Language Localization in Multilingual Patients—Evidence From Direct Electrical Stimulation: A Systematic Review and Single Institution Case Series

Abstract INTRODUCTION To enable the safe mapping of language function in multilinguals, we need to understand how language organization in multilinguals differ from well-described organizations in monolingual patients. The development and appropriate administration of standardized test batteries intraoperatively is important to ensure accuracy of mapping, as interlanguage differences cannot be accounted by accurate translations alone. Individual or linguistic factors affects language organization. This study aims to review the published literature on language organization in multilinguals and illustrate intraoperative findings from a case series of multilingual patients who underwent language mapping during awake craniotomy at an Asian institution. METHODS This PRISMA guided review included studies on multilingual patients undergoing awake craniotomy utilizing direct electrical stimulation (DES) to localize language sites during awake craniotomy. Similar details from case series of multilingual individuals with more than one language mapped at our center, and strategies used to develop intraoperative tasks for non-English languages are also presented. RESULTS A total of 142 patients in 21 studies were included. These studies included 80.9% bilinguals, 10.5% trilinguals, 6.3% tetralinguals, 2.8% pentalinguals. Most common first languages (L1) are French (26.7%), English (16.9%), Spanish (14.0%), second languages (L2) are English (38%), Spanish (19.7%), Mandarin (7.7%). Our study noted large variation in fluency definition and evaluation methods for language and cognitive evaluation. Stimulation protocols, error definitions were similar. Naming and counting tasks most commonly used. Majority of studies (76.1%) found distinct cortical sites for L1 and L2, and shared sites as well (66.7%). There was no clear relationship between pattern of distribution and age of acquisition, proficiency or nature of language. Sites for specific tasks such as voluntary and involuntary switching, translation, and reading were identified. CONCLUSION There are distinct differences language organization between multilinguals and monolinguals. It is crucial for understanding of these differences for maximal preservation of each mapped language function to achieve maximal quality of life.

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Difficulty in identification of the frontal language area in patients with dominant frontal gliomas that involve the pars triangularis

Journal of Neurosurgery ◽

10.3171/2015.8.jns151204 ◽

2016 ◽

Vol 125 (4) ◽

pp. 803-811 ◽

Cited By ~ 11

Author(s):

Taiichi Saito ◽

Yoshihiro Muragaki ◽

Takashi Maruyama ◽

Manabu Tamura ◽

Masayuki Nitta ◽

...

Keyword(s):

Electrical Stimulation ◽

Brain Mapping ◽

Awake Craniotomy ◽

Language Function ◽

Language Mapping ◽

Positive Mapping ◽

Language Area ◽

Pars Triangularis ◽

Language Areas ◽

Dominant Side

OBJECTIVE Identification of language areas using functional brain mapping is sometimes impossible using current methods but essential to preserve language function in patients with gliomas located within or near the frontal language area (FLA). However, the factors that influence the failure to detect language areas have not been elucidated. The present study evaluated the difficulty in identifying the FLA in dominant-side frontal gliomas that involve the pars triangularis (PT) to determine the factors that influenced failed positive language mapping. METHODS Awake craniotomy was performed on 301 patients from April 2000 to October 2013 at Tokyo Women's Medical University. Recurrent cases were excluded, and patients were also excluded if motor mapping indicated their glioma was in or around the motor area on the dominant or nondominant side. Eighty-two consecutive cases of primary frontal glioma on the dominant side were analyzed for the present study. MRI was used for all patients to evaluate whether tumors involved the PT and to perform language functional mapping with a bipolar electrical stimulator. Eighteen of 82 patients (mean age 39 ± 13 years) had tumors that showed involvement of the PT, and the detailed characteristics of these 18 patients were examined. RESULTS The FLA could not be identified with intraoperative brain mapping in 14 (17%) of 82 patients; 11 (79%) of these 14 patients had a tumor involving the PT. The negative response rate in language mapping was only 5% in patients without involvement of the PT, whereas this rate was 61% in patients with involvement of the PT. Univariate analyses showed no significant correlation between identification of the FLA and sex, age, histology, or WHO grade. However, failure to identify the FLA was significantly correlated with involvement of the PT (p < 0.0001). Similarly, multivariate analyses with the logistic regression model showed that only involvement of the PT was significantly correlated with failure to identify the FLA (p < 0.0001). In 18 patients whose tumors involved the PT, only 1 patient had mild preoperative dysphasia. One week after surgery, language function worsened in 4 (22%) of 18 patients. Six months after surgery, 1 (5.6%) of 18 patients had a persistent mild speech deficit. The mean extent of resection was 90% ± 7.1%. Conclusions Identification of the FLA can be difficult in patients with frontal gliomas on the dominant side that involve the PT, but the positive mapping rate of the FLA was 95% in patients without involvement of the PT. These findings are useful for establishing a positive mapping strategy for patients undergoing awake craniotomy for the treatment of frontal gliomas on the dominant side. Thoroughly positive language mapping with subcortical electrical stimulation should be performed in patients without involvement of the PT. More careful continuous neurological monitoring combined with subcortical electrical stimulation is needed when removing dominant-side frontal gliomas that involve the PT.

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A focal brain-cooling device as an alternative to electrical stimulation for language mapping during awake craniotomy: patient series

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21131 ◽

2021 ◽

Vol 2 (2) ◽

Author(s):

Sadahiro Nomura ◽

Takao Inoue ◽

Hirochika Imoto ◽

Hirokazu Sadahiro ◽

Kazutaka Sugimoto ◽

...

