Abstracts

It is well known that focal resection involving the language dominant hemisphere can result in mild decrements in language functions, such as confrontation naming, even when cortical language areas are mapped during electrical stimulation studies prior to surgery. However, it is unclear to what extent postoperative language change occurs following resection of frontal or temporal cortex in the [quot]nondominant[quot] or minor language hemisphere when patients have a bilateral capacity for language. Three males and 1 female (ages 10-34) underwent the intracarotid amobarbital procedure (IAP) and cortical language mapping prior to focal resection for intractable seizures. In each case, surgery involved frontal and/or temporal cortex in the minor language hemisphere. All patients were classified with bilateral language, three of whom were primarily left dominant with one being primarily right dominant. Cortical language areas were identified during stimulation studies in the frontal region in all patients and in the temporal region in three patients. In no case did the surgery include resection of mapped language cortex. Postoperative interval ranged from four to seven months. Pre- and postoperative cognitive test performance was compared on tests of verbal fluency and confrontation naming. Two patients displayed declines in verbal fluency and confrontation naming post operatively. For one of these, language decline was part of a more generalized cognitive decline possibly attributable to a medication change. In the second patient, initial postoperative deficits had recovered to baseline levels when the patient was re-evaluated at 1 year, 3 months postoperatively. Stable verbal fluency and confrontation naming were observed in the other two patients. These limited data do not support the likelihood of persistent language impairment following [quot]nondominant[quot] frontal or temporal lobe surgery in patients with bilateral language who underwent language mapping. Nonetheless, these preliminary findings are insufficient to suggest that language cortex in the minor language hemisphere can be routinely resected in this population. A single individual in a sample of four patients displayed decline on formal tests during the early postoperative interval, which later resolved. This suggests the possibility that postoperative language decrements, when they do occur, may be transient in these cases.