Category Naming Effects during Intraoperative Language Mapping

OBJECTIVENavigated transcranial magnetic stimulation (nTMS) in combination with diffusion tensor imaging fiber tracking (DTI FT) is increasingly used to locate subcortical language-related pathways. The aim of this study was to establish nTMS-based DTI FT for preoperative risk stratification by evaluating associations between lesion-to-tract distances (LTDs) and aphasia and by determining a cut-off LTD value to prevent surgery-related permanent aphasia.METHODSFifty patients with left-hemispheric, language-eloquent brain tumors underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by tumor resection. nTMS-based DTI FT was performed with a predefined fractional anisotropy (FA) of 0.10, 0.15, 50% of the individual FA threshold (FAT), and 75% FAT (minimum fiber length [FL]: 100 mm). The arcuate fascicle (AF), superior longitudinal fascicle (SLF), inferior longitudinal fascicle (ILF), uncinate fascicle (UC), and frontooccipital fascicle (FoF) were identified in nTMS-based tractography, and minimum LTDs were measured between the lesion and the AF and between the lesion and the closest other subcortical language-related pathway (SLF, ILF, UC, or FoF). LTDs were then associated with the level of aphasia (no/transient or permanent surgery-related aphasia, according to follow-up examinations).RESULTSA significant difference in LTDs was observed between patients with no or only surgery-related transient impairment and those who developed surgery-related permanent aphasia with regard to the AF (FA = 0.10, p = 0.0321; FA = 0.15, p = 0.0143; FA = 50% FAT, p = 0.0106) as well as the closest other subcortical language-related pathway (FA = 0.10, p = 0.0182; FA = 0.15, p = 0.0200; FA = 50% FAT, p = 0.0077). Patients with surgery-related permanent aphasia showed the lowest LTDs in relation to these tracts. Thus, LTDs of ≥ 8 mm (AF) and ≥ 11 mm (SLF, ILF, UC, or FoF) were determined as cut-off values for surgery-related permanent aphasia.CONCLUSIONSnTMS-based DTI FT of subcortical language-related pathways seems suitable for risk stratification and prediction in patients suffering from language-eloquent brain tumors. Thus, the current role of nTMS-based DTI FT might be expanded, going beyond the level of being a mere tool for surgical planning and resection guidance.

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A Novel Language Paradigm for Intraoperative Language Mapping: Feasibility and Evaluation

Journal of Clinical Medicine ◽

10.3390/jcm10040655 ◽

2021 ◽

Vol 10 (4) ◽

pp. 655

Author(s):

Katharina Rosengarth ◽

Delin Pai ◽

Frank Dodoo-Schittko ◽

Katharina Hense ◽

Teele Tamm ◽

...

Keyword(s):

Healthy Subjects ◽

Intraoperative Complications ◽

Evaluation Study ◽

Awake Craniotomy ◽

Language Mapping ◽

Tumor Patients ◽

Language Functions ◽

Before And After ◽

Assessment Time ◽

Neuropsychological Outcomes

(1) Background—Mapping language using direct cortical stimulation (DCS) during an awake craniotomy is difficult without using more than one language paradigm that particularly follows the demand of DCS by not exceeding the assessment time of 4 s to prevent intraoperative complications. We designed an intraoperative language paradigm by combining classical picture naming and verb generation, which safely engaged highly relevant language functions. (2) Methods—An evaluation study investigated whether a single trial of the language task could be performed in less than 4 s in 30 healthy subjects and whether the suggested language paradigm sufficiently pictured the cortical language network using functional magnetic resonance imaging (fMRI) in 12 healthy subjects. In a feasibility study, 24 brain tumor patients conducted the language task during an awake craniotomy. The patients’ neuropsychological outcomes were monitored before and after surgery. (3) Results—The fMRI results in healthy subjects showed activations in a language-associated network around the (left) sylvian fissure. Single language trials could be performed within 4 s. Intraoperatively, all tumor patients showed DCS-induced language errors while conducting the novel language task. Postoperatively, mild neuropsychological impairments appeared compared to the presurgical assessment. (4) Conclusions—These data support the use of a novel language paradigm that safely monitors highly relevant language functions intraoperatively, which can consequently minimize negative postoperative neuropsychological outcomes.

