'Moderate global aphasia': A generalized decline of language processing caused by glioma surgery but not stroke.

Unlike stroke, neurosurgical removal of left-hemisphere gliomas acts upon a reorganized language network and involves brain areas rarely damaged by stroke. We addressed whether this causes the profiles of neurosurgery- and stroke-induced language impairments to be distinct. K-means clustering of language assessment data (neurosurgery cohort: N = 88, stroke cohort: N = 95) identified similar profiles in both cohorts. But critically, a cluster of individuals with specific phonological deficits was only evident in the stroke but not in the neurosurgery cohort. Thus, phonological deficits are less clearly distinguished from other language deficits after glioma surgery compared to stroke. Furthermore, the correlations between language production and comprehension scores at different linguistic levels were more extensive in the neurosurgery than in the stroke cohort. Our findings suggest that neurosurgery-induced language impairments do not correspond to those caused by stroke, but rather manifest as a 'moderate global aphasia' - a generalized decline of language processing abilities.

Functional linguistic specificity of the left frontal aslant tract for spontaneous speech fluency: Evidence from intraoperative language mapping.

The left frontal aslant tract (FAT) has been proposed to be relevant for language, and specifically for spontaneous speech fluency. However, there is missing causal evidence that stimulation of the FAT affects spontaneous speech, and not language production in general. We present a series of 12 neurosurgical cases with awake language mapping of the cortex near the left FAT. Tasks for language mapping included the commonly used action picture naming, and sentence completion, tapping more specifically into spontaneous speech. A task dissociation was found in 10 participants: while being stimulated on specific sites, they were able to name a picture but could not complete a sentence. Overlaying of these sites on preoperative white-matter tract reconstructions revealed that in each individual case they were located on cortical terminations of the FAT. This corroborates the language functional specificity of the left FAT as a tract underlying fluent spontaneous speech.

Endovascular Coiling of Ruptured Very Small Dissecting Fusiform Aneurysm of Posterior Inferior Cerebellar Artery with Parent Artery Preservation by Microcatheter Auto-Assistance.

BACKGROUND: Aneurysmal subarachnoid hemorrhage secondary to ruptured small dissecting fusiform aneurysms of the posterior inferior cerebellar artery (PICA) is rare and particularly challenging. Different treatment strategies have been reported in these rare cases. We report 2 patients treated with a novel endovascular approach. CASE DESCRIPTION: Two patients presented with subarachnoid hemorrhage secondary to very small (3 mm and 4 mm) ruptured fusiform aneurysms of the proximal section of the PICA trunk. Both patients were treated by coil embolization combined with parent artery preservation by microcatheter auto-assistance. Both coiling procedures were uneventful, and the patients remained asymptomatic. Long-term follow-up angiography in both patients showed complete occlusion of aneurysms with patency of PICA. CONCLUSIONS: There is no single treatment strategy suitable for all PICA aneurysms. Our proposed method may be best applied to small dissecting fusiform aneurysms located on a small (≤1 mm in diameter) PICA distally to its origin.