Whittle I R, Pringle A M, Taylor R
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
Lancet. 1998 Apr 4;351(9108):1014-8. doi: 10.1016/S0140-6736(97)08295-0.
Although language disorders occur in about 50% of patients with a left hemispheric tumour and are a significant cause of morbidity, the effects of resective neurosurgery and their relation to tumour pathology are unclear. We report the immediate effects of resective surgery on language functions in a heterogeneous group of patients with left-sided intracranial tumours.
40 patients were studied. The Western Aphasia Battery (WAB) and Boston Naming Test (BNT) were administered preoperatively and before discharge following resective neurosurgery. Dexamethasone dose at time of testing was recorded, as was time taken to complete the tests, and tumour neuropathology.
15 patients with normal aphasia quotients and language quotients before resective surgery all had normal quotients postoperatively. 25 who were dysphasic (ie, aphasia quotient <93.8) preoperatively showed significant postoperative improvements in both their mean aphasia quotient (from 81.8 to 89.1, p=0.004) and their mean language quotient (from 73.4 to 85.4, p=0.001), though 13 remained dysphasic. Two of the 25 dysphasic patients had their WAB scores lowered by tumour resection. The findings and postoperative changes in BNT scores were almost identical to the pattern of those in WAB scores. At second assessment, dexamethasone therapy was significantly (p<0.01) lower than preoperative dose (reduction from mean 10.3 mg/day to 0.7 mg/day in the dysphasic group). Patients with glioblastoma were more likely to have lower aphasia quotients, language quotients, and BNT scores than patients with anaplastic glioma, metastasis, or meningioma. Although the glioblastoma group had the greatest improvements in WAB operative scores, 57% remained dysphasic after resective surgery. Two additional patients declined postoperative assessment.
Resective surgery for left-sided intracranial tumours significantly improves language function in dysphasic patients, and is unlikely to impair language functions in non-dysphasic patients. Dysphasia and its response to resective surgery are related to the tumour neuropathology.
尽管约50%的左半球肿瘤患者会出现语言障碍，且这是导致发病的重要原因，但切除性神经外科手术的效果及其与肿瘤病理学的关系尚不清楚。我们报告了切除性手术对一组患有左侧颅内肿瘤的异质性患者语言功能的即时影响。
对40例患者进行研究。术前及切除性神经外科手术后出院前进行西方失语成套测验（WAB）和波士顿命名测验（BNT）。记录测试时的地塞米松剂量、完成测试所需时间以及肿瘤神经病理学情况。
15例在切除性手术前失语商数和语言商数正常的患者术后商数均正常。25例术前存在言语障碍（即失语商数<93.8）的患者术后平均失语商数（从81.8提高到89.1，p=0.004）和平均语言商数（从73.4提高到85.4，p=0.001）均有显著改善，不过仍有13例存在言语障碍。25例言语障碍患者中有2例因肿瘤切除导致WAB评分降低。BNT评分的结果及术后变化与WAB评分的模式几乎相同。在第二次评估时，地塞米松治疗剂量显著低于术前剂量（言语障碍组从平均10.3毫克/天降至0.7毫克/天，p<0.01）。与间变性胶质瘤、转移瘤或脑膜瘤患者相比，胶质母细胞瘤患者的失语商数、语言商数和BNT评分更可能较低。尽管胶质母细胞瘤组在WAB手术评分方面改善最大，但切除性手术后仍有57%的患者存在言语障碍。另外2例患者拒绝术后评估。
左侧颅内肿瘤的切除性手术可显著改善言语障碍患者的语言功能，且不太可能损害非言语障碍患者的语言功能。言语障碍及其对切除性手术的反应与肿瘤神经病理学有关。
