Frontal operculum gliomas: language outcome following resection

Abstract

OBJECT The dominant hemisphere frontal operculum may contain critical speech and language pathways, and due to these properties, patients with tumors of the opercular region may be at higher risk for postoperative speech dysfunction. However, the likelihood of incurring temporary or permanent language dysfunction is unknown. METHODS The authors retrospectively analyzed their cohort of patients with frontal gliomas to identify those tumors that predominantly involved the dominant frontal operculum. Each tumor was classified as involving the pars orbitalis, pars triangularis, pars opercularis, or a combination of some or all of these areas. The authors then identified and compared characteristics between those patients experiencing transient or permanent speech deficits, as opposed to those with no language dysfunction. RESULTS Forty-three patients were identified for inclusion in this analysis. Transient deficits occurred in 12 patients (27.9%), while 4 patients (9.8%) had persistent deficits involving language. Individuals with preoperative language deficits and patients with seizures characterized by speech dysfunction appear to be at the highest risk to develop a deficit (relative risks 3.09 and 1.75, respectively). No patient with a tumor involving the pars orbitalis experienced a persistent deficit. CONCLUSIONS Resection of gliomas is widely recognized as a critical element of improved outcome. Given the low rate of language morbidity reported in this group of patients, resection of gliomas within the dominant frontal operculum is well-tolerated with acceptable morbidity and, in this particular location, should not be a deterrent in the overall management of these tumors.

Stereotactic probability and variability of speech arrest and anomia sites during stimulation mapping of the language dominant hemisphere

“…9 The variability and plasticity of the frontal operculum has also recently been highlighted by our recent work, which demonstrated only a 2.9% chance of new speech deficits after tumor resection in this area. 16 Taken together, these results support the assertion that the classic model of speech has little predictive value for these patients and underscores the importance of tailoring surgical plans to individual patients. 12 There are certainly limitations to the present study that deserve mention.…”

Inhibition of Manual Movements at Speech Arrest Sites in the Posterior Inferior Frontal Lobe

“…A strong body of empiric data shows that postoperative aphasia can be avoided if speech arrest areas are preserved, making the distinction seem trivial in current clinical practice. 8,[37][38][39] However, the observation that there are 2 types of IFL speech arrest sites-one that is speechspecific, and another that is nonspecific-leads to a clinically important question: are both of these sites essential to language function? In previous studies, resection of nonspeech NMAs has caused only transient clumsiness and no permanent motor deficits, although postoperative testing of action inhibition was not reported.…”

The transsylvian approach for resection of insular gliomas: technical nuances of splitting the Sylvian fissure

“…Intraoperative motor or speech/language mapping are used to identify safe areas for resection. Then, with the additional benefits as minimizing potential injury to the superior longitudinal fasciculus (SLF), a critical connection between anterior and posterior language areas, however resection of gliomas within the dominant frontal operculum is well-tolerated with acceptabile morbidity [37].…”