Predicting language outcome after left hemisperotomy: A systematic literature review

Objective:Hemi-decortication 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 prior to surgery. A systematic overview of potential predictors of language outcome after left hemi-decortication in children is warranted.Methods:In a systematic literature review, we analysed 58 studies on language lateralization after congenital or post-neonatally acquired left-hemispheric pathology, and on language outcome after left-sided hemi-disconnection, such as hemispherotomy. Single-subject data was pooled to determine the distribution of lateralization across aetiologies in congenital lesions and across age groups in acute post-neonatal lesions. A hierarchical linear regression assessed the influence of age at surgery, lesion type, age at seizure onset, and pre-surgery language function on language outcome after left hemi-decortication.Results:(1) In acute post-neonatal lesions, younger age at injury was significantly associated with right-sided language lateralization (Cramér’s V = .458; p = .039). (2) In patients with hemi-decortication, age at surgery was not significantly associated with language outcome (Cramér’s V = -.056; p = .584). Pre-surgical language function was the most powerful predictor for post-surgical language outcome (F4,47 = 7.35, p < .0001), with good pre-surgical language bearing the risk of post-surgical deterioration. (3) In congenital pathology, right-sided language lateralization was most frequent in pre-/perinatal stroke (Cramér’s V = .357; p < .0001).Conclusions:We propose a pre-surgical decision algorithm with age, pre-surgical language function, language lateralization and left-hemispheric structural pathology as decision points regarding surgery.

Selective lesion of the hippocampus increases the differentiation of immature neurons in the monkey amygdala

A large population of immature neurons is present in the ventromedial portion of the adult primate amygdala, a region that receives substantial direct projections from the hippocampal formation. Here, we show the effects of neonatal (n = 8) and adult (n = 6) hippocampal lesions on the populations of mature and immature neurons in the paralaminar, lateral, and basal nuclei of the adult monkey amygdala. Compared with unoperated controls (n = 7), the number of mature neurons was about 70% higher in the paralaminar nucleus of neonate- and adult-lesioned monkeys, and 40% higher in the lateral and basal nuclei of neonate-lesioned monkeys. The number of immature neurons in the paralaminar nucleus was 40% higher in neonate-lesioned monkeys and 30% lower in adult-lesioned monkeys. Similar changes in neuron numbers were also found in two monkeys with nonexperimental, selective, bilateral hippocampal damage. These changes in neuron numbers following hippocampal lesions appear to reflect the differentiation of immature neurons present in the paralaminar nucleus. After adult lesions, the differentiation of immature neurons was essentially restricted to the paralaminar nucleus and was associated with a decrease in the population of immature neurons. In contrast, after neonatal lesions, the differentiation of immature neurons involved the paralaminar, lateral, and basal nuclei. It was associated with an increase in the population of immature neurons in the paralaminar nucleus. Such lesion-induced neuronal plasticity sheds new light on potential mechanisms that may facilitate functional recovery following focal brain injury.

Diagnosis and management of congenital epulis of new-born: a rare case report and literature review

<p class="abstract">The congenital epulis of new-born is a rare disease of idiopathic etiology and lineage. The literature recorded spontaneous regression of some cases. This finding rendered skeptical questions about its neoplastic nature and posed some speculations about hormonal influences, towards the end of pregnancy, on the growth of the lesion. No malignant potential has been ever reported. Surgery is indicated if the lesion grossly interferes with breast feeding. This paper reports an established diagnosis of congenital epulis of new-born, which was excised surgically with no evidence of recurrence hitherto. </p><p><strong>Keywords: </strong>Congenital epulis, Neonatal lesions, Mucosal swellings, Pediatric oncology</p>