DOES SPARING AUDITORY NAMING SITES COMPROMISE SEIZURE OUTCOME?
Abstract number :
1.440
Submission category :
Year :
2003
Submission ID :
477
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Marla J. Hamberger, Robert R. Goodman, Guy M. McKhann, William T. Seidel Neurology, Columbia University, New York, NY; Ortho McNeil Pharmaceutical, Raritan, NJ
Visual naming sites identified by cortical stimulation mapping are typically spared from surgical resection to preserve postoperative language functioning. A common concern of the surgical team, however, is whether sparing functional tissue will reduce the likelihood of good seizure control or seizure freedom postoperatively, as potentially epileptogenic cortex might be excluded from the resection. In previous work, we identified auditory naming sites, distinct from visual naming sites, the latter of which are considered [ldquo]essential[rdquo] for normal postoperative language. As there has not yet been adequate evidence to suggest that auditory naming sites are critical as well, these sites have not routinely been spared from resection. To determine whether sparing auditory naming sites compromises seizure outcome, we compared seizure outcome in patients who had auditory naming sites spared with those who had these sites resected.
Subjects were 16 left TLE patients who underwent preoperative cortical language mapping (7 intraoperative, 9 extraoperative) utilizing both visual and auditory naming tasks. Surgical resections were tailored to preserve visual but not auditory naming sites. Auditory naming sites were spared in 7 patients, resected in 6 patients, and fell within 2 cm from the resection boundary in 3 patients. Visual naming sites were preserved in all patients. Engel[rsquo]s seizure outcome ratings (i.e., Class I [ndash] IV; Engel, 1993) were obtained for each patient one-year postoperatively. To be conservative, analysis included only patients from the [ldquo]spared[rdquo] and [ldquo]resected[rdquo] groups, as all patients in the [ldquo]middle[rdquo] group (i.e., auditory naming sites [lt] 2 cm from resection boundary) had Class I outcomes. Fisher[rsquo]s exact test was used to compare seizure outcome in [ldquo]spared[rdquo] and [ldquo]resected[rdquo] groups.
Comparison of seizure outcome between [ldquo]spared[rdquo] and [ldquo]resected[rdquo] groups showed no significant difference (p. = 1.0).
These preliminary results suggest that sparing auditory naming sites is not associated with poor seizure outcome.
[Supported by: The National Institute of Neurological Disorders and Stroke, Grant Number NS35140.]