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Game-changing, or business as usual?

Why is it that naming skills decline in so many patients after left temporal lobe resection for epilepsy? More importantly, why do naming skills decline even when language mapping allows surgeons to spare cortical zones identified as critical for naming? On average, patients who undergo left temporal lobe resection face a 30% to 50% risk of significant postoperative decline in naming, whether or not language mapping is employed.1,2

Over the last decade, Hamberger and colleagues' impressive studies have contributed to our understanding of temporal lobe organization of language, cognitive effects of epilepsy surgery, and optimum methods for language mapping in surgical patients. Their primary line of inquiry involves auditory naming, assessed by having patients provide the word corresponding to a verbal description (“The yellow part of an egg”). In contrast, visual naming involves providing the name for a pictured object. The idea is that auditory naming is a closer analog than visual naming to the word-finding problems that patients encounter in everyday life. These authors found that auditory naming tends to cluster anteriorly in the left temporal lobe. This should render auditory naming more vulnerable to temporal lobectomy than visual naming, which tends to be located more …