Intraoperative mapping of language functions: a longitudinal neurolinguistic analysis
-
- Josef Ilmberger
- Departments of Physical Medicine and Rehabilitation,
-
- Maximilian Ruge
- Neurosurgical Department, Ludwig Maximilians University, Munich, Germany
-
- Friedrich-Wilhelm Kreth
- Neurosurgical Department, Ludwig Maximilians University, Munich, Germany
-
- Josef Briegel
- Anesthesiology, and
-
- Hans-Juergen Reulen
- Neurosurgery, and
-
- Joerg-Christian Tonn
- Neurosurgical Department, Ludwig Maximilians University, Munich, Germany
Bibliographic Information
- Other Title
-
- Clinical article
Description
<jats:sec> <jats:title>Object</jats:title> <jats:p>This prospective longitudinally designed study was conducted to evaluate language functions pre- and postoperatively in patients who underwent microsurgical treatment of tumors in close proximity to or within language areas and to detect those patients at risk for a postoperative aphasic disturbance.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 1991 and 2005, 153 awake craniotomies with subsequent cortical mapping of language functions were performed in 149 patients. Language functions were assessed using a standardized test battery. Risk factors were obtained from multivariate logistic regression models.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Language mapping was able to be performed in all patients, and complete tumor resection was achieved in 48.4%. Within 21 days after surgery a new language deficit (aphasic disturbance) was observed in 41 (32%) of the 128 cases without preoperative deficits. There were a total of 60 cases involving postoperative aphasic disturbances, including cases both with and without preoperative disturbances. Risk factors for postoperative aphasic disturbance were preoperative aphasia (p < 0.0002), intraoperative complications (p < 0.02), language-positive sites within the tumor (p < 0.001), and nonfrontal lesion location (p < 0.001). In patients without a preoperative deficit, a normal (yet submaximal) naming performance was a powerful predictor for an early postoperative aphasic disturbance (p < 0.0003). Seven months after treatment 10.9% of the 128 cases without preoperative aphasic disturbances continued to demonstrate new postoperative language disturbances. A total of 17.6% of all cases demonstrated new postoperative language disturbances after 7 months. Risk factors for persistent aphasic disturbance were increased age (> 40 years, p < 0.02) and preoperative aphasia (p < 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Every attempt should be undertaken to preserve language-relevant areas intraoperatively, even when they are located within the tumor. New postoperative deficits resolve in the majority of patients, which may be a result of cortical mapping as well as functional reorganization.</jats:p></jats:sec>
Journal
-
- Journal of Neurosurgery
-
Journal of Neurosurgery 109 (4), 583-592, 2008-10
Journal of Neurosurgery Publishing Group (JNSPG)
- Tweet
Details 詳細情報について
-
- CRID
- 1360011145025624064
-
- ISSN
- 19330693
- 00223085
-
- Data Source
-
- Crossref