title: Transient aphasias after left hemisphere resective surgery.
abstract: OBJECTIVE
  Transient aphasias are often observed in the first few days after a patient has undergone resection in the language-dominant hemisphere. The aims of this prospective study were to characterize the incidence and nature of these aphasias and to determine whether there are relationships between location of the surgical site and deficits in specific language domains.
  
  
  METHODS
  One hundred ten patients undergoing resection to the language-dominant hemisphere participated in the study. Language was evaluated prior to surgery and 2-3 days and 1 month postsurgery using the Western Aphasia Battery and the Boston Naming Test. Voxel-based lesion-symptom mapping was used to identify relationships between the surgical site location assessed on MRI and deficits in fluency, information content, comprehension, repetition, and naming.
  
  
  RESULTS
  Seventy-one percent of patients were classified as aphasic based on the Western Aphasia Battery 2-3 days postsurgery, with deficits observed in each of the language domains examined. Fluency deficits were associated with resection of the precentral gyrus and adjacent inferior frontal cortex. Reduced information content of spoken output was associated with resection of the ventral precentral gyrus and posterior inferior frontal gyrus (pars opercularis). Repetition deficits were associated with resection of the posterior superior temporal gyrus. Naming deficits were associated with resection of the ventral temporal cortex, with midtemporal and posterior temporal damage more predictive of naming deficits than anterior temporal damage. By 1 month postsurgery, nearly all language deficits were resolved, and no language measure except for naming differed significantly from its presurgical level.
  
  
  CONCLUSIONS
  These findings show that transient aphasias are very common after left hemisphere resective surgery and that the precise nature of the aphasia depends on the specific location of the surgical site. The patient cohort in this study provides a unique window into the neural basis of language because resections are discrete, their locations are not limited by vascular distribution or patterns of neurodegeneration, and language can be studied prior to substantial reorganization.
authors.affiliation: Departments of 1 Speech, Language, and Hearing Sciences and.|Neurology, University of Arizona, Tucson, Arizona; and 
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Wilson
authors.affiliation: Departments of 3 Neurological Surgery.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lam
authors.affiliation: Departments of 3 Neurological Surgery.
authors.forename: Miranda C
authors.initials: MC
authors.lastname: Babiak
authors.affiliation: Departments of 3 Neurological Surgery.
authors.forename: David W
authors.initials: DW
authors.lastname: Perry
authors.affiliation: Neurology, and.|UCSF Epilepsy Center, University of California, San Francisco, California.
authors.forename: Tina
authors.initials: T
authors.lastname: Shih
authors.affiliation: Neurology, and.|Radiology and.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Hess
authors.affiliation: Departments of 3 Neurological Surgery.
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.affiliation: Departments of 3 Neurological Surgery.|UCSF Epilepsy Center, University of California, San Francisco, California.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000209:etiology*; D001921:Brain / Q000601:surgery*; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000601:surgery; D004827:Epilepsy / Q000601:surgery; D005260:Female; D007839:Functional Laterality; D005910:Glioma / Q000601:surgery; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011446:Prospective Studies; D055815:Young Adult
keywords: ADC = apparent diffusion coefficient; AQ = Aphasia Quotient; BNT = Boston Naming Test; BTLA = basal temporal language area; DWI = diffusion-weighted imaging; MNI = Montreal Neurological Institute; ROI = region of interest; VLSM = voxel-based lesion-symptom mapping; WAB = Western Aphasia Battery; aphasia; resective surgery; voxel-based lesion-symptom mapping