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Long-term stability of cortical language sites following resective epilepsy surgery

Published online by Cambridge University Press:  10 May 2018

Robert Matthew Gramer
Affiliation:
School of Medicine, Duke University, Durham, NC, USA;
Sandra Serafini
Affiliation:
Department of Neurosurgery, Duke University, Durham, NC, USA;
David Madigan
Affiliation:
Department of Statistics, Columbia University, New York, NY, USA;
Gerald Grant
Affiliation:
Department of Neurosurgery, Stanford University, Stanford, NY, USA;
George Ojemann
Affiliation:
Department of Neurosurgery, University of Washington, Seattle, WA, USA
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Abstract

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BACKGROUND: Of the ~50 million cases of epilepsy worldwide, an estimated 80% originate from cortical areas implicated in language. Although the precise language loci can vary significantly across individuals, electrical stimulation mapping for eloquent areas has become standard of care in resective surgery for frontotemporal epilepsies. Although considerable work has been done to establish the minimum necessary resection distance from these sites to preserve language, no previous work has shown how these representations are affected by proximal resections. METHODS: Between 1967 and 2005, 22 patients [seizure onset (y): 11.5 (0.2–33); age at initial resection (y): 27.7 (10–39); time between operations (y): 8.4 (1–20.3); sex: 14 females; hemisphere: 21 left] underwent repeated perisylvian resective epilepsy surgeries of the language-dominant hemisphere. Each set of operations comprised intraoperative language mapping and cortical photographs. Using this data, a Bayesian hierarchical model was used to estimate the variability of language localization pre-resection Versus post-resection. RESULTS: The statistical model shows the posterior median difference in cortical location of language sites preresection Versus postresection is 0.6 cm, with a posterior 95% CI of 0.4 cm, 0.9 cm. CONCLUSION: This work suggests permanence in cortical language centers following resection of infringing cortex, while providing a reasonable statistical method to impute unobserved sites during the mappings, and confirming the validity of using proximity sites defined by shortest distance in the current literature.

Type
Outcomes Research/Health Services Research/Comparative Effectiveness
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Association for Clinical and Translational Science 2018