EFFECTS OF RESECTIVE SURGERY FOR LEFT-SIDED INTRACRANIAL TUMORS ON LANGUAGE FUNCTION - A PROSPECTIVE-STUDY

Background Although language disorders occur in about 50% of patients with a left hemispheric tumour and are a significant cause of morbidit y, the effects of resective neurosurgery and their relation to tumour pathology are unclear. We report the immediate effects of resective su rgery on language functions in a heterogeneous group of patients with left-sided intracranial tumours. Methods 40 patients were studied. The Western Aphasia Battery (WAB) and Boston Naming Test (BNT) were admin istered preoperatively and before discharge following resective neuros urgery. Dexamethasone dose at time of testing was recorded, as was tim e taken to complete the tests, and tumour neuropathology. Findings 15 patients with normal aphasia quotients and language quotients before r esective surgery all had normal quotients postoperatively. 25 who were dysphasic tie, aphasia quotient <93.8) preoperatively showed signific ant postoperative improvements in both their mean aphasia quotient (fr om 81.8 to 89.1, p=0.004) and their mean language quotient (from 73.4 to 85.4, p=0.001), though 13 remained dysphasic. Two of the 25 dysphas ic patients had their WAB scores lowered by tumour resection. The find ings and postoperative changes in BNT scores were almost identical to the pattern of those in WAB scores. At second assessment, dexamethason e therapy was significantly (p<0.01) lower than preoperative dose (red uction from mean 10.3 mg/day to 0.7 mg/day in the dysphasic group). Pa tients with glioblastoma were more likely to have lower aphasia quotie nts, language quotients, and BNT scores than patients with anaplastic glioma, metastasis, or meningioma, Although the glioblastoma group had the greatest improvements in WAB operative scores, 57% remained dysph asic after resective surgery. Two additional patients declined postope rative assessment. Interpretation Resective surgery for left-sided int racranial tumours significantly improves language function in dysphasi c patients, and is unlikely to impair language functions in non-dyspha sic patients. Dysphasia and its response to resective surgery are rela ted to the tumour neuropathology.