Language mapping: A systematic review of protocols that evaluate linguistic functions in awake surgery

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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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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Accuracy of Presurgical Functional MR Imaging for Language Mapping of Brain Tumors: A Systematic Review and Meta-Analysis

Radiology ◽

10.1148/radiol.2017162971 ◽

2018 ◽

Vol 286 (2) ◽

pp. 512-523 ◽

Cited By ~ 17

Author(s):

Hsu-Huei Weng ◽

Kyle R. Noll ◽

Jason M. Johnson ◽

Sujit S. Prabhu ◽

Yuan-Hsiung Tsai ◽

...

Keyword(s):

Systematic Review ◽

Brain Tumors ◽

Mr Imaging ◽

Meta Analysis ◽

Language Mapping ◽

Functional Mr Imaging

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Language Assessment in Multilingualism and Awake Neurosurgery

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.750013 ◽

2021 ◽

Vol 15 ◽

Author(s):

Maria De Martino ◽

Andrea Talacchi ◽

Rita Capasso ◽

Annapina Mazzotta ◽

Gabriele Miceli

Keyword(s):

Standardized Testing ◽

Language Assessment ◽

Naming Task ◽

Awake Surgery ◽

Linguistic Features ◽

Language Mapping ◽

Great Heterogeneity ◽

Critical Issues ◽

Worldwide Phenomenon ◽

Cortical Regions

Multilingualism has become a worldwide phenomenon that poses critical issues about the language assessment in patients undergoing awake neurosurgery in eloquent brain areas. The accuracy and sensitivity of multilingual perioperative language assessment procedures is crucial for a number of reasons: they should be appropriate to detect deficits in each of the languages spoken by the patient; they should be suitable to identify language-specific cortical regions; they should ensure that each of the languages of a multilingual patient is tested at an adequate and comparable level of difficulty. In clinical practice, a patient-tailored approach is generally preferred. This is a necessary compromise since it is impossible to predict all the possible language combinations spoken by individuals and thus the availability of standardized testing batteries is a potentially unattainable goal. On the other hand, this leads to high inconsistency in how different neurosurgical teams manage the linguistic features that determine similarity or distance between the languages spoken by the patient and that may constrain the neuroanatomical substrate of each language. The manuscript reviews the perioperative language assessment methodologies adopted in awake surgery studies on multilingual patients with brain tumor published from 1991 to 2021 and addresses the following issues: (1) The language selected for the general neuropsychological assessment of the patient. (2) The procedures adopted to assess the dimensions that may constrain language organization in multilingual speakers: age and type of acquisition, exposure, proficiency, and use of the different languages. (3) The type of preoperative language assessment used for all the languages spoken by the patient. (4) The linguistic tasks selected in the intraoperative setting. The reviewed data show a great heterogeneity in the perioperative clinical workup with multilingual patients. The only exception is the task used during language mapping, as the picture naming task is highly preferred. The review highlights that an objective and accurate description of both the linguistic profile of multilingual patients and the specific properties of the languages under scrutiny can profitably support clinical management and decision making in multilingual awake neurosurgery settings.

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A Data-Based Approach for Selecting Pre- and Intra-Operative Language Mapping Tasks

Frontiers in Neuroscience ◽

10.3389/fnins.2021.743402 ◽

2021 ◽

Vol 15 ◽

Author(s):

Justyna O. Ekert ◽

Matthew A. Kirkman ◽

Mohamed L. Seghier ◽

David W. Green ◽

Cathy J. Price

Keyword(s):

Naming Task ◽

Object Naming ◽

Auditory Modality ◽

Language Mapping ◽

Novel Approach ◽

Brain Responses ◽

Linguistic Functions ◽

Classical Language ◽

Language Areas ◽

Naming Tasks

Background: Pre- and intra-operative language mapping in neurosurgery patients frequently involves an object naming task. The choice of the optimal object naming paradigm remains challenging due to lack of normative data and standardization in mapping practices. The aim of this study was to identify object naming paradigms that robustly and consistently activate classical language regions and could therefore be used to improve the sensitivity of language mapping in brain tumor and epilepsy patients.Methods: Functional magnetic resonance imaging (fMRI) data from two independent groups of healthy controls (total = 79) were used to generate threshold-weighted voxel-based consistency maps. This novel approach allowed us to compare inter-subject consistency of activation for naming single objects in the visual and auditory modality and naming two objects in a phrase or a sentence.Results: We found that the consistency of activation in language regions was greater for naming two objects per picture than one object per picture, even when controlling for the number of names produced in 5 s.Conclusion: More consistent activation in language areas for naming two objects compared to one object suggests that two-object naming tasks may be more suitable for delimiting language eloquent regions with pre- and intra-operative language testing. More broadly, we propose that the functional specificity of brain mapping paradigms for a whole range of different linguistic and non-linguistic functions could be enhanced by referring to databased models of inter-subject consistency and variability in typical and atypical brain responses.

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Systematic review on awake surgery for lung metastases

Video-Assisted Thoracic Surgery ◽

10.21037/vats.2017.09.06 ◽

2017 ◽

Vol 2 ◽

pp. 70-70

Author(s):

Marcello Migliore ◽

Francesco Borrata ◽

Marco Nardini ◽

Valentina Timpanaro ◽

Marinella Astuto ◽

...

Keyword(s):

Systematic Review ◽

Lung Metastases ◽

Awake Surgery

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SURG-03. RESECTION OF HIGHLY LANGUAGE-ELOQUENT BRAIN LESIONS PURELY BASED ON rTMS LANGUAGE MAPPING WITHOUT AWAKE SURGERY

Neuro-Oncology ◽

10.1093/neuonc/now212.804 ◽

2016 ◽

Vol 18 (suppl_6) ◽

pp. vi191-vi191

Author(s):

Sebastian Ille ◽

Nico Sollmann ◽

Florian Ringel ◽

Bernhard Meyer ◽

Sandro M. Krieg

Keyword(s):

Brain Lesions ◽

Awake Surgery ◽

Language Mapping

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Navigated transcranial magnetic stimulation for preoperative language mapping in a patient with a left frontoopercular glioblastoma

Journal of Neurosurgery ◽

10.3171/2012.9.jns121053 ◽

2013 ◽

Vol 118 (1) ◽

pp. 175-179 ◽

Cited By ~ 55

Author(s):

Nico Sollmann ◽

Thomas Picht ◽

Jyrki P. Mäkelä ◽

Bernhard Meyer ◽

Florian Ringel ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Right Hemisphere ◽

Inferior Frontal Gyrus ◽

Awake Surgery ◽

Navigated Transcranial Magnetic Stimulation ◽

Clear Speech ◽

Language Mapping ◽

Motor Mapping ◽

The Right

Up to now, navigated transcranial magnetic stimulation (nTMS) has been used for motor mapping in the vicinity of rolandic brain lesions. Recently, nTMS has also been suggested to be useful in mapping human language areas. The authors describe the case of a left-handed patient with a left-side glioblastoma within the opercular inferior frontal gyrus who presented with severe motor aphasia. Preoperative functional MRI (fMRI) indicated speech dominance of the right hemisphere and did not show any language-related activation in the vicinity of the tumor. Navigated TMS, however, showed a significantly higher rate of induced speech arrests for the left than for the right. Left-side direct cortical stimulation induced clear speech arrests during awake surgery. This case suggests that nTMS may be useful for preoperative speech mapping in tumors affecting the anatomy, vasculature, and brain oxygen levels and therefore impairing fMRI reliability.

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