title: Speech preservation using a non-linear paradigm for determination of the extent of neocortical resection in patients with mesial temporal sclerosis submitted to cortico-amygdalo-hippocampectomy (CAH).
abstract: BACKGROUND
  The rationale for using a non-linear (proportional) paradigm for determining the extent of the neocortex to be removed in temporal lobe resection was based on anatomical and intra-operative cortical mapping findings. We present our results regarding speech preservation in patients submitted to CAH using the central artery as an anatomical landmark for determining the posterior border of neocortical resection.
  
  
  METHODS
  Two hundred and fifty consecutive right-handed patients with left unilateral mesial sclerosis were studied. All patients were submitted to CAH under general anesthesia and without intraoperative electrocorticography. The posterior border of the lateral neocortical resection was defined by a line perpendicular to the temporal axis at the level of the central artery.
  
  
  RESULTS
  Seven patients had transient (1-3 weeks; mean=9 days) receptive speech disturbance. There was no permanent speech deficit. Imaging documented edema or contusion at the posterior temporal cortical border in all patients who had transient speech deficits. The mean extent of cortical resection was 3.9 cm in adults and 3.1cm in kids.
  
  
  CONCLUSIONS
  This is the first report in the literature discussing the use of a non-linear paradigm to determine the extent of lateral neocortical removal in this patient population. We found no permanent speech disturbances in this series. The non-linear approach used in this series proved to be safe and effective to avoid post-operative speech disorders. It was able to compensate for different brain and head sizes, and allowed smaller neocortical removal when compared to traditional linear approaches.
authors: Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, SP, Brazil. acukiert@uol.com.br
authors: Arthur
authors: A
authors: Cukiert
authors: José Augusto
authors: JA
authors: Burattini
authors: Alessandra Moura
authors: AM
authors: Lima
authors: Cristine Mella
authors: CM
authors: Cukiert
authors: Meire
authors: M
authors: Argentoni-Baldochi
authors: Carla
authors: C
authors: Baise
authors: Cássio Roberto
authors: CR
authors: Forster
authors: Valeria Antakli
authors: VA
authors: Mello
mesh_terms: D000293:Adolescent; D000328:Adult; D000679:Amygdala / Q000473:pathology / Q000601:surgery*; D002648:Child; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000601:surgery*; D006624:Hippocampus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019579:Neocortex / Q000473:pathology / Q000601:surgery*; D017711:Nonlinear Dynamics; D012598:Sclerosis / Q000473:pathology / Q000601:surgery; D013060:Speech; D013064:Speech Disorders / Q000517:prevention & control; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery; D055815:Young Adult