Hamberger Marla J, Seidel William T, McKhann Guy M, Perrine Kenneth, Goodman Robert R
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Brain. 2005 Nov;128(Pt 11):2742-9. doi: 10.1093/brain/awh621. Epub 2005 Aug 18.
One challenge in dominant temporal lobe epilepsy surgery is to remove sufficient epileptogenic tissue without compromising post-operative language functioning. Pre-resection electrical stimulation mapping enables identification of language areas that can be spared from resection, and also provides a unique opportunity to investigate brain-language relationships. Visual object naming is the gold standard for identifying 'essential' language cortex; however, sparing visual naming (VN) sites has not reliably prevented post-operative language decline. In addition to visual object naming, we included a more 'ecologically valid' auditory description naming task in our pre-resection cortical mapping protocol. Of the seven patients who had auditory naming (AN) sites removed, six declined post-operatively, whereas of the 12 patients who did not have AN sites removed, only 3 declined post-operatively (P = 0.02), suggesting an association between AN site removal and post-operative naming decline. Interestingly, although VN sites were preserved in all patients, AN site removal resulted in decline in both auditory and VN tasks. These findings not only have potentially critical clinical significance, but also argue for modality specificity, with considerable integration within the semantic system.
颞叶优势型癫痫手术中的一个挑战是，在不影响术后语言功能的前提下，切除足够的致痫组织。术前切除电刺激图谱能够识别可免于切除的语言区域，还提供了一个研究脑-语言关系的独特机会。视觉物体命名是识别“必需”语言皮质的金标准；然而，保留视觉命名（VN）部位并不能可靠地防止术后语言功能下降。除了视觉物体命名外，我们在术前皮质图谱方案中纳入了一项更具“生态效度”的听觉描述命名任务。在7例切除了听觉命名（AN）部位的患者中，6例术后出现功能下降，而在12例未切除AN部位的患者中，只有3例术后出现功能下降（P = 0.02），这表明切除AN部位与术后命名功能下降之间存在关联。有趣的是，尽管所有患者的VN部位均得以保留，但切除AN部位导致听觉和VN任务功能均下降。这些发现不仅具有潜在的关键临床意义，还支持了模态特异性，以及语义系统内相当程度的整合。
