Jeffrey R Binder1, Jia-Qing Tong1, Sara B Pillay1, Lisa L Conant1, Colin J Humphries1, Manoj Raghavan1, Wade M Mueller2, Robyn M Busch3, Linda Allen1, William L Gross1, Christopher T Anderson1, Chad E Carlson1, Mark J Lowe4, John T Langfitt5, Madalina E Tivarus6, Daniel L Drane7, David W Loring7, Monica Jacobs8, Victoria L Morgan9, Jane B Allendorfer10, Jerzy P Szaflarski10, Leonardo Bonilha11, Susan Bookheimer12, Thomas Grabowski13, Jennifer Vannest14, Sara J Swanson1. 1. Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. 2. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. 3. Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 4. Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 5. Department of Neurology, University of Rochester, Rochester, New York, USA. 6. Department of Imaging Sciences, University of Rochester, Rochester, New York, USA. 7. Department of Neurology and Pediatrics, Emory University, Atlanta, Georgia, USA. 8. Department of Psychology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 9. Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 10. Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA. 11. Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA. 12. Department of Neurology, University of California, Los Angeles, California, USA. 13. Department of Neurology, University of Washington, Seattle, Washington, USA. 14. Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.
Abstract
OBJECTIVE: To define left temporal lobe regions where surgical resection produces a persistent postoperative decline in naming visual objects. METHODS: Pre- and postoperative brain magnetic resonance imaging data and picture naming (Boston Naming Test) scores were obtained prospectively from 59 people with drug-resistant left temporal lobe epilepsy. All patients had left hemisphere language dominance at baseline and underwent surgical resection or ablation in the left temporal lobe. Postoperative naming assessment occurred approximately 7 months after surgery. Surgical lesions were mapped to a standard template, and the relationship between presence or absence of a lesion and the degree of naming decline was tested at each template voxel while controlling for effects of overall lesion size. RESULTS: Patients declined by an average of 15% in their naming score, with wide variation across individuals. Decline was significantly related to damage in a cluster of voxels in the ventral temporal lobe, located mainly in the fusiform gyrus approximately 4-6 cm posterior to the temporal tip. Extent of damage to this region explained roughly 50% of the variance in outcome. Picture naming decline was not related to hippocampal or temporal pole damage. SIGNIFICANCE: The results provide the first statistical map relating lesion location in left temporal lobe epilepsy surgery to picture naming decline, and they support previous observations of transient naming deficits from electrical stimulation in the basal temporal cortex. The critical lesion is relatively posterior and could be avoided in many patients undergoing left temporal lobe surgery for intractable epilepsy.
OBJECTIVE: To define left temporal lobe regions where surgical resection produces a persistent postoperative decline in naming visual objects. METHODS: Pre- and postoperative brain magnetic resonance imaging data and picture naming (Boston Naming Test) scores were obtained prospectively from 59 people with drug-resistant left temporal lobe epilepsy. All patients had left hemisphere language dominance at baseline and underwent surgical resection or ablation in the left temporal lobe. Postoperative naming assessment occurred approximately 7 months after surgery. Surgical lesions were mapped to a standard template, and the relationship between presence or absence of a lesion and the degree of naming decline was tested at each template voxel while controlling for effects of overall lesion size. RESULTS:Patients declined by an average of 15% in their naming score, with wide variation across individuals. Decline was significantly related to damage in a cluster of voxels in the ventral temporal lobe, located mainly in the fusiform gyrus approximately 4-6 cm posterior to the temporal tip. Extent of damage to this region explained roughly 50% of the variance in outcome. Picture naming decline was not related to hippocampal or temporal pole damage. SIGNIFICANCE: The results provide the first statistical map relating lesion location in left temporal lobe epilepsy surgery to picture naming decline, and they support previous observations of transient naming deficits from electrical stimulation in the basal temporal cortex. The critical lesion is relatively posterior and could be avoided in many patients undergoing left temporal lobe surgery for intractable epilepsy.
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Authors: William Louis Gross; Alexander I Helfand; Sara J Swanson; Lisa L Conant; Colin J Humphries; Manoj Raghavan; Wade M Mueller; Robyn M Busch; Linda Allen; Christopher Todd Anderson; Chad E Carlson; Mark J Lowe; John T Langfitt; Madalina E Tivarus; Daniel L Drane; David W Loring; Monica Jacobs; Victoria L Morgan; Jane B Allendorfer; Jerzy P Szaflarski; Leonardo Bonilha; Susan Bookheimer; Thomas Grabowski; Jennifer Vannest; Jeffrey R Binder Journal: Neurology Date: 2022-04-11 Impact factor: 11.800
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