Predicting Language Outcome After Left Hemispherotomy: A Systematic Literature Review

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Developmental Neuroscience

Background:

• Hemidecortication is a surgical option for drug-resistant epilepsy.
• Left-hemispheric pathology in children may lead to right-hemisphere language takeover if surgery is timely.
• Predictors of language outcome after left hemidecortication require systematic review.

Purpose of the Study:

• To systematically review predictors of language outcome after left hemidecortication in children.
• To analyze language lateralization in relation to congenital and acquired left-hemispheric lesions.
• To identify factors influencing postsurgical language function.

Main Methods:

• Systematic literature review of 58 studies.
• Analysis of language lateralization and outcome after left-sided hemidisconnection procedures.
• Hierarchical linear regression to assess age at surgery, lesion type, seizure onset, and presurgical language function.

Main Results:

• Younger age at injury correlated with right-sided language lateralization in postneonatal lesions.
• Age at surgery did not significantly predict language outcome in hemidecortication patients.
• Presurgical language function was the most potent predictor of postsurgical outcome; good pre-op function risked deterioration.
• Right-sided language lateralization was most common in pre-/perinatal stroke with congenital pathology.

Conclusions:

• A presurgical decision algorithm is proposed.
• Key decision points include age, presurgical language function, language lateralization, and left-hemispheric pathology.
• This algorithm aims to optimize surgical candidacy and predict language outcomes.