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Language mapping functions: Improving softmax estimation and word embedding quality

Concurrency and Computation Practice and Experience ◽

10.1002/cpe.6464 ◽

2021 ◽

Author(s):

Emad Rangriz ◽

Vahid Pourahmadi

Keyword(s):

Word Embedding ◽

Language Mapping ◽

Mapping Functions

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LANGUAGE REORGANIZATION IN APHASICS

Neurosurgery ◽

10.1227/01.neu.0000324725.84854.04 ◽

2008 ◽

Vol 63 (3) ◽

pp. 487-497 ◽

Cited By ~ 15

Author(s):

Timothy H. Lucas ◽

Daniel L. Drane ◽

Carl B. Dodrill ◽

George A. Ojemann

Keyword(s):

Brain Injury ◽

Temporal Lobe ◽

Intractable Epilepsy ◽

Cortical Lesions ◽

Language Mapping ◽

Neurosurgical Planning ◽

Anatomic Distribution ◽

And Performance ◽

And Control ◽

Language Profiles

ABSTRACT OBJECTIVE The purpose of this investigation was to determine whether clinical speech deficits after brain injury are associated with functional speech reorganization. METHODS Across an 18-year interval, 11 patients with mild-to-moderate speech deficits underwent language mapping as part of their treatment for intractable epilepsy. These “aphasics” were compared with 14 matched “control” patients with normal speech who also were undergoing epilepsy surgery. Neuroanatomic data were compared with quantitative language profiles and clinical variables. RESULTS Cortical lesions were evident near speech areas in all aphasia cases. As expected, aphasic and control patients were distinguished by quantitative language profiles. The groups were further distinguished by the anatomic distribution of their speech sites. A significantly greater proportion of frontal speech sites was found in patients with previous brain injury, consistent with frontal site recruitment. The degree of frontal recruitment varied as a function of patient age at the time of initial brain injury; earlier injuries were associated with greater recruitment. The overall number of speech sites remained the same after injury. Significant associations were found between the number of the speech sites, naming fluency, and the lesion proximity in the temporal lobe. CONCLUSION Language maps in aphasics demonstrated evidence for age-dependent functional recruitment in the frontal, but not temporal, lobe. The proximity of cortical lesions to temporal speech sites predicted the overall extent of temporal lobe speech representation and performance on naming fluency. These findings have implications for neurosurgical planning in patients with preoperative speech deficits.

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Impairment of preoperative language mapping by lesion location: a functional magnetic resonance imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation study

Journal of Neurosurgery ◽

10.3171/2014.10.jns141582 ◽

2015 ◽

Vol 123 (2) ◽

pp. 314-324 ◽

Cited By ~ 42

Author(s):

Sebastian Ille ◽

Nico Sollmann ◽

Theresa Hauck ◽

Stefanie Maurer ◽

Noriko Tanigawa ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Positive Predictive Value ◽

