Use of preoperative functional neuroimaging to predict language deficits from epilepsy surgery

TLDR

Left anterior temporal lobectomy can lead to confrontation naming deficits. The study aimed to determine whether preoperative fMRI can predict naming deficits in epilepsy patients undergoing left anterior temporal lobectomy. Twenty‑four patients underwent preoperative fMRI language mapping, Wada testing for language dominance, and pre‑ and post‑operative neuropsychological assessments, with fMRI laterality indices used to analyze associations with naming outcomes. Both fMRI laterality indices and Wada testing predicted naming decline, with fMRI achieving 100 % sensitivity and 73 % specificity, outperforming age at seizure onset and preoperative naming performance.

Abstract

<b><i>Background:</i></b> Left anterior temporal lobectomy (L-ATL) may be complicated by confrontation naming deficits. <b><i>Objective: </i></b> To determine whether preoperative fMRI predicts such deficits in patients with epilepsy undergoing L-ATL. <b><i>Methods:</i></b> Twenty-four patients with L-ATL underwent preoperative language mapping with fMRI, preoperative intracarotid amobarbital (Wada) testing for language dominance, and pre- and postoperative neuropsychological testing. fMRI laterality indexes (LIs), reflecting the interhemispheric difference between activated volumes in left and right homologous regions of interest, were calculated for each patient. Relationships between the fMRI LI, Wada language dominance, and naming outcome were examined. <b><i>Results:</i></b> Both the fMRI LI (<i>p</i> &lt; 0.001) and the Wada test (<i>p</i> &lt; 0.05) were predictive of naming outcome. fMRI showed 100% sensitivity and 73% specificity in predicting significant naming decline. Both fMRI and the Wada test were more predictive than age at seizure onset or preoperative naming performance. <b><i>Conclusions:</i></b> Preoperative fMRI predicted naming decline in patients undergoing left anterior temporal lobectomy surgery.