Transient aphasias after left hemisphere resective surgery.
Transient aphasias after left hemisphere resective surgery.
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DOI：
10.3171/2015.4.jns141962
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发表时间：
2015-09
影响因子：
4.1
通讯作者：
Chang EF
中科院分区：
文献类型：
--
作者：
Wilson SM;Lam D;Babiak MC;Perry DW;Shih T;Hess CP;Berger MS;Chang EF
在语言占主导地位的半球接受手术切除的患者，通常在最初几天观察到一过性失语。这项前瞻性研究的目的是确定这些失语症的发生率和性质，并确定手术部位的位置与特定语言领域的缺陷之间是否存在关系。110名接受语言优势半球切除的患者参与了这项研究。采用西方失语症成套测验和波士顿命名测验对患者手术前、术后2-3天和术后1个月的语言进行评估。使用基于体素的病变-症状映射来确定MRI评估的手术部位位置与流利性、信息内容、理解力、重复和命名缺陷之间的关系。71%的患者在术后2-3天根据西方失语症成套测验被分类为失语症，并观察到每个语言领域的缺陷。流畅性障碍与切除中央前回和邻近的额叶下部皮质有关。言语输出的信息量减少与切除腹侧中央前回和额叶后下回(盖部)有关。重复缺陷与切除后上回有关。命名缺陷与切除前颞叶皮质有关，与前颞叶损伤相比，中、后颞叶损伤更能预测命名缺陷。到术后1个月，几乎所有的语言障碍都被解决了，除了命名外，没有任何语言测试与手术前有显著差异。这些发现表明，左半球切除手术后，短暂性失语症非常常见，失语症的确切性质取决于手术部位的具体位置。这一患者队列为语言的神经基础提供了一个独特的窗口，因为手术切除是离散的，其位置不受血管分布或神经变性模式的限制，并且语言可以在实质性重组之前进行研究。
Transient aphasias are often observed in the first few days in patients who undergo surgical 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. 110 patients undergoing resection to the language-dominant hemisphere participated in the study. Patients’ language was evaluated prior to surgery, 2-3 days post-surgery, and 1 month post-surgery using the Western Aphasia Battery and the Boston Naming Test. Voxel-based lesion-symptom mapping was used to identify relationships between the location of the surgical site assessed by MRI, and deficits in fluency, information content, comprehension, repetition, and naming. 71% of patients were classified as aphasic based on the Western Aphasia Battery 2-3 days post-surgery, 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 ventral temporal cortex, with mid temporal and posterior temporal damage more predictive of naming deficits than anterior temporal damage. By 1 month post-surgery, nearly all language deficits were resolved, and no language measure except for naming differed significantly from pre-surgical levels. 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. This patient cohort provides a unique window on the neural basis of language, since surgical resections are discrete, their locations are not limited by vascular distribution or patterns of neurodegeneration, and language can be studied prior to substantial reorganization.