Predictive Value ◽

Magnetic Stimulation ◽

Cortical Stimulation ◽

Awake Surgery ◽

Navigated Transcranial Magnetic Stimulation ◽

Language Mapping ◽

Direct Cortical Stimulation ◽

Neurosurgical Patients

OBJECT Language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) is increasingly used and has already replaced functional MRI (fMRI) in some institutions for preoperative mapping of neurosurgical patients. Yet some factors affect the concordance of both methods with direct cortical stimulation (DCS), most likely by lesions affecting cortical oxygenation levels. Therefore, the impairment of the accuracy of rTMS and fMRI was analyzed and compared with DCS during awake surgery in patients with intraparenchymal lesions. METHODS Language mapping was performed by DCS, rTMS, and fMRI using an object-naming task in 27 patients with left-sided perisylvian lesions, and the induced language errors of each method were assigned to the cortical parcellation system. Subsequently, the receiver operating characteristics were calculated for rTMS and fMRI and compared with DCS as ground truth for regions with (w/) and without (w/o) the lesion in the mapped regions. RESULTS The w/ subgroup revealed a sensitivity of 100% (w/o 100%), a specificity of 8% (w/o 5%), a positive predictive value of 34% (w/o: 53%), and a negative predictive value (NPV) of 100% (w/o: 100%) for the comparison of rTMS versus DCS. Findings for the comparison of fMRI versus DCS within the w/ subgroup revealed a sensitivity of 32% (w/o: 62%), a specificity of 88% (w/o: 60%), a positive predictive value of 56% (w/o: 62%), and a NPV of 73% (w/o: 60%). CONCLUSIONS Although strengths and weaknesses exist for both rTMS and fMRI, the results show that rTMS is less affected by a brain lesion than fMRI, especially when performing mapping of language-negative cortical regions based on sensitivity and NPV.

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Stereoelectroencephalographic language mapping of the basal temporal cortex predicts postoperative naming outcome

Journal of Neurosurgery ◽

10.3171/2020.8.jns202431 ◽

2021 ◽

pp. 1-11

Author(s):

Chifaou Abdallah ◽

Hélène Brissart ◽

Sophie Colnat-Coulbois ◽

Ludovic Pierson ◽

Olivier Aron ◽

...

Keyword(s):

Temporal Lobe ◽

Verbal Fluency ◽

Temporal Cortex ◽

Visual Object ◽

Drug Resistant ◽

Language Mapping ◽

Individual Level ◽

Language Outcome ◽

Temporal Lobe Resection ◽

The Individual

OBJECTIVEIn drug-resistant temporal lobe epilepsy (TLE) patients, the authors evaluated early and late outcomes for decline in visual object naming after dominant temporal lobe resection (TLR) according to the resection status of the basal temporal language area (BTLA) identified by cortical stimulation during stereoelectroencephalography (SEEG).METHODSTwenty patients who underwent SEEG for drug-resistant TLE met the inclusion criteria. During language mapping, a site was considered positive when stimulation of two contiguous contacts elicited at least one naming impairment during two remote sessions. After TLR ipsilateral to their BTLA, patients were classified as BTLA+ when at least one positive language site was resected and as BTLA− when all positive language sites were preserved. Outcomes in naming and verbal fluency tests were assessed using pre- and postoperative (means of 7 and 25 months after surgery) scores at the group level and reliable change indices (RCIs) for clinically meaningful changes at the individual level.RESULTSBTLA+ patients (n = 7) had significantly worse naming scores than BTLA− patients (n = 13) within 1 year after surgery but not at the long-term evaluation. No difference in verbal fluency tests was observed. When RCIs were used, 5 of 18 patients (28%) had naming decline within 1 year postoperatively (corresponding to 57% of BTLA+ and 9% of BTLA− patients). A significant correlation was found between BTLA resection and naming decline.CONCLUSIONSBTLA resection is associated with a specific and early naming decline. Even if this decline is transient, naming scores in BTLA+ patients tend to remain lower compared to their baseline. SEEG mapping helps to predict postoperative language outcome after dominant TLR.

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BRMP-01. Awake cranial surgery with intraoperative language mapping for brain tumors. A single-center experience

Neuro-Oncology ◽

10.1093/neuonc/noab196.894 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi223-vi223

Author(s):

Andrés Cervio ◽

Sebastían Giovannini ◽

Sonia Hasdeu ◽

Lucía Pertierra ◽

Blanca Diez

Keyword(s):

