Abdallah Chifaou, Brissart Hélène, Colnat-Coulbois Sophie, Pierson Ludovic, Aron Olivier, Forthoffer Natacha, Vignal Jean-Pierre, Tyvaert Louise, Jonas Jacques, Maillard Louis
Departments of1Neurology and.
4Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
J Neurosurg. 2021 Feb 26;135(5):1466-1476. doi: 10.3171/2020.8.JNS202431. Print 2021 Nov 1.
OBJECTIVE: In drug-resistant temporal lobe epilepsy (TLE) patients, the authors evaluated early and late outcomes for decline in visual object naming after dominant temporal lobe resection (TLR) according to the resection status of the basal temporal language area (BTLA) identified by cortical stimulation during stereoelectroencephalography (SEEG). METHODS: Twenty patients who underwent SEEG for drug-resistant TLE met the inclusion criteria. During language mapping, a site was considered positive when stimulation of two contiguous contacts elicited at least one naming impairment during two remote sessions. After TLR ipsilateral to their BTLA, patients were classified as BTLA+ when at least one positive language site was resected and as BTLA- when all positive language sites were preserved. Outcomes in naming and verbal fluency tests were assessed using pre- and postoperative (means of 7 and 25 months after surgery) scores at the group level and reliable change indices (RCIs) for clinically meaningful changes at the individual level. RESULTS: BTLA+ patients (n = 7) had significantly worse naming scores than BTLA- patients (n = 13) within 1 year after surgery but not at the long-term evaluation. No difference in verbal fluency tests was observed. When RCIs were used, 5 of 18 patients (28%) had naming decline within 1 year postoperatively (corresponding to 57% of BTLA+ and 9% of BTLA- patients). A significant correlation was found between BTLA resection and naming decline. CONCLUSIONS: BTLA resection is associated with a specific and early naming decline. Even if this decline is transient, naming scores in BTLA+ patients tend to remain lower compared to their baseline. SEEG mapping helps to predict postoperative language outcome after dominant TLR.
目的:在耐药性颞叶癫痫(TLE)患者中,作者根据立体定向脑电图(SEEG)期间皮质刺激确定的颞叶基底语言区(BTLA)的切除状态,评估优势颞叶切除术(TLR)后视觉物体命名能力下降的早期和晚期结果。 方法:20例因耐药性TLE接受SEEG检查的患者符合纳入标准。在语言映射过程中,当两个连续触点的刺激在两个远程会话中至少引起一次命名障碍时,该部位被视为阳性。在与他们的BTLA同侧进行TLR后,当至少一个阳性语言部位被切除时,患者被分类为BTLA+,当所有阳性语言部位均被保留时,患者被分类为BTLA-。在组水平上使用术前和术后(术后7个月和25个月的平均值)评分评估命名和语言流畅性测试的结果,并在个体水平上使用可靠变化指数(RCI)评估具有临床意义的变化。 结果:BTLA+组患者(n = 7)在术后1年内的命名得分明显低于BTLA-组患者(n = 13),但在长期评估中没有差异。在语言流畅性测试中未观察到差异。当使用RCI时,18例患者中有5例(28%)在术后1年内出现命名能力下降(相当于BTLA+组患者的57%和BTLA-组患者的9%)。发现BTLA切除与命名能力下降之间存在显著相关性。 结论:BTLA切除与特定的早期命名能力下降有关。即使这种下降是短暂的,BTLA+组患者的命名得分与基线相比往往仍然较低。SEEG映射有助于预测优势TLR术后的语言结果。
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