Ekert, Justyna O.; (2021) Improving our understanding of speech and language outcome in neurosurgery patients. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Malignant gliomas remain incurable and result in more years of life lost than any other tumours. Surgical resection is strongly recommended but carries a risk of causing functional impairment. This thesis aims to demonstrate how state-of-the-art functional magnetic resonance imaging (fMRI) language paradigms can contribute to neurosurgical planning. The first three experiments use a multitask fMRI language paradigm to functionally segregate left posterior temporal and left posterior frontal regions involved in the perception and production of speech. Experiment 1 demonstrated three functionally distinct responses in the left posterior superior temporal sulcus (STS), left temporo-parietal junction and anterior ascending terminal branch of the left STS. Experiment 2 validates these findings in an independent group of participants, increasing confidence that they are robust. Experiment 3 dissociates the response of three different parts of the left premotor cortex during speech production. Experiment 4 shows that left posterior temporal regions are more consistently activated, in neurotypical controls, when a picture naming task presents pairs of objects rather than single objects. Further work could therefore test whether paired object naming is a more sensitive task for pre- and intra-operative language mapping. Finally, Experiment 5 found that successful reading before and after surgery, in two patients with gliomas affecting the left temporo-parietal junction, enhanced activation in bilateral perirhinal regions that were associated with semantic identification of visually presented objects in neurotypical controls. Future studies can now test whether patients who undergo resection of the left temporo-parietal junction have better reading, post-surgery, when bilateral perirhinal activation is enhanced prior to surgery. Taken together, this work expands our knowledge of the functional anatomy of language, proposes a new way of utilising fMRI data from neurotypical controls to tailor pre- and intra-operative language mapping strategies and provides an insight into how the reading system reorganises itself after brain damage.

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