title: Agraphia after awake surgery for brain tumor: new insights into the anatomo-functional network of writing.
abstract: BACKGROUND
  Controversy still exists about neural basis underlying writing and its relation with the sites subserving oral language. Our objective is to study functional areas involved in writing network, based on the observations of different postoperative writing disorders in a population of patients without preoperative agraphia.
  
  
  METHODS
  We analyzed the postoperative agraphia profiles in 15 patients who underwent surgery for cerebral LGGs in functional language areas, using electrical mapping under local anesthesia. These profiles were then correlated to the sites of the lesions, shown by preoperative cerebral imaging.
  
  
  RESULTS
  Our findings showed that (1) spoken language and writing functions could be dissociated, and that (2) writing is subserved, at least partially, by a network of 5 areas located in the dominant hemisphere for language: the superior parietal region, the supramarginalis gyrus, the second and third frontal convolutions, the supplementary motor area, and the insula. Each of these areas seems to have a different role in writing, which will be detailed in this article. However, among the patients, only those with lesions of the supplementary motor area did not recover from agraphia in the postoperative period (in 50% of cases).
  
  
  CONCLUSIONS
  On the basis of these results, and in the light of the recent literature, we discuss the relevance of each area in this anatomo-functional network as well as the clinical implications of such better knowledge of the neural basis of writing, especially for brain surgery and functional rehabilitation.
authors.affiliation: Department of Neurosurgery, Hôpital Foch, Suresnes, France 92150.
authors.forename: Pietro
authors.initials: P
authors.lastname: Scarone
authors.forename: Peggy
authors.initials: P
authors.lastname: Gatignol
authors.forename: Sophie
authors.initials: S
authors.lastname: Guillaume
authors.forename: Dominique
authors.initials: D
authors.lastname: Denvil
authors.forename: Laurent
authors.initials: L
authors.lastname: Capelle
authors.forename: Hugues
authors.initials: H
authors.lastname: Duffau
mesh_terms: D000328:Adult; D000381:Agraphia / Q000209:etiology* / Q000503:physiopathology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000503:physiopathology; D004558:Electric Stimulation; D005260:Female; D005910:Glioma / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006236:Handwriting; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D012720:Severity of Illness Index; D014851:Wakefulness