title: Words are not enough: nonword repetition as an indicator of arcuate fasciculus integrity during brain tumor resection.
abstract: OBJECTIVE Subcortical electrical stimulation during brain surgery may allow localization of functionally crucial white matter fibers and thus tailoring of the tumor resection according to its functional limits. The arcuate fasciculus (AF) is a white matter bundle connecting frontal, temporal, and parietal cortical areas that is often disrupted by left brain lesions. It plays a critical role in several cognitive functions related to phonological processing, but current intraoperative monitoring methods do not yet allow mapping of this tract with sufficient precision. In the present study the authors aimed to test a new paradigm for the intraoperative monitoring of the AF. METHODS In this report, the authors studied 12 patients undergoing awake brain surgery for tumor resection with a related risk of AF damage. To preserve AF integrity and the cognitive processes sustained by this tract in the intraoperative context, the authors used real word repetition (WR) and nonword repetition (NWR) tasks as complements to standard picture naming. RESULTS Compared with the errors identified by WR or picture naming, the NWR task allowed the detection of subtle errors possibly related to AF alterations. Moreover, only 3 patients demonstrated phonological paraphasias in standard picture naming, and in 2 of these patients the paraphasias co-occurred with the total loss of WR and NWR ability. Before surgery, lesion volume predicted a patient's NWR performance. CONCLUSIONS The authors suggest that monitoring NWR intraoperatively may complement the standard naming tasks and could permit better preservation of the important language production functions subserved by the AF.
authors.affiliation: Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat.|Department of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat.
authors.forename: Joanna
authors.initials: J
authors.lastname: Sierpowska
authors.affiliation: Hospital Universitari de Bellvitge, Neurosurgery Section, Campus Bellvitge, University of Barcelona, IDIBELL, L'Hospitalet de Llobregat.
authors.forename: Andreu
authors.initials: A
authors.lastname: Gabarrós
authors.affiliation: Hospital Universitari de Bellvitge, Neurosurgery Section, Campus Bellvitge, University of Barcelona, IDIBELL, L'Hospitalet de Llobregat.|CIBER de Bioingeniería, Biomateriales y Nanomedicina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Fernandez-Coello
authors.affiliation: Institut de Diagnòstic per la Imatge, Centre Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat.
authors.forename: Àngels
authors.initials: À
authors.lastname: Camins
authors.affiliation: Institut de Diagnòstic per la Imatge, Centre Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat.
authors.forename: Sara
authors.initials: S
authors.lastname: Castañer
authors.affiliation: Hospital Universitari de Bellvitge, Neurology Section, Campus Bellvitge, University of Barcelona, IDIBELL, L'Hospitalet de Llobregat; and.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Juncadella
authors.affiliation: Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat.|Department of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Morís
authors.affiliation: Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat.|Department of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat.|Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Rodríguez-Fornells
mesh_terms: D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000503:physiopathology* / Q000523:psychology* / Q000601:surgery; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D015203:Reproducibility of Results; D013060:Speech / Q000502:physiology*; D066127:White Matter / Q000503:physiopathology*; D055815:Young Adult
keywords: AF = arcuate fasciculus; CA = conduction aphasia; CUSA = cavitron ultrasonic surgical aspirator; DTI = diffusion tensor imaging; ESM = electrical stimulation mapping; MNI = Montreal Neurological Institute; NWR = nonword repetition; ROI = region of interest; Spt = sylvian parietotemporal; WR = word repetition; arcuate fasciculus; dual pathway model for language processing; electrical stimulation mapping; nonword repetition; oncology