Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Canada.
Department of Speech Language Pathology, Université du Québec à Trois-Rivières, Canada.
Clin Neurol Neurosurg. 2021 Dec;211:107014. doi: 10.1016/j.clineuro.2021.107014. Epub 2021 Oct 30.
Operculoinsular cortectomy is increasingly recognized as a therapeutic avenue for perisylvian refractory epilepsy. However, most neurosurgeons are reluctant to perform this type of procedure because of feared neurological complications, especially in the language-dominant hemisphere, as the insula is involved in speech and language processes. The goal of this retrospective study is to quantify the incidence and types of speech and language deficits associated with operculoinsulectomies in the dominant hemisphere for language, and to identify factors associated with these complications.
Clinical, imaging, and surgical data of all patients who had an operculoinsulectomy for refractory epilepsy at our center between 1998 and 2018 were reviewed. Language lateralization was determined by functional magnetic resonance imaging (fMRI) and/or Wada test. Speech and language assessments were carried out by neurosurgeons, neurologists, neuropsychologists and/or speech language pathologists, before surgery, during the first week after surgery, and at least 6 months after surgery.
Amongst 44 operculoinsulectomies, 13 were performed in the language-dominant hemisphere. 46% of these patients presented with transient aphasia post-surgery. However, a few months later, the patients' performances on language assessments were not statistically different from before surgery, thus suggesting a complete recovery of speech and language functions.
Temporary aphasias after operculoinsulectomy for refractory epilepsy in the language-dominant hemisphere are frequent, but eventually subside. Potential mechanisms underlying this recovery are discussed.
岛盖部脑皮质切除术越来越被认为是治疗外侧裂难治性癫痫的一种方法。然而，由于担心神经并发症，尤其是在语言优势半球，因为脑岛参与言语和语言过程，大多数神经外科医生都不愿意进行这种类型的手术。本回顾性研究的目的是量化与优势半球语言相关的岛盖部脑皮质切除术相关的言语和语言缺陷的发生率和类型，并确定与这些并发症相关的因素。
回顾了 1998 年至 2018 年期间在我们中心因难治性癫痫接受岛盖部脑皮质切除术的所有患者的临床、影像学和手术数据。语言侧化通过功能磁共振成像（fMRI）和/或瓦达测试确定。在手术前、手术后第一周以及手术后至少 6 个月，由神经外科医生、神经科医生、神经心理学家和/或言语语言病理学家进行言语和语言评估。
在 44 例岛盖部脑皮质切除术中，有 13 例在语言优势半球进行。这些患者中有 46%在手术后出现短暂性失语症。然而，几个月后，患者的语言评估结果与手术前没有统计学差异，表明言语和语言功能完全恢复。
在语言优势半球进行难治性癫痫的岛盖部脑皮质切除术后出现暂时性失语症很常见，但最终会消退。讨论了这种恢复的潜在机制。
