Intraoperative mapping of language functions: a longitudinal neurolinguistic analysis.
OBJECTIVE
This prospective longitudinally designed study was conducted to evaluate language functions pre- and postoperatively in patients who underwent microsurgical treatment of tumors in close proximity to or within language areas and to detect those patients at risk for a postoperative aphasic disturbance.


METHODS
Between 1991 and 2005, 153 awake craniotomies with subsequent cortical mapping of language functions were performed in 149 patients. Language functions were assessed using a standardized test battery. Risk factors were obtained from multivariate logistic regression models.


RESULTS
Language mapping was able to be performed in all patients, and complete tumor resection was achieved in 48.4%. Within 21 days after surgery a new language deficit (aphasic disturbance) was observed in 41 (32%) of the 128 cases without preoperative deficits. There were a total of 60 cases involving postoperative aphasic disturbances, including cases both with and without preoperative disturbances. Risk factors for postoperative aphasic disturbance were preoperative aphasia (p<0.0002), intraoperative complications (p<0.02), language-positive sites within the tumor (p<0.001), and nonfrontal lesion location (p<0.001). In patients without a preoperative deficit, a normal (yet submaximal) naming performance was a powerful predictor for an early postoperative aphasic disturbance (p<0.0003). Seven months after treatment 10.9% of the 128 cases without preoperative aphasic disturbances continued to demonstrate new postoperative language disturbances. A total of 17.6% of all cases demonstrated new postoperative language disturbances after 7 months. Risk factors for persistent aphasic disturbance were increased age (>40 years, p<0.02) and preoperative aphasia (p<0.001).


CONCLUSIONS
Every attempt should be undertaken to preserve language-relevant areas intraoperatively, even when they are located within the tumor. New postoperative deficits resolve in the majority of patients, which may be a result of cortical mapping as well as functional reorganization.
Ilmberger
Josef
J
Department of Physical Medicine and Rehabilitation, Ludwig Maximilians University, Munich, Germany.
Ruge
Maximilian
M
Kreth
Friedrich-Wilhelm
FW
Briegel
Josef
J
Reulen
Hans-Juergen
HJ
Tonn
Joerg-Christian
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001037:Aphasia / Q000453:epidemiology; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000453:epidemiology / Q000601:surgery*; D003243:Consciousness; D003399:Craniotomy / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007802:Language; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D020557:Neurolinguistic Programming; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome