Contemporary model of language organization: an overview for neurosurgeons
Contemporary model of language organization: an overview for neurosurgeons
复制标题
DOI：
10.3171/2014.10.jns132647
复制
发表时间：
2015-02-01
影响因子：
4.1
通讯作者：
Berger, Mitchel S.
中科院分区：
文献类型：
--
作者：
Chang, Edward F.;Raygor, Kunal P.;Berger, Mitchel S.
语言组织的经典模型认为，运动和感觉语言焦点分别存在于额下回（布罗卡区）和上级颞回（韦尼克区），这些部位之间的连接（弓状束）允许大脑-运动相互作用。这些理论已经主导了一个多世纪，但神经成像和刺激映射的进展提供了更详细的描述语言的功能神经解剖学。新的见解塑造了现代基于网络的语音处理模型，该模型由涉及皮层和皮层下区域的并行和互连流组成。最近的模型强调在“背”和“腹”的途径，调解语音和语义处理，分别处理。语音加工沿着背侧通路进行，从颞叶后上皮层到额叶下皮层。另一方面，语义信息是通过腹侧通路传递的，该通路从颞极延伸到基底枕颞皮层，并有前部连接。功能磁共振成像在确定关键语言部位方面的阳性预测值较差，仅应用作术前计划的辅助手段。皮质和皮质下标测应用于确定功能区的功能切除边界，并仍然是临床金标准。在追踪我们对语言处理理解的历史进步时，作者希望不仅为执业神经外科医生提供有助于手术计划和预防术后发病的额外信息，而且还强调神经外科医生处于独特的位置，以进一步推进我们对语言的解剖和功能组织的理解。
Classic models of language organization posited that separate motor and sensory language foci existed in the inferior frontal gyrus (Broca's area) and superior temporal.gyrus (Wernicke's area), respectively, and that connections between these sites (arcuate fasciculus) allowed for auditory-motor interaction. These theories have predominated for more than a century, but advances in neuroimaging and stimulation mapping have provided a more detailed description of the functional neuroanatomy of language. New insights have shaped modern network-based models of speech processing composed of parallel and interconnected streams involving both cortical and subcortical areas. Recent models emphasize processing in "dorsal" and "ventral" pathways, mediating phonological and semantic processing, respectively. Phonological processing occurs along a dorsal pathway, from the posterosuperior temporal to the inferior frontal cortices. On the other hand, semantic information is carried in a ventral pathway that runs from the temporal pole to the basal occipitotemporal cortex, with anterior connections. Functional MRI has poor positive predictive value in determining critical language sites and should only be used as an adjunct for preoperative planning. Cortical and subcortical mapping should be used to define functional resection boundaries in eloquent areas and remains the clinical gold standard. In tracing the historical advancements in our understanding of speech processing, the authors hope to not only provide practicing neurosurgeons with additional information that will aid in surgical planning and prevent postoperative morbidity, but also underscore the fact that neurosurgeons are in a unique position to further advance our understanding of the anatomy and functional organization of language.