Abstracts

RATIONALE: While reports of aphasia following left temporal lobectomy (LTL) are rare, deterioration in confrontation naming performance and other subtle language functions are frequently described. We report language outcome in LTL patients who have undergone cortical language mapping with subdural electrode array (SEA). METHODS: 40 adult patients underwent LTL guided by functional cortical mapping with SEA. All were confirmed left hemisphere dominant for speech and language by intracarotid amytal procedure (IAP). All underwent comprehensive pre- and post-operative neuropsychological assessment that included measures of language functions such as verbal processing, verbal fluency, confrontation naming and digit memory. RESULTS: There were no statistically significant differences in pre- to post-operative change scores on any language measures for the group as a whole, however, clinically significant language decline did occur in some patients. On measures of verbal processing (WAIS-R, WAIS-III subtests) and verbal fluency, clinically significant decline was evident in only 11% of cases. Digit memory was reduced in 13%. The most significant clinical decline occurred in confrontation naming with 34% (14 patients) demonstrating post-operative deterioration. 74% of patients achieved Engel's Class I outcome. An additional 17% achieved Engel's Class II outcome for a total of 91% who evidenced significant improvement in seizure control. CONCLUSIONS: In 40 patients who underwent mapping of language areas prior to dominant LTL, post-operative language deficits were minimal while seizure outcome was optimal. Results will be discussed in relation to outcome trends and extent of cortical resection.