fMRI Language Activation-If You See It Don't Resect It…

Area of Science:

• Neurosurgery
• Epileptology
• Neuroimaging

Background:

• Temporal lobe epilepsy surgery aims to improve seizure control.
• Predicting postoperative language deficits, particularly naming ability, is crucial for patient outcomes.
• Previous studies focused on surgical factors, but the role of resected functional activation was less clear.

Purpose of the Study:

• To predict language deficits after temporal lobe epilepsy surgery.
• To assess the impact of resected functional magnetic resonance imaging (fMRI) activation on naming ability.
• To identify predictors of postoperative naming changes.

Main Methods:

• Thirty-five adult temporal lobe epilepsy patients underwent preoperative fMRI and the Boston Naming Test (BNT).
• Temporal lobe resections were performed, and anatomic resection masks were generated to quantify overlap with fMRI activation and language areas.
• Stepwise linear regression analyzed predictors of postoperative naming change, including fMRI activation overlap, language dominance, age at seizure onset, and BNT scores.

Main Results:

• Seven of 35 patients experienced significant naming decline, primarily those with dominant-side resections.
• The final model predicted 38% of naming score variance.
• The percentage of top 10% fMRI activation resected was the most significant predictor (P = .017), alongside Wernicke area laterality index, age at seizure onset, and volume of Wernicke area resected.

Conclusions:

• Resection of fMRI-identified language activation is a significant factor influencing postoperative naming changes after temporal lobe epilepsy surgery.
• The amount of language fMRI activation within the planned resection area offers additional predictive power beyond traditional factors.
• Integrating fMRI activation extent into surgical planning may improve prediction of naming outcomes.