Jabbour Rosette A, Hempel Ann, Gates John R, Zhang Wenbo, Risse Gail L
Minnesota Epilepsy Group, PA, St. Paul, MN, USA.
Epilepsy Behav. 2005 Jun;6(4):587-92. doi: 10.1016/j.yebeh.2005.03.008.
The configuration of language cortex in the dominant left hemisphere has been well described in the literature. However, language representation in the right hemisphere, particularly in patients with some degree of bilateral language, remains unclear. Herein, we report six patients who underwent electrocortical stimulation (ECS) for language mapping following implantation of a right subdural electrode array (SEA).
The medical records of six bilateral language patients with right SEA implantation at the Minnesota Epilepsy Group between January 1996 and July 2004 were retrospectively reviewed. Language lateralization was based on the results of the intracarotid amobarbital procedure performed preoperatively. Anatomical localization of the SEA for each patient was verified using colored photographs of the cortical surface before and after SEA placement and by review of MRI scans taken with the SEA in place. Frontal and temporal language areas were identified by errors in any language modality including automatic speech, reading, naming, repetition, and comprehension during ECS.
Language maps revealed the presence of frontal and/or temporal language areas analogous to the classic essential language areas of the dominant left hemisphere in four of six patients. One patient had a widespread distribution of single-language-error sites over the right temporal lobe. One patient had a silent language map.
Our results identified the presence of language cortex in the right hemisphere in five of six patients classified with bilateral language based on intracarotid amobarbital procedure. These areas are assumed to be accessory language zones in relation to the left hemisphere. Further exploratory studies are needed to evaluate their clinical significance.
文献中已对优势半球左侧语言皮质的结构进行了详尽描述。然而，右侧半球的语言表征，尤其是在具有一定程度双侧语言功能的患者中，仍不清楚。在此，我们报告6例在植入右侧硬膜下电极阵列（SEA）后接受皮质电刺激（ECS）进行语言图谱绘制的患者。
回顾性分析1996年1月至2004年7月在明尼苏达癫痫组植入右侧SEA的6例双侧语言功能患者的病历。语言侧化基于术前进行的颈动脉内异戊巴比妥试验结果。通过SEA放置前后皮质表面的彩色照片以及对SEA在位时所拍摄的MRI扫描进行回顾，来验证每位患者SEA的解剖定位。在ECS期间，通过包括自动言语、阅读、命名、重复和理解在内的任何语言模式中的错误来识别额叶和颞叶语言区。
语言图谱显示，6例患者中有4例存在与优势半球左侧经典必需语言区类似的额叶和/或颞叶语言区。1例患者在右侧颞叶有广泛分布的单语言错误位点。1例患者有沉默的语言图谱。
我们的结果表明，在基于颈动脉内异戊巴比妥试验被归类为双侧语言功能的6例患者中，有5例右侧半球存在语言皮质。这些区域被认为是相对于左侧半球的辅助语言区。需要进一步的探索性研究来评估它们的临床意义。
