Temporal lobe (TL) epilepsy surgery is an effective treatment option for patients with drug-resistant epilepsy. However, neurosurgery poses a risk for cognitive deficits - up to one third of patients have a decline in naming ability following TL surgery. In this study, we aimed to better understand the neural correlates associated with reduced naming performance after TL surgery, with the goal of informing surgical planning strategies to mitigate the risk of dysnomia. We retrospectively identified 85 patients who underwent temporal lobe (TL) resective surgery (49 left TL, 36 right TL) for whom naming ability was assessed before and >3 months post-surgery using the Boston Naming Test (BNT). We used multivariate lesion-symptom mapping to identify resection sites associated with naming decline, and we used lesion-network mapping to evaluate the broader functional and structural connectivity profiles of resection sites associated with naming decline. We validated our findings in an independent cohort of 59 individuals with left temporal lobectomy, along with repeating all analyses after combining the cohorts. Lesion laterality and location were important predictors of post-surgical naming performance. Naming performance significantly improved after right temporal lobectomy (P = 0.015) while a decrement in performance was observed following left temporal lobectomy (P = 0.002). Declines in naming performance were associated with surgical resection of the left anterior middle temporal gyrus (Brodmann area 21, r =0.41, P = <.001), along with a previously implicated basal temporal language area. Resection sites linked to naming decline showed a functional connectivity profile featuring a left-lateralized network closely resembling the extended semantic \ default mode network, and a structural connectivity profile featuring major temporo-frontal association white matter tracts coursing through the temporal stem. This extends prior work by implicating the left anterior middle temporal gyrus in naming decline and provides additional support for the role of the previously identified basal temporal language area in naming decline. Importantly, the structural and functional connectivity profiles of these regions suggest they are key nodes of a broader extended semantic network. Together these regional and network findings may help in surgical planning and discussions of prognosis.

中文翻译：

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癫痫手术后命名障碍的病灶和病灶网络定位


颞叶 （TL） 癫痫手术是耐药性癫痫患者的有效治疗选择。然而，神经外科存在认知缺陷的风险——多达 1/3 的患者在 TL 手术后命名能力下降。在这项研究中，我们旨在更好地了解与 TL 手术后命名性能降低相关的神经相关性，目的是为手术计划策略提供信息，以降低失认症的风险。我们回顾性地确定了 85 例接受颞叶 （TL） 切除手术的患者 （49 例左 TL，36 例右 TL），他们在术前和术后 >3 个月使用波士顿命名测试 （BNT） 评估了命名能力。我们使用多变量病变-症状映射来识别与命名下降相关的切除部位，我们使用病变-网络映射来评估与命名下降相关的切除部位的更广泛的功能和结构连接概况。我们在 59 名接受左颞叶切除术的个体组成的独立队列中验证了我们的发现，并在合并队列后重复所有分析。病灶偏侧性和位置是术后命名性能的重要预测因子。右颞叶切除术后命名性能显着改善 （P = 0.015），而左颞叶切除术后观察到性能下降 （P = 0.002）。命名性能的下降与手术切除左前颞中回 （Brodmann 区 21，r =0.41，P = <.001） 以及先前涉及的基底颞叶区有关。 与命名下降相关的切除部位显示出功能连接性剖面，其特点是左侧化网络与扩展语义\默认模式网络非常相似，结构连接性剖面的特点是主要的颞额关联白质束穿过颞干。这扩展了之前的工作，将左前颞中回与命名衰退联系起来，并为先前确定的基础颞叶语言区在命名衰退中的作用提供了额外的支持。重要的是，这些区域的结构和功能连接概况表明它们是更广泛的扩展语义网络的关键节点。这些区域和网络发现共同可能有助于手术计划和预后讨论。