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Previous Volume 358:18-27 January 3, 2008 Number 1 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Interactive Graphic Perspective by Snyder, S. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

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.

Source Information

From the Department of Neurological Surgery and the Brain Tumor Research Center, University of California at San Francisco, San Francisco.

Address reprint requests to Dr. Sanai at the Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., M-779, San Francisco, CA 94143-0112, or at sanain{at}neurosurg.ucsf.edu.

Full Text of this Article

Related Letters:

Outcome after Language Mapping for Glioma Resection
Mayer L., Sanai N., Berger M. S.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:1750-1751, Apr 17, 2008. Correspondence

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