LANGUAGE DOMINANCE IN PATIENTS WITH EARLY-CHILDHOOD TUMORS NEAR LEFT-HEMISPHERE LANGUAGE AREAS

Rationale: Language function often develops in the right hemisphere fo llowing an acute left hemispheric insult in early childhood. Little is known, however, about lateralization of language function in patients with early childhood tumors near potential left hemisphere language a reas. Issues of language dominance are important in the strategy for r esection of left temporal and frontal tumors. Methods: We studied 12 p atients who had determination of hemispheric language dominance by the intracarotid amobarbital procedure prior to resection of a left infer olateral frontal or left mid or posterior temporal. tumor that (1) was : near a classic language area and (2) first manifested with partial s eizures by age 6 years (mean, 3.7). Results: Hemispheric language domi nance was left in 10 patients (83%), right in one patient, and bilater al in one patient. Six patients with left temporal tumors had localiza tion of Wernicke's area with cortical, stimulation, and in five the la nguage area was posterior to the tumor. In one patient, the tumor infi ltrated Wernicke's area. Eleven of the 12 patients had complete tumor resection (mean age at operation, 11.8 years) and were seizure-free at follow-up (mean, 3.1 years). Neuropsychological testing showed a tend ency for improved language function after operation, and no patient ha d new overt language deficits. Conclusions: Early low-grade left front al and temporal tumors usually did not result in transfer of language dominance to the contralateral hemisphere. Tumors may grow slowly alon g with the developing brain in young children, with continued left hem isphere language development in regions separate from the neoplasm. Su ccessful tumor resection can be accomplished, but it may require corti cal stimulation for localization and sparing of nearby language areas.