Keyword(s):

Electrical Stimulation ◽

Functional Mapping ◽

Awake Craniotomy ◽

Mapping Technique ◽

Broca’S Area ◽

Brain Cooling ◽

Broca's Area ◽

Cooling Device ◽

Language Mapping ◽

Patient Series

BACKGROUND Functional mapping in awake craniotomy has the potential risk of electrical stimulation-related seizure. The authors have developed a novel mapping technique using a brain-cooling device. The cooling probe is cylindrical in shape with a thermoelectric cooling plate (10 × 10 mm) at the bottom. A proportional integration and differentiation-controlled system adjusts the temperature accurately (Japan patent no. P5688666). The authors used it in two patients with glioblastoma. Broca’s area was identified by electrical stimulation, and then the cooling probe set at 5°C was attempted on it. OBSERVATIONS Electrocorticogram was suppressed, and the temperature dropped to 8°C in 50 sec. A positive aphasic reaction was reproduced on Broca’s area at a latency of 7 sec. A negative reaction appeared on the adjacent cortices despite the temperature decrease. The sensitivity and specificity were 60% and 100%, respectively. No seizures or other adverse events related to the cooling were recognized, and no histological damage to the cooled cortex was observed. LESSONS The cooling probe suppressed topographical brain function selectively and reversibly. Awake functional mapping based on thermal neuromodulation technology could substitute or compensate for the conventional electrical mapping.

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Two Different Subcortical Networks of Language System: Morphogram and Phonogram, Through the Analysis of Unique Japanese Characters

10.21203/rs.3.rs-554010/v1 ◽

2021 ◽

Author(s):

Sho Tamai ◽

Masashi Kinoshita ◽

Riho Nakajima ◽

Hirokazu Okita ◽

Mitsutoshi Nakada

Keyword(s):

Electrical Stimulation ◽

White Matter ◽

Surgical Resection ◽

Parietal Lobe ◽

The Other ◽

Reading Process ◽

Direct Electrical Stimulation ◽

Cerebral Glioma ◽

Language Mapping ◽

Language Assessments

Abstract Language systems worldwide are based on morphograms or phonograms, and Japanese is a unique language that uses a complicated combination of kanji (morphogram) and kana (phonogram) characters. The white matter networks associated with reading have been investigated previously but remain unclear. In this study, we performed intraoperative language mapping under local anesthesia and postoperative language assessments of 65 consecutive patients who underwent surgical resection for cerebral glioma within the dominant temporal or parietal lobe. The cases showing intraoperative dyslexia elicited by direct electrical stimulation (DES) or postoperative kanji and/or kana dyslexia were extracted. Five patients showed transient kanji or kana dyslexia intraoperatively, and 8 patients showed kanji or kana dyslexia postoperatively. During intraoperative mapping, kanji or kana dyslexia were indeed reproduced by DES. We investigated the maximal overlapping lesions of the resection cavity that were associated with kanji or kana dyslexia, and then determined the subcortical elicited points that evoked kanji or kana dyslexia. These areas were localized near three white matter bundles: the arcuate fascicle, posterior superior longitudinal fascicle, and inferior longitudinal fascicle (ILF). The intraoperative DES distributions for kanji dyslexia were especially associated with the anterior-inferior side of the ILF. On the other hand, the DES point associated with kana dyslexia was localized on the posterior-superior side of the complex of these three tracts. These results suggested the presence of specific non-interfering networks that subserved the reading process for morphograms and phonograms.

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P03.06 Boolean logic puzzles as a neurosurgical mapping tool to preserve programming skill

Neuro-Oncology ◽

10.1093/neuonc/noab180.058 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii18-ii18

Author(s):

M Donders-Kamphuis ◽

K J Miller ◽

B F W van der Kallen ◽

M L D Broekman

Keyword(s):

Electrical Stimulation ◽

Programming Language ◽

Computer Programming ◽

Extent Of Resection ◽

Brodmann Area ◽

Awake Craniotomy ◽

Boolean Logic ◽

Direct Electrical Stimulation ◽

Glioma Surgery ◽

Mapping Tool

Abstract BACKGROUND In glioma surgery, awake craniotomy with Direct Electrical Stimulation (DES) is increasingly becoming the gold standard treatment to preserve language, cognition and motor function and to optimize extent of resection. Computer programming is historically seen as an integration of cognition, language, and mathematics but an intraoperative task to monitor computer programming does not exist yet. In this study we describe a new task for intraoperative monitoring, using visual Boolean Logic Puzzles. MATERIAL AND METHODS We describe a computer programmer who underwent awake craniotomy to resect an anaplastic astrocytoma in the left superior frontal gyrus. At the request of the patient we tested programming language. We developed a new task and set of logic puzzle visual stimuli to monitor underlying cognitive function used for programming language. This test was used during preoperative functional MRI (fMRI), direct electrical stimulation (DES) and ongoing monitoring during resection. RESULTS In fMRI this task showed bilateral activation in Brodmann area 6 and 8 and for left hemisphere in Brodmann area 10. These areas are below and lateral of the tumor. Monitoring of language, motor skills and Boolean mapping was performed during DES and while resection was performed. No deficits in programming ability could be identified intra- and postoperatively. CONCLUSION Boolean Logic Puzzles may be a useful intraoperative task to preserve programming skills.

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SURG-38. DIRECT EVIDENCE OF PLASTICITY WITHIN PRIMARY MOTOR AND SENSORY CORTICES VIA