Visual confrontation naming outcome after standard left anterior temporal lobectomy with sparing versus resection of the superior temporal gyrus: A randomized prospective clinical trial

Purpose: Intraoperative mapping of eloquent cortex during left (speech domi nant) anterior temporal lobectomy has shown a significant proportion of pat ients to have sites on the anterior superior temporal gyrus at which visual confrontation naming can be disrupted by electrical stimulation. The purpo se of this investigation was to conduct a randomized clinical trial to dete rmine whether sparing versus resection of the superior temporal gyrus affec ted visual confrontation naming outcome after standard left anterior tempor al lobectomy. Also examined was the degree to which inherent patient charac teristics were associated with language outcome regardless of surgical tech nique. Methods: Thirty patients with intractable left temporal lobe epilepsy under going standard anterior temporal lobectomy were randomized in regard to whe ther the superior temporal gyrus was resected or spared. Patients were test ed preoperatively and 6-8 months postoperatively by using two conventional tests of visual confrontation naming ability. Results: No significant differences were found between the groups in either confrontation naming or surgical outcome. Postoperative decline in nominal speech was most closely associated with later age at onset of epilepsy/abs ence of hippocampal sclerosis. Conclusions: It appears that specific types of localization-related tempora l lobe epilepsy are more closely associated with the risk of adverse langua ge outcome after anterior temporal lobectomy than with the surgical variati ons investigated in this study.