• Jonathan D Breshears, Derek G Southwell, and Edward F Chang.
• Department of Neurological Surgery, University of California San Francisco, San Francisco, California.
• Neurosurgery. 2019 Sep 1; 85 (3): E496-E501.

BackgroundIntraoperative stimulation of the posterior inferior frontal lobe (IFL) induces speech arrest, which is often interpreted as demonstration of essential language function. However, prior reports have described "negative motor areas" in the IFL, sites where stimulation halts ongoing limb motor activity.ObjectiveTo investigate the spatial and functional relationship between IFL speech arrest areas and negative motor areas (NMAs).MethodsIn this retrospective cohort study, intraoperative stimulation mapping was performed to localize speech and motor function, as well as arrest of hand movement, hand posture, and guitar playing in a set of patients undergoing awake craniotomy for dominant hemisphere pathologies. The incidence and localization of speech arrest and motor inhibition was analyzed.ResultsEleven patients underwent intraoperative localization of speech arrest sites and inhibitory motor areas. A total of 17 speech arrest sites were identified in the dominant frontal lobe, and, of these, 5 sites (29.4%) were also identified as NMAs. Speech arrest and arrest of guitar playing was also evoked by a single IFL site in 1 subject.ConclusionInferior frontal gyrus speech arrest sites do not function solely in speech production. These findings provide further evidence for the complexity of language organization, and suggest the need for refined mapping strategies that discern between language-specific sites and inhibitory motor areas.Copyright © 2018 by the Congress of Neurological Surgeons.

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