Intraoperative mapping of language functions: a longitudinal neurolinguistic analysis.

Full Abstract

OBJECT: This prospective longitudinally designed study was conducted to evaluate language functions pre- and postoperatively in patients who underwent microsurgical treatment of tumors in close proximity to or within language areas and to detect those patients at risk for a postoperative aphasic disturbance. METHODS: Between 1991 and 2005, 153 awake craniotomies with subsequent cortical mapping of language functions were performed in 149 patients. Language functions were assessed using a standardized test battery. Risk factors were obtained from multivariate logistic regression models. RESULTS: Language mapping was able to be performed in all patients, and complete tumor resection was achieved in 48.4%. Within 21 days after surgery a new language deficit (aphasic disturbance) was observed in 41 (32%) of the 128 cases without preoperative deficits. There were a total of 60 cases involving postoperative aphasic disturbances, including cases both with and without preoperative disturbances. Risk factors for postoperative aphasic disturbance were preoperative aphasia (p<0.0002), intraoperative complications (p<0.02), language-positive sites within the tumor (p<0.001), and nonfrontal lesion location (p<0.001). In patients without a preoperative deficit, a normal (yet submaximal) naming performance was a powerful predictor for an early postoperative aphasic disturbance (p<0.0003). Seven months after treatment 10.9% of the 128 cases without preoperative aphasic disturbances continued to demonstrate new postoperative language disturbances. A total of 17.6% of all cases demonstrated new postoperative language disturbances after 7 months. Risk factors for persistent aphasic disturbance were increased age (>40 years, p<0.02) and preoperative aphasia (p<0.001). CONCLUSIONS: Every attempt should be undertaken to preserve language-relevant areas intraoperatively, even when they are located within the tumor. New postoperative deficits resolve in the majority of patients, which may be a result of cortical mapping as well as functional reorganization.

Author information

Author/s: Ilmberger, Josef (J); Ruge, Maximilian (M); Kreth, Friedrich-Wilhelm (FW); Briegel, Josef (J); Reulen, Hans-Juergen (HJ); Tonn, Joerg-Christian (JC);

Affiliation: Department of Physical Medicine and Rehabilitation, Ludwig Maximilians University, Munich, Germany.

Journal and publication information

Publication Type: Clinical Trial; Journal Article

Journal: Journal of neurosurgery (J Neurosurg), published in United States. (Language: eng)

Reference: 2008-Oct; vol 109 (issue 4) : pp 583-92

Dates: Created 2008/10/01; Completed 2008/11/13;

PMID: 18826344, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: 18 Feb 2009 00:00:00)

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