Multimodality Language Mapping Using Cortical Stimulation in Paediatric Patients With Epilepsy

Abstract

Abstract INTRODUCTION Pediatric patients with epilepsy often undergo language mapping using electrical cortical stimulation. Previous studies have shown general localization of auditory naming in the anterior temporal lobe and visual naming in the posterior parietal and temporal lobe. No probabilistic map exists, however, that quantifiably details the location of the different language modalities for pediatric patients with epilepsy. METHODS A series of 41 consecutive pediatric patients underwent cortical language mapping (24 female; range 5.2-18.5 yr; mean age 13.8 yr), either extraoperative (n = 34) or intraoperative (n = 7), prior to epileptic focus resection. The exact location of where an error occurred was recorded and transposed on a cortical parcellation system. Statistical analysis used a binomial one sided exact test with a cut off set at 60%. RESULTS Results show an increased range of sites for both visual and auditory naming as compared to adults. Cortical stimulation language testing was conducted 2102 times; 1201 visual and 901 auditory. Visual naming sites extended into the anterior temporal lobe. Auditory naming sites extended from the anterior temporal lobe to the middle temporal and posterior temporal gyrus. CONCLUSION The anterior temporal lobe is a commonly resected region, often felt to be of minimal risk. Knowledge of how these 2 language modalities extend into the temporal lobe in addition to how they differ from adults provides insight into which areas are safe to resect and which areas to spare during pediatric epilepsy surgery.