“The Mute Who Can Sing”: a cortical stimulation study on singing

Clinical article

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Object

In an attempt to identify cortical areas involved in singing in addition to language areas, the authors used a singing task during direct cortical mapping in 5 patients who were amateur singers and had undergone surgery for brain tumors. The organization of the cortical areas involved in language and singing was analyzed in relation with these surgical data.

Methods

One left-handed and 4 right-handed patients with brain tumors in left (2 cases) and right (3 cases) hemispheres and no significant language or singing deficits underwent surgery with the “awake surgery” technique. All patients had a special interest in singing and were involved in amateur singing activities. They were tested using naming, reading, and singing tasks.

Results

Outside primary sensorimotor areas, singing interferences were rare and were exclusively localized in small cortical areas (< 1 cm2). A clear distinction was found between speech and singing in the Broca region. In the Broca region, no singing interference was found in areas in which interference in naming and reading tasks were detected. Conversely, a specific singing interference was found in nondominant middle frontal gyri in one patient. This interference consisted of abrupt singing arrest without apparent face, mouth, and tongue contraction. Finally, nonspecific singing interferences were found in the right and left precentral gyri in all patients (probably by interference in final articulatory mechanisms of singing).

Conclusions

Dissociations between speech and singing found outside primary sensorimotor areas showed that these 2 functions use, in some cortical stages, different cerebral pathways.

Abbreviation used in this paper: fMR = functional MR.

Article Information

Address correspondence to: Franck-Emmanuel Roux, M.D., Ph.D., Institut National de la Santé Et de la Recherche Médicale 825 et Service de Neurochirurgie, Hôpital Purpan, F-31059 Toulouse, France. email: franck.roux@club-internet.fr.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Schematic representation of the localization of the singing interference and language (naming and reading tasks) found in the left and right hemispheres in our 5 patients. The dotted line denotes the area of craniotomy. The numbers in the upper left of each panel denote the case number. F1 = superior frontal gyrus; F2 = middle frontal gyrus; F3 = inferior frontal gyrus; T1 = superior temporal gyrus.

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    Case 1. Illustration of preserved singing during direct brain mapping in the Broca area and the supramarginal gyrus where speech was impaired. The bilingual right-handed French/Rwandan 37-year-old patient had a low-grade astrocytoma in the postcentral gyrus for which he had previously undergone surgery at another institution. Although the patient spoke rather slowly, no preoperative language impairment was noted. A and B: Intraoperative images showing naming mappings in French and Rwandan. Naming interferences (L) in both languages were found in common (Broca region) or distinct areas (supramarginal gyrus). To improve the understanding of the intraoperative pictures, cortical sites that did not produce a naming impairment were not systematically labeled by a sterile ticket. The blue thread indicates the rolandic sulcus. Naming “motor” interferences were found in primary sensorimotor areas. C: Intraoperative photograph showing singing mapping in French and Rwandan. No singing interference was found (N) in the regions (supramarginal and opercular ramus) where the patient had a typical “speech arrest” during naming and reading tasks. Singing interference was only found in the primary sensorimotor area. D: Diagram showing the French and Rwandan naming and singing interference found in this patient. Outside the sensorimotor areas, no singing interference was detected.

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    Case 3. Example of impaired singing in the right hemisphere in a right-handed 70-year-old patient with a metastasis close the right precentral gyrus. Two specific singing interferences (S) were found in the nondominant middle frontal gyrus. No naming or reading interference were found in this region. A: Three-dimensional intraoperative reconstructions of the patient's brain with brain mapping findings. B: Corresponding intraoperative picture. The black line indicates the rolandic sulcus. C and D: Photographs of the patient's face during singing interference. Once stimulation was applied in nondominant middle frontal gyrus, the patient stopped singing suddenly. Note that there is no contraction of the face, lips, or tongue. F = face motor areas within the precentral gyrus; H = hand areas (contraction of the fingers during stimulation of these 2 areas); P = face or hand paresthesia areas found in the postcentral gyrus.

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