Brain Tumors ◽

Functional Mri ◽

Tumor Resection ◽

Awake Surgery ◽

Anesthetic Technique ◽

Low Grade ◽

Safe Procedure ◽

Language Mapping ◽

Cranial Surgery

Abstract BACKGROUND Maximal safe resection of brain tumors affecting language areas has been a matter of increasing interest worldwide in the last decades. Functional MRI, tractography, and awake cranial surgery are standard procedures in our department since 2006. The aim of this study was to describe our experience in a series of 58 patients who underwent awake cranial surgery with intraoperative language mapping. METHODS Retrospective study of 58 adult patients who underwent awake surgery for brain tumors between January 2006 and January 2021. Preoperative neuropsychological assessment served as inclusion criteria. Language was evaluated according to the BDAE (Boston diagnostic aphasia examination) and WAB (Western aphasia battery) and strength according to the MRC (Medical Research Council) motor scale in the preoperative, immediate postoperative, and 3-months follow up. Functional MRI and tractography depicting white-matter tracts, neuronavigation, cortical and subcortical stimulation were performed in all cases. Conscious sedation was the anesthetic technique (propofol, fentanyl, and NSAIDs). Minimum follow-up was 6 months. FINDINGS The average age was 35 years (16–74). The anatomopathological findings were: low-grade glioma in 75,8% (n = 44), high-grade glioma in 15,6% (n = 9) and others in 8,6% (n = 5). No complications were registered during postoperative course. At the immediate postoperative evaluation 65% of patients presented with speech disturbances but at the 3-months follow up speech recovery was observed in all cases. Only 1 patient remained with moderate aphasia. mRS score at 3- months follow up was ≤ 1 in 96% of patients. Two patients had a persistent moderate hemiparesis. CONCLUSION Tumor resection in awake patients showed to be a safe procedure, and well tolerated by the patients. Preoperative planning of anatomical and functional aspects and intraoperative neurophysiological assessment are the cornerstones for pursuing maximal safe resection.

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Abstract 3734: Presurgical fMRI and Morbidity Outcomes in Patients with Vascular Lesions

Stroke ◽

10.1161/str.43.suppl_1.a3734 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Andrew C Radtke ◽

Joshua Pankratz ◽

Ryan Holdsworth ◽

Dovile Baniulis ◽

Nicole Kornder ◽

...

Keyword(s):

Logistic Regression ◽

Preoperative Planning ◽

Binary Logistic Regression ◽

Vascular Lesion ◽

Vascular Lesions ◽

Motor Deficits ◽

Binary Logistic Regression Analysis ◽

Language Mapping ◽

Motor Mapping ◽

The Relationship

Background fMRI is being increasingly used as an adjunct imaging technique for preoperative planning for patients with various brain lesions. The proximity of the lesion to eloquent cortex is a major factor in guiding surgical planning. Our group has previously reported significant association between the distance between brain tumor periphery and area of fMRI activation (Lesion-Activation Distance; LAD) and morbidity and mortality outcomes. This study investigated the relationship between vascular lesion LAD and morbidity. Methods This study was a retrospective analysis of data from patients with vascular lesions [arteriovenous malformations (AVMs) (n=49), and cavernomas (n=57)], who had received fMRI as part of their preoperative planning. The preoperative fMRI included motor mapping (n=87) and/or language mapping (n=102). The fMRI paradigms were chosen based on observed preoperative weakness (aphasia, paresis) and anticipated functional areas of the brain that may be affected by treatment. Results Multiple logistic regression analyses showed that a model that combines Age and Language LAD was a significant predictor of postoperative deficits (p= 0.04). Broca’s LAD(1-2 cm) X Age was a significant predictor of postoperative deficits (change in odds ratio (OR) =0.82, CI:0.68-0.98). The relationship between Brocas’s LAD and postoperative aphasia and Broca’s LAD and pre and postoperative aphasia trended towards significance (p = .08 and p =.07 respectively). Wernicke’s LAD, independently or combined with Age, was not a significant predictor of postoperative deficits. Binary logistic regression analysis for SMC LAD and postop deficits did not reach significance (p =.10). There were no significant differences in postoperative language or motor deficits as a function of gender or handedness. Conclusions These results suggest that both age and the proximity of a vascular lesion to language LAD are factors that can help predict postoperative outcomes, especially for Broca’s LAD. The lack of similar results when investigating the relationship between Wernicke’s LAD and postoperative deficits suggests potential brain reorganization and/or robustness of this brain region. These results have implications for the potential use of fMRI as a presurgical tool for language mapping in patients with vascular lesions.

