Music is a universal human attribute. The study of amusia, a neurologic music processing deficit, has increasingly elaborated our view on the neural organization of the musical brain. However, lesions causing amusia occur in multiple brain locations and often also cause aphasia, leaving the distinct neural networks for amusia unclear. Here, we utilized lesion network mapping to identify these networks. A systematic literature search was carried out to identify all published case reports of lesion-induced amusia. The reproducibility and specificity of the identified amusia network were then tested in an independent prospective cohort of 97 stroke patients (46 female and 51 male) with repeated structural brain imaging, specifically assessed for both music perception and language abilities. Lesion locations in the case reports were heterogeneous but connected to common brain regions, including bilateral temporoparietal and insular cortices, precentral gyrus, and cingulum. In the prospective cohort, lesions causing amusia mapped to a common brain network, centering on the right superior temporal cortex and clearly distinct from the network causally associated with aphasia. Lesion-induced longitudinal structural effects in the amusia circuit were confirmed as reduction of both gray and white matter volume, which correlated with the severity of amusia. We demonstrate that despite the heterogeneity of lesion locations disrupting music processing, there is a common brain network that is distinct from the language network. These results provide evidence for the distinct neural substrate of music processing, differentiating music-related functions from language, providing a testable target for noninvasive brain stimulation to treat amusia.

音乐是人类的普遍属性。对失乐症（一种神经性音乐处理缺陷）的研究日益阐明了我们对音乐大脑神经组织的看法。然而，导致失语症的病变发生在多个大脑位置，并且通常也会导致失语症，导致失语症的独特神经网络尚不清楚。在这里，我们利用病变网络映射来识别这些网络。我们进行了系统的文献检索，以确定所有已发表的损伤引起失乐症的病例报告。然后，在一个由 97 名中风患者（46 名女性和 51 名男性）组成的独立前瞻性队列中，通过重复的大脑结构成像，对所确定的失乐网络的再现性和特异性进行了测试，并专门评估了音乐感知和语言能力。病例报告中的病变位置各不相同，但与常见的大脑区域有关，包括双侧颞顶叶和岛叶皮质、中央前回和扣带回。在前瞻性队列中，导致失语症的病变映射到一个共同的大脑网络，以右上颞叶皮层为中心，与失语症因果相关的网络明显不同。失乐症回路中损伤引起的纵向结构效应被证实为灰质和白质体积的减少，这与失乐症的严重程度相关。我们证明，尽管病变位置的异质性扰乱了音乐处理，但存在一个与语言网络不同的共同大脑网络。这些结果为音乐处理的独特神经基质提供了证据，将音乐相关功能与语言区分开来，为无创性脑刺激治疗失乐症提供了可测试的目标。