Department of Neurology, College of Physicians and Surgeons, Columbia University, 710 West 168th Street, New York, NY 10032, USA.
Ann Neurol. 2010 Mar;67(3):345-52. doi: 10.1002/ana.21903.
Preresection electrical stimulation mapping is frequently used to identify cortical sites critical for visual object naming. These sites are typically spared from surgical resection with the goal of preserving postoperative language. Recent studies, however, suggest a potential role of the hippocampus in naming, although this is inconsistent with neurocognitive models of language and memory. We sought to determine whether preservation of visual naming sites identified via cortical stimulation mapping protects against naming decline when resection includes the hippocampal region.
We assessed postoperative changes in visual naming in 33 patients, 14 who underwent left temporal resection including hippocampal removal and 19 who had left temporal resection without hippocampal removal. All patients had preresection cortical language mapping. Visual object naming sites identified via electrical stimulation were always preserved.
Patients without hippocampal resection showed no significant naming decline, suggesting a clinical benefit from cortical mapping. In contrast, patients who had hippocampal resection exhibited significant postoperative naming decline, despite preresection mapping and preservation of all visual naming sites (p < or = 0.02). These group effects were also evident in individual patients (p = 0.02). More detailed, post hoc examination of patients who had hippocampal resection revealed that overall, patients who declined were those with a preoperative, structurally intact hippocampus, whereas patients with preoperative hippocampal sclerosis did not exhibit significant decline.
Despite cortical language mapping with preservation of visual naming sites from resection, removal of an intact dominant hippocampus will likely result in visual naming decline postoperatively.
术前电刺激定位常用于识别对视觉物体命名至关重要的皮质部位。这些部位通常可以避免手术切除，目的是保留术后语言功能。然而，最近的研究表明海马体可能在命名中发挥作用，尽管这与语言和记忆的神经认知模型不一致。我们试图确定通过皮质刺激图定位识别的视觉命名部位的保留是否可以防止切除包括海马区在内的情况下的命名下降。
我们评估了 33 名患者的术后视觉命名变化，其中 14 名患者接受了包括海马切除的左侧颞叶切除术，19 名患者接受了不包括海马切除的左侧颞叶切除术。所有患者均接受了术前皮质语言定位。通过电刺激确定的视觉命名部位始终保留。
未切除海马的患者无明显命名下降，提示皮质图定位具有临床益处。相比之下，尽管进行了术前定位并保留了所有视觉命名部位，但切除海马的患者术后出现了明显的命名下降（p ≤ 0.02）。这些组间效应在个别患者中也很明显（p = 0.02）。对切除海马的患者进行更详细的事后检查发现，总体而言，下降的患者是术前海马结构完整的患者，而术前有海马硬化的患者则没有明显的下降。
尽管进行了皮质语言映射并保留了视觉命名部位，但切除结构完整的优势海马仍可能导致术后视觉命名下降。
