Document Detail

Functional outcome after language mapping for glioma resection.
MedLine Citation:
PMID:  18172171     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Language sites in the cortex of the brain vary among patients. Language mapping while the patient is awake is an intraoperative technique designed to minimize language deficits associated with brain-tumor resection. METHODS: To study language function after brain-tumor resection with language mapping, we examined 250 consecutive patients with gliomas. Positive language sites (i.e., language regions in the cortex of the brain, 1 cm by 1 cm, which were temporarily inactivated by means of a bipolar electrode) were identified and categorized into cortical language maps. The tumors were resected up to 1 cm from the cortical areas where intraoperative stimulation produced a disturbance in language. Our resection strategy did not require identification of the stimulation-induced language sites within the field of exposure. RESULTS: A total of 145 of the 250 patients (58.0%) had at least one site with an intraoperative stimulation-induced speech arrest, 82 patients had anomia, and 23 patients had alexia. Overall, 3094 of 3281 cortical sites (94.3%) were not associated with stimulation-induced language deficits. A total of 159 patients (63.6%) had intact speech preoperatively. One week after surgery, baseline language function remained in 194 patients (77.6%), it worsened in 21 patients (8.4%), and 35 patients (14.0%) had new speech deficits. However, 6 months after surgery, only 4 of 243 surviving patients (1.6%) had a persistent language deficit. Cortical maps generated with intraoperative language data also showed surprising variability in language localization within the dominant hemisphere. CONCLUSIONS: Craniotomies tailored to limit cortical exposure, even without localization of positive language sites, permit most gliomas to be aggressively resected without language deficits. The composite language maps generated in our study suggest that our current models of human language organization insufficiently account for observed language function.
Nader Sanai; Zaman Mirzadeh; Mitchel S Berger
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  358     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-03     Completed Date:  2008-01-08     Revised Date:  2008-04-22    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-27     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2008 Massachusetts Medical Society.
Department of Neurological Surgery and the Brain Tumor Research Center, University of California at San Francisco, San Francisco, CA 94143-0112, USA.
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MeSH Terms
Aged, 80 and over
Anomia / diagnosis,  etiology
Brain Mapping* / methods
Brain Neoplasms / physiopathology*,  surgery
Cerebral Cortex* / physiology
Dominance, Cerebral
Dyslexia / diagnosis,  etiology
Glioma / physiopathology*,  surgery
Language Tests
Middle Aged
Monitoring, Intraoperative
Postoperative Complications / prevention & control
Comment In:
N Engl J Med. 2008 Apr 17;358(16):1750; author reply 1751   [PMID:  18420509 ]
N Engl J Med. 2008 Jan 3;358(1):6-7   [PMID:  18172169 ]

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