title: Frontal operculum gliomas: language outcome following resection.
abstract: OBJECTIVE
  The dominant hemisphere frontal operculum may contain critical speech and language pathways, and due to these properties, patients with tumors of the opercular region may be at higher risk for postoperative speech dysfunction. However, the likelihood of incurring temporary or permanent language dysfunction is unknown.
  
  
  METHODS
  The authors retrospectively analyzed their cohort of patients with frontal gliomas to identify those tumors that predominantly involved the dominant frontal operculum. Each tumor was classified as involving the pars orbitalis, pars triangularis, pars opercularis, or a combination of some or all of these areas. The authors then identified and compared characteristics between those patients experiencing transient or permanent speech deficits, as opposed to those with no language dysfunction.
  
  
  RESULTS
  Forty-three patients were identified for inclusion in this analysis. Transient deficits occurred in 12 patients (27.9%), while 4 patients (9.8%) had persistent deficits involving language. Individuals with preoperative language deficits and patients with seizures characterized by speech dysfunction appear to be at the highest risk to develop a deficit (relative risks 3.09 and 1.75, respectively). No patient with a tumor involving the pars orbitalis experienced a persistent deficit.
  
  
  CONCLUSIONS
  Resection of gliomas is widely recognized as a critical element of improved outcome. Given the low rate of language morbidity reported in this group of patients, resection of gliomas within the dominant frontal operculum is well-tolerated with acceptable morbidity and, in this particular location, should not be a deterrent in the overall management of these tumors.
authors: Department of Neurological Surgery, and.
authors: John D
authors: JD
authors: Rolston
authors: Dario J
authors: DJ
authors: Englot
authors: Arnau
authors: A
authors: Benet
authors: Jing
authors: J
authors: Li
authors: Soonmee
authors: S
authors: Cha
authors: Mitchel S
authors: MS
authors: Berger
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005625:Frontal Lobe / Q000473:pathology / Q000601:surgery*; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007806:Language Disorders / Q000209:etiology* / Q000523:psychology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000523:psychology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: AF = arcuate fasciculus; Broca's area; CI = confidence interval; EOR = extent of resection; GTR = gross-total resection; MSI = magnetic source imaging; RR = risk ratio; SLF = superior longitudinal fasciculus; STR = subtotal resection; glioma; oncology; operculum; pars opercularis; pars triangularis
references: Trends Cogn Sci. 2012 Aug;16(8):418-26
references: 22763211
references: J Neurosci. 2009 Nov 18;29(46):14607-16
references: 19923293
references: J Neurosurg. 2010 Mar;112(3):528-38
references: 19681682
references: Top Stroke Rehabil. 2010 Nov-Dec;17(6):401-10
references: 21239364
references: Neuroimage. 2008 Oct 1;42(4):1499-507
references: 18603004
references: Neuron. 2009 Aug 27;63(4):508-22
references: 19709632
references: Neurosurgery. 1994 Apr;34(4):567-76; discussion 576
references: 7516498
references: Cortex. 2014 Sep;58:325-37
references: 24050218
references: J Neurosurg. 1990 Mar;72(3):383-7
references: 2303872
references: Brain. 2007 May;130(Pt 5):1432-41
references: 17405763
references: Stereotact Funct Neurosurg. 1992;58(1-4):153-61
references: 1439333
references: Brain. 2012 Dec;135(Pt 12):3529-50
references: 23107648
references: PLoS Biol. 2009 Aug;7(8):e1000170
references: 19668354
references: Trends Cogn Sci. 2005 Sep;9(9):416-23
references: 16054419
references: Ann Neurol. 2005 Jan;57(1):8-16
references: 15597383
references: Neurosurgery. 2006 Feb;58(1 Suppl):ONS36-43; discussion ONS36-43
references: 16479627
references: Neurosurg Clin N Am. 2011 Oct;22(4):425-42, v
references: 21939841
references: Neurosurg Clin N Am. 1990 Jan;1(1):65-80
references: 2135974
references: Arch Neurol. 1983 Nov;40(12):720-7
references: 6625983
references: J Anat. 2011 Oct;219(4):531-41
references: 21767263
references: Science. 1999 Mar 12;283(5408):1657-61
references: 10073923
references: Pol J Radiol. 2012 Jul;77(3):39-45
references: 23049580
references: Cortex. 2012 Jan;48(1):58-81
references: 21481342
references: Neurology. 1978 Apr;28(4):311-24
references: 565019
references: Neurology. 1990 Feb;40(2):353-62
references: 2300260
references: Physiol Rev. 2011 Oct;91(4):1357-92
references: 22013214
references: Handb Clin Neurol. 2013;116:39-54
references: 24112883
references: Behav Brain Sci. 2000 Feb;23(1):1-21; discussion 21-71
references: 11303337
references: Trends Cogn Sci. 2002 Feb 1;6(2):78-84
references: 15866191
references: J Neurosurg. 2003 Aug;99(2):311-8
references: 12924706
references: Neurocase. 2009 Aug;15(4):294-310
references: 19274574
references: N Engl J Med. 2008 Jan 3;358(1):18-27
references: 18172171
references: Neurology. 1978 Jun;28(6):545-51
references: 565884
references: Brain Lang. 1979 Jul;8(1):34-50
references: 476474