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April 2021; 11 (2) Review

Predicting Language Outcome After Left Hemispherotomy

A Systematic Literature Review

Karen Lidzba, Sarah E. Bürki, Martin Staudt
First published May 6, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000000852
Karen Lidzba
Department of Pediatric Neurology and Developmental Medicine (KL, MS), University Children's Hospital Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation (MS), Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Pediatric Neurology (KL), Inselspital University Children's Hospital, University of Bern, Switzerland; and Department of Neuropediatrics (SEB), University Children's Hospital Zurich, Switzerland.
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Sarah E. Bürki
Department of Pediatric Neurology and Developmental Medicine (KL, MS), University Children's Hospital Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation (MS), Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Pediatric Neurology (KL), Inselspital University Children's Hospital, University of Bern, Switzerland; and Department of Neuropediatrics (SEB), University Children's Hospital Zurich, Switzerland.
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Martin Staudt
Department of Pediatric Neurology and Developmental Medicine (KL, MS), University Children's Hospital Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation (MS), Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Pediatric Neurology (KL), Inselspital University Children's Hospital, University of Bern, Switzerland; and Department of Neuropediatrics (SEB), University Children's Hospital Zurich, Switzerland.
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Predicting Language Outcome After Left Hemispherotomy
A Systematic Literature Review
Karen Lidzba, Sarah E. Bürki, Martin Staudt
Neurol Clin Pract Apr 2021, 11 (2) 158-166; DOI: 10.1212/CPJ.0000000000000852

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Abstract

Objective Hemidecortication is a therapeutic option in patients with drug-resistant structural epilepsy. If surgery is performed early enough in left-hemispheric pathology, the plasticity of the developing brain may enable the right hemisphere to take over language—if this has not occurred before surgery. A systematic overview of potential predictors of language outcome after left hemidecortication in children is warranted.

Methods In a systematic literature review, we analyzed 58 studies on language lateralization after congenital or postneonatally acquired left-hemispheric pathology, and on language outcome after left-sided hemidisconnection, such as hemispherotomy. Single-subject data were pooled to determine the distribution of lateralization across etiologies in congenital lesions and across age groups in acute postneonatal lesions. A hierarchical linear regression assessed the influence of age at surgery, lesion type, age at seizure onset, and presurgery language function on language outcome after left hemidecortication.

Results In acute postneonatal lesions, younger age at injury was significantly associated with right-sided language lateralization (Cramér V = 0.458; p = 0.039). In patients with hemidecortication, age at surgery was not significantly associated with language outcome (Cramér V = −0.056; p = 0.584). Presurgical language function was the most powerful predictor for postsurgical language outcome (F4,47 = 7.35, p < 0.0001), with good presurgical language bearing the risk of postsurgical deterioration. In congenital pathology, right-sided language lateralization was most frequent in pre-/perinatal stroke (Cramér V = 0.357; p < 0.0001).

Conclusions We propose a presurgical decision algorithm with age, presurgical language function, language lateralization, and left-hemispheric structural pathology as decision points regarding surgery.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received August 12, 2019.
  • Accepted February 28, 2020.
  • © 2020 American Academy of Neurology
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