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Magnetoencephalographic mapping of the language-specific cortex

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.5.2 ◽

1998 ◽

Vol 5 (5) ◽

pp. E2 ◽

Cited By ~ 1

Author(s):

Andrew C. Papanicolaou ◽

Panagiotis G. Simos ◽

Joshua I. Breier ◽

George Zouridakis ◽

L. James Willmore ◽

...

Keyword(s):

Receptive Language ◽

Cortical Stimulation ◽

Hemispheric Dominance ◽

Mapping Technique ◽

Dominant Hemisphere ◽

Language Mapping ◽

Valuable Adjunct ◽

Simple Language ◽

Noninvasive Mapping ◽

Further Development

Object In this paper the authors introduce a novel use of magnetoencephalography (MEG) for noninvasive mapping of language-specific cortex in individual patients and in healthy volunteers. Methods The authors describe a series of six experiments in which normative MEG data were collected and the reliability, validity, and topographical accuracy of the data were assessed in patients who had also undergone the Wada procedure or language mapping through intraoperative cortical stimulation. Conclusions Findings include: 1) receptive language-specific areas can be reliably activated by simple language tasks and this activation can be readily recorded in short MEG sessions; 2) MEG-derived maps of each individual are reliable because they remain stable over time and are independent of whether auditory or visual stimuli are used to activate the brain; and 3) these maps are also valid because they concur with results of the Wada procedure in assessing hemispheric dominance for language and with the results of cortical stimulation in identifying the precise topography of receptive language regions within the dominant hemisphere. Although the MEG mapping technique should be further refined, it has been shown to be efficacious by correctly identifying the language-dominant hemisphere and specific language-related regions within this hemisphere. Further development of the technique may render it a valuable adjunct for routine presurgical planning in many patients who harbor tumors or have epilepsy.

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Multimodality Word-Finding Distinctions in Cortical Stimulation Mapping

Neurosurgery ◽

10.1227/01.neu.0000429861.42394.d8 ◽

2013 ◽

Vol 73 (1) ◽

pp. 36-47 ◽

Cited By ~ 5

Author(s):

Sandra Serafini ◽

Merlise Clyde ◽

Matt Tolson ◽

Michael M. Haglund

Keyword(s):

Cortical Stimulation ◽

Sentence Completion ◽

Resection Margins ◽

Dominant Hemisphere ◽

Language Mapping ◽

Hierarchical Logistic Regression ◽

Word Finding ◽

Cortical Stimulation Mapping ◽

Multimodality Approach ◽

Patients With Epilepsy

Abstract BACKGROUND: Cortical stimulation mapping (CSM) commonly uses visual naming to determine resection margins in the dominant hemisphere of patients with epilepsy. Visual naming alone may not identify all language sites in resection-prone areas, prompting additional tasks for comprehensive language mapping. OBJECTIVE: To demonstrate word-finding distinctions between visual, auditory, and reading modalities during CSM and the percentage of modality-specific language sites within dominant hemisphere subregions. METHODS: Twenty-eight patients with epilepsy underwent CSM by the use of visual, auditory, and sentence-completion tasks. Hierarchical logistic regression analyzed errors to identify language sites and provide modality-specific percentages within subregions. RESULTS: The percentage of sites classified as language sites based on auditory naming was twice as high in anterior temporal regions compared with visual naming, marginally higher in posterior temporal areas, and comparable in parietal regions. Sentence completion was comparable to visual and auditory naming in parietal regions and lower in most temporal areas. Of 470 sites tested with both visual and auditory naming, 95 sites were distinctly auditory, whereas 48 sites were distinctly visual. The remaining sites overlapped. CONCLUSION: Distinct cortical areas were found for distinct input modalities, with language sites in anterior tip regions found most often by using auditory naming. The vulnerability of anterior temporal tip regions to resection in this population and distinct sites for each modality suggest that a multimodality approach may be needed to spare crucial language sites, if sparing those sites can be shown to significantly reduce the rate of postoperative language deficits without sacrificing seizure control.

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