Young Jacob S, Morshed Ramin A, Andrews John P, Cha Soonmee, Berger Mitchel S
Departments of Neurological Surgery and.
Radiology, University of California, San Francisco, California.
J Neurosurg Case Lessons. 2021 Sep 6;2(10):CASE21277. doi: 10.3171/CASE21277.
Prosopagnosia is a rare neurological condition characterized by the impairment of face perception with preserved visual processing and cognitive functioning and is associated with injury to the fusiform gyrus and inferior longitudinal fasciculus (ILF). Reports of this clinical impairment following resection of right temporal lobe diffuse gliomas in the absence of contralateral injury are exceedingly scarce and not expected as a complication of surgery.
The authors describe the case of a young female patient found to have an incidental diffuse glioma in the right inferior temporal lobe despite evidence of preoperative ILF disruption by the tumor. Following resection of the lesion, despite the preoperative disruption to the ILF by the tumor, the patient developed prosopagnosia. There was no evidence of contralateral, left-sided ILF injury.
Given the significant functional impairment associated with prosopagnosia, neurosurgeons should be aware of the exceedingly rare possibility of a visual-processing deficit following unilateral and, in this case, right-sided inferior temporal lobe glioma resections. More investigation is needed to determine whether preoperative testing can determine dominance of facial-processing networks for patients with lesions in the right inferior posterior temporooccipital lobe and whether intraoperative mapping could help prevent this complication.
面孔失认症是一种罕见的神经疾病，其特征是面部感知受损，而视觉处理和认知功能保留，且与梭状回和下纵束（ILF）损伤有关。在没有对侧损伤的情况下，右侧颞叶弥漫性胶质瘤切除术后出现这种临床损伤的报道极为罕见，且不被认为是手术并发症。
作者描述了一名年轻女性患者的病例，该患者尽管术前有肿瘤导致ILF中断的证据，但右侧颞下叶发现了偶然的弥漫性胶质瘤。病变切除后，尽管术前肿瘤对ILF造成了破坏，但患者仍出现了面孔失认症。没有对侧左侧ILF损伤的证据。
鉴于面孔失认症会导致严重的功能障碍，神经外科医生应意识到单侧，在本病例中为右侧颞下叶胶质瘤切除术后出现视觉处理缺陷这种极其罕见的可能性。需要更多研究来确定术前检查是否能确定右颞后枕叶病变患者面部处理网络的优势，以及术中定位是否有助于预防这种并发症。
