothesized to depend on a right hemispheric cortical-subcortical network. Its impairment deeply disturbs social relationships. To spare right hemispheric cortical areas involved in recognizing facial emotion, the authors used intraoperative cortical stimulation and the awake surgery technique in a consecutive series of patients. The feasibility and the interest to map them during brain mapping for neurosurgical procedures are discussed.


METHODS
After a preoperative neuropsychological evaluation, 18 consecutive patients with right hemispheric lesions (5 metastases, 6 high-grade gliomas, 4 low-grade gliomas, 2 arteriovenous malformations, and 1 malignant meningioma) were tested by intraoperative cortical stimulation while performing a facial emotion recognition task along with sensorimotor and visuospatial tasks.


RESULTS
Three hundred eighty-six cortical sites were studied. Five (1.30%) reproducible interference sites for facial emotion recognition were identified in 5 patients: 1 site in the medial segment of T1; 1 site in the posterior segment of T1; 1 site in the posterior segment of T2; and 2 sites in the supramarginal gyrus. No selective impairment was found regarding the emotion category. All facial emotion recognition sites were spared during surgery, and none of the patients experienced postoperative deficits in recognition of facial emotions.


CONCLUSIONS
The finding of interference sites in facial emotion recognition in the right posterior perisylvian area, independent to sensorimotor or visuospatial orientation processes, reinforces the theory about the role of anatomically and functionally segregated right hemisphere structures in this cognitive process. The authors advocate offering a brain mapping of facial emotion recognition to patients with right posterior perisylvian tumors.
Giussani
Carlo
C
Institute National de la Santé et de la Recherche Médicale Unité 825, Hôpital Purpan, Toulouse, France.
Pirillo
David
D
Roux
Franck-Emmanuel
FE
D000328:Adult; D000368:Aged; D001921:Brain / Q000002:abnormalities / Q000502:physiology* / Q000601:surgery; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery; D004558:Electric Stimulation / Q000379:methods; D005149:Facial Expression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D010364:Pattern Recognition, Visual / Q000502:physiology*; D015203:Reproducibility of Results