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Language function after temporal lobectomy without stimulation mapping of cortical function

K G Davies1, R E Maxwell, T E Beniak

  • 1Department of Neurosurgery, University of Minnesota, Minneapolis.

Epilepsia
|February 1, 1995
PubMed
Summary
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Standard anterior temporal lobectomy (ATL) without language mapping is safe for long-term language function. Patients undergoing left dominant ATL showed no language loss, with some improvements, indicating pre-existing dysfunction in this group.

Area of Science:

  • Neurosurgery
  • Neuropsychology
  • Epilepsy Surgery

Background:

  • Anterior temporal lobectomy (ATL) is a common surgical treatment for epilepsy.
  • The necessity of intraoperative language mapping during ATL remains a subject of debate.
  • Assessing the impact of ATL on language and memory function is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the long-term effects of standard anterior temporal lobectomy (ATL) without language mapping on language and memory functions.
  • To compare language and memory outcomes between patients with left-dominant hemisphere language (LHDL) and right/mixed-dominant hemisphere language (RHDL/MDL) undergoing ATL.
  • To determine the safety and efficacy of ATL regarding seizure control and neuropsychological status.

Main Methods:

Related Experiment Videos

  • A cohort of 95 patients undergoing ATL without stimulation mapping was assessed.
  • Neuropsychological tests evaluated language function (Boston Naming Test, Verbal Fluency) and cognitive abilities (WAIS subtests) preoperatively and 1 year postoperatively.
  • Intracarotid amytal test confirmed hemisphere language dominance.

    • Main Results:

    • Seizure-free rates at 1 year were 57% for LHDL and 59% for right-dominant ATL groups.
    • The LHDL group exhibited significantly lower preoperative language and memory scores compared to the right-dominant group.
    • Postoperative assessment revealed no significant language decline in the LHDL group, with notable improvements in several parameters.

    Conclusions:

    • Standard ATL without intraoperative language mapping is safe for preserving long-term language function.
    • Patients undergoing left-dominant ATL may present with pre-existing language and memory deficits.
    • ATL can be performed safely with conservative resection, achieving good seizure control and maintaining or improving cognitive functions.