Cortical calculation localization using electrostimulation

Clinical article

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Object

A naming task has been used to spare cortical areas involved in language. In the present study, a calculation task was combined with electrostimulation mapping (awake surgery) to spare cortical areas involved in calculation in patients undergoing surgery for brain lesions. The organization of language and calculation areas was analyzed in relation to these surgical data.

Methods

Twenty patients with brain lesions close to areas possibly involved in calculation (dominant parietal lobe and F2) were prospectively studied over a 4-year period. Four patients had preoperative symptoms of acalculia and therefore were not included in the brain mapping procedure.

Results

In 16 patients, direct electrostimulation caused calculation interferences in localized small cortical areas (< 2 cm2). Of the 53 calculation interferences found, 23 were independent of language areas, especially those in the inferior left parietal lobule. Various patterns of interference were observed (11 complete acalculia, 5 acalculia with wrong answers, 2 hesitations, and 5 mixed responses), although error patterns were fairly similar across angular, parietal, and frontal stimulation sites. Calculation areas in 4 patients could not be spared for oncological reasons; postoperatively, 3 of these patients showed significant acalculia symptoms. In contrast, none of the patients whose calculation areas were spared had arithmetic difficulties 1 month after surgery. Improvements in acalculia symptoms after surgery were also found in 3 of the 4 patients with preoperative calculation difficulties.

Conclusions

To limit the risk of personal and professional disturbances caused by acquired anarithmetia in patients undergoing surgery for brain tumors or epilepsy, the authors think it is necessary to use a calculation task during brain mapping, especially when operating in the dominant parietal lobe.

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 Unité 825 et Service de Neurochirurgie, Hôpital Purpan, F-31059 Toulouse, France. email: franck.roux@club-internet.fr.

Please include this information when citing this paper: published online December 1, 2008; DOI: 10.3171/2008.8.JNS17649.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Schematic showing the localization of calculation interference sites found in the left hemisphere. The cortex has been divided schematically into several regions limited by dotted lines. Circles with numbers indicate the number of times a cortical region was studied (> 16 brain mappings). C = number of specific calculation interferences found in the region tested; C + L = number of common calculation and language (naming and/or reading) interferences found; L = number of naming or reading interferences found (without calculation interference).

  • View in gallery

    Examples of specific calculation sites found in the angular gyrus. A: Magnetic resonance image showing a parietal tumor classified as a ganglioglioma. B: Three-dimensional reconstruction revealing brain sites of positive calculation (C and asterisks) and language (L) interferences. C: Photograph depicting cortical language sites (L, naming interference sites). D: Photograph showing cortical calculation sites. One nonspecific calculation site (C) was common with naming sites in T2. Other specific calculation sites were detected: 1 complete acalculia (C) and 2 calculation hesitation sites (asterisks).

  • View in gallery

    Example of common and specific calculation sites in the F2. A: Magnetic resonance image showing a deep frontal cavernoma. Brain mapping was performed before a transcortical approach. B: Three-dimensional reconstruction demonstrating brain sites of positive calculation interferences (C). One site is common to calculation and language (L). Two specific calculation sites were found on F2. C: Intraoperative photograph depicting language cortical sites (L, naming interference sites). D: Intraoperative photograph showing cortical calculation sites (C). One calculation site was common with a naming site. M = motor interference site.

References

  • 1

    Anderson SWDamasio ARDamasio H: Troubled letters but not numbers: domain specific cognitive impairments following focal damage in frontal cortex. Brain 113:7497661990

    • Search Google Scholar
    • Export Citation
  • 2

    Butterworth B: The Mathematical Brain LondonMacmillan1999

  • 3

    Caporali ABurgio FBasso A: The natural course of acalculia in left brain-damaged patients. Neurol Sci 21:1431492000

  • 4

    Cipolotti LCostello Ade Lacy Selective impairment for simple division. Cortex 31:4334391995

  • 5

    Cipolotti LWarrington EKButterworth B: Selective impairment in manipulating Arabic numerals. Cortex 31:73861995

  • 6

    Clottes J: Voyage en préhistoire ParisLa Maison des Roches1998

  • 7

    Cohen LDehaene S: Amnesia for arithmetic facts: a single case study. Brain Lang 47:2142321994

  • 8

    Corbett AJMcCuster EADavidson OR: Acalculia following a dominant hemisphere subcortical infarct. Arch Neurol 43:9649661986

  • 9

    Dehaene STzourio NFrak VRaynaud LCohen LMehler J: Cerebral activations during number multiplication and comparison: a PET study. Neuropsychologia 34:109711061996

    • Search Google Scholar
    • Export Citation
  • 10

    Delazer MBenke T: Arithmetic facts without meaning. Cortex 33:6977101997

  • 11

    Deloche GSeron XLarroque CMagnien CMetz-Lutz MNNoel MN: Calculation and number processing: assessment battery; role of demographic factors. J Clin Exp Neuropsychol 16:1952081994

    • Search Google Scholar
    • Export Citation
  • 12

    Duffau HDenvil DLopes MGasparini FCohen LCapelle L: Intraoperative mapping of the cortical areas involved in multiplication and substraction: an electrostimulation study in a patient with a left parietal glioma. J Neurol Neurosurg Psychiatry 73:7337362002

    • Search Google Scholar
    • Export Citation
  • 13

    Fehr TCode CHerrmann M: Common brain regions underlying different arithmetic operations as revealed by conjunct fMRI-BOLD activation. Brain Res 1172:931022007

    • Search Google Scholar
    • Export Citation
  • 14

    Gerstmann J: Syndrome of finger agnosia, disorientation for right and left, agraphia, and acalculia. Arch Neurol Psychiatry 44:3984081940

    • Search Google Scholar
    • Export Citation
  • 15

    Gobel SWalsh VRushworth MFS: The mental number line and the human angular gyrus. Neuroimage 14:127812892001

  • 16

    Henschen SE: [Klinische und Anatomische Beitraege zur Pathologie des Gehirns.] StockholmNordiska Bokhandeln1920. (German)

  • 17

    Hittmair-Delazer MSailer UBenke Th: Impaired arithmetic facts but intact conceptual knowledge – a single case study of dyscalculia. Cortex 31:1391471995

    • Search Google Scholar
    • Export Citation
  • 18

    Kurimoto MAsahi TShibata TTakahashi CNagai SHayashi N: Safe removal of glioblastoma near the angular gyrus by awake surgery preserving calculation ability. Neurol Med Chir (Tokyo) 46:46502006

    • Search Google Scholar
    • Export Citation
  • 19

    Kyoung-Min L: Cortical areas differently involved in multiplication and subtraction: a fMRI study and correlation with a case of selective acalculia. Ann Neurol 48:6576612000

    • Search Google Scholar
    • Export Citation
  • 20

    Lampl YEshel YGilad RSarova-Pinhas I: Selective acalculia with sparing of substraction process in a patient with left parietotemporal hemorrhage. Neurology 44:175917611994

    • Search Google Scholar
    • Export Citation
  • 21

    Le Clec'H GDehaene SCohen LMehler JDupoux EPoline JB: Distinct cortical areas for names of numbers and body parts independent of language and input modality. Neuroimage 12:3813912000

    • Search Google Scholar
    • Export Citation
  • 22

    Lewandowsky MStadelmann E: [Über einen bemerkenswerten Fall von Hirnblutungen und über Rechenstörungen bei Herderkrankungen des Gehirns.]. Journal für Psychologie und Neurologie 11:2492651908. (German)

    • Search Google Scholar
    • Export Citation
  • 23

    Luchelli FDe Renzi E: Primary dyscalculia after a medial frontal lesion in the left hemisphere. J Neurol Neurosurg Psychiatry 56:3043071993

    • Search Google Scholar
    • Export Citation
  • 24

    Marangolo PNasti MZorzi M: Selective impairment for reading numbers and numbers words: a single case study. Neuropsychologia 42:99710062004

    • Search Google Scholar
    • Export Citation
  • 25

    McCloskey MCaramazza ADissociations of calculation processes. Deloche GSeron X: Mathematical disabilities: A Cognitive Neuropsychological Perspective Hillsdale, NJLawrence Erlbaum1987

    • Search Google Scholar
    • Export Citation
  • 26

    Ojemann GA: Mental arithmetic during human thalamic stimulation. Neuropsychologia 12:1101974

  • 27

    Ojemann GOjemann JLettich EBerger M: Cortical language localization in left, dominant hemisphere. J Neurosurg 71:3163261989

  • 28

    Oldfield RC: The assessment and analysis of handedness. The Edinburgh Inventory Neuropsychologia 9:971131971

  • 29

    Penfield WJasper H: Epilepsy and the Functional Anatomy of the Human Brain BostonLittle, Brown and Company1954

  • 30

    Penfield WRobert L: Speech and Brain Mechanisms PrincetonPrinceton University Press1959

  • 31

    Pesenti MSeron Xvan der Linden M: Selective impairment as evidence for mental organisation of arithmetical facts: BB, a case of preserved subtraction?. Cortex 30:6616711994

    • Search Google Scholar
    • Export Citation
  • 32

    Rossor MNWarrington EKCipolotti L: The isolation of calculation skills. J Neurol 242:78811995

  • 33

    Roux FEBoetto SSacko OChollet FTremoulet M: Writing, calculating, and finger recognition in the region of the angular gyrus: a cortical stimulation study of Gerstmann syndrome. J Neurosurg 99:7167272003

    • Search Google Scholar
    • Export Citation
  • 34

    Roux FELubrano VLauwers-Cances VGiussani CDemonet JF: The cortical areas involved in Arabic number reading. Neurology 70:2102172008

    • Search Google Scholar
    • Export Citation
  • 35

    Sakurai YMomose TIwata MSasaki YKanazawa I: Activation of prefrontal and posterior superior temporal areas in visual calculation. J Neurol Sci 139:89941996

    • Search Google Scholar
    • Export Citation
  • 36

    Shalev RSManor OGross-Tsur V: Developmental dyscalculia: a prospective six-year follow-up. Dev Med Child Neurol 47:1211252005

  • 37

    Takayama YSugishita MAkigushi IKimura J: Isolated acalculia due to left parietal lesion. Arch Neurol 51:2862911994

  • 38

    Thogi HSaitoh KTakahashi STakahashi HUtsugisawa KYonezawa H: Agraphia and Acalculia after a left prefrontal (F1, F2) infarction. J Neurol Neurosurg Psychiatry 58:6296321995

    • Search Google Scholar
    • Export Citation
  • 39

    Warrington E: The fractionation of arithmetical skills: a single case study. Q J Exp Psychol A 34:31511982

  • 40

    Whalen JMcClosley MLesser RPGordon B: Localizing arithmetic processes in the brain: evidence from atransient deficit during cortical stimulation. J Cogn Neurosci 3:409 4171997

    • Search Google Scholar
    • Export Citation
  • 41

    Zago LPesenti MMellet ECrivello FMazoyer BTzourio-Mazoyer N: Neural correlates of simple and complex mental calculation. Neuroimage 13:3143272001

    • Search Google Scholar
    • Export Citation

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