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Presurgical Language fMRI and Postsurgical Deficits: A Single Centre Experience

Published online by Cambridge University Press:  23 September 2014

Charmaine Wiens ,
Bradley G. Goodyear ,
Ankur Goel ,
Paolo Federico ,
Walter Hader  and
Mayank Goyal
Charmaine Wiens
Affiliation:
Departments of Radiology, University of Calgary, Calgary, Alberta, Canada
Bradley G. Goodyear*
Affiliation:
Departments of Radiology, University of Calgary, Calgary, Alberta, Canada Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Psychiatry, University of Calgary, Calgary, Alberta, Canada Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Ankur Goel
Affiliation:
Departments of Radiology, University of Calgary, Calgary, Alberta, Canada
Paolo Federico
Affiliation:
Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Walter Hader
Affiliation:
Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Mayank Goyal
Affiliation:
Departments of Radiology, University of Calgary, Calgary, Alberta, Canada Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada
*
Seaman Family MR Research Centre, Foothills Medical Centre/University of Calgary, 1403-29th Street NW, Calgary, Alberta, T2N 2T9, Canada. Email: goodyear@ucalgary.ca.
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Abstract

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Background:

In this study, we conducted a retrospective investigation of our initial single-centre experience with the clinical use of functional magnetic resonance imaging (fMRI) of hemisphere dominance for language processing (i.e., language lateralization). We demonstrated its association with surgical outcome and its potential impact on surgical planning and patient management.

Methods:

Fifty-two cases were reviewed, covering the period from July 2007 to July 2010. Clinical fMRI reports were examined to determine the hemisphere dominance for language processing. Neurological reports were examined to determine if new language deficits were present post-surgery. Neurosurgeon notes were also reviewed to determine if fMRI had an impact on surgical planning.

Results:

Of the cases reviewed, 49 (94%) generated conclusive fMRI. Eleven (22%) patients exhibited fMRI language lateralization contralateral to pathology; zero of nine of these patients that had surgery experienced post-surgical deficits. Twenty-two (44%) patients exhibited fMRI language lateralization ipsilateral to pathology; three of 13 of these patients that had surgery experienced post-surgical deficits. Sixteen (34%) patients exhibited bilateral lateralization of language; five of 13 of these patients that had surgery experienced post-surgery deficits. Several post-fMRI reports indicated that fMRI results had an impact on surgical planning.

Conclusions:

Our results suggest that fMRI demonstrations of language processing within the hemisphere ipsilateral to pathology (either ipsilateral alone or bilateral) is associated with a greater risk for post-surgical language deficits, and in these cases, fMRI results should be taken into consideration for pre-surgical planning.

Résumé

RÉSUMÉ Contexte:

Nous avons examiné rétrospectivement notre expérience initiale dans notre centre concernant l'utilisation en clinique de l'imagerie par résonance magnétique fonctionnelle (IRMf) de l'hémisphère dominant pour le traitement du langage (c.-à-d. sa latéralisation). Nous avons démontré son association avec le résultat chirurgical et son impact potentiel sur la planification de la chirurgie et le traitement du patient.

Méthode:

Les dossiers de 52 patients, traités entre juillet 2007 et juillet 2010, ont été examinés. Les rapports cliniques d'IRMf ont été examinés afin de déterminer quel était l'hémisphère dominant pour le traitement du langage chez le patient. Les rapports neurologiques ont été examinés pour déterminer s'il existait de nouveaux déficits langagiers après la chirurgie. Nous avons également examiné les notes du neurochirurgien pour déterminer si l'IRMf avait eu un impact sur la planification de la chirurgie.

Résultats:

Parmi les dossiers examinés, 49 (94%) contenaient un examen IRMf concluant. Onze patients (22%) avaient une latéralisation du langage contralatérale à la pathologie et aucun parmi neuf de ces patients qui ont subi une chirurgie n'a présenté de déficit postchirurgical. Vingt-deux patients (44%) avaient une latéralisation du langage ipsilatérale à la pathologie à l'IRMf. Trois parmi 13 des patients qui ont subi une chirurgie ont présenté des déficits postchirurgicaux. Plusieurs rapports post-IRMf indiquaient que les résultats de l'IRMf avaient eu un impact sur la planification de la chirurgie.

Conclusions:

Nos résultats suggèrent que la démonstration par IRMf que le centre du langage est dans l'hémisphère ipsilatéral par rapport à la pathologie (soit ipsilatéral seulement ou bilatéral) est associé à un risque plus élevé de déficit du langage et que dans ces cas, les résultats de l'IRMf devraient être pris en compte lors de la planification de la chirurgie.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 6 , November 2013 , pp. 819 - 823
Copyright
Copyright © The Canadian Journal of Neurological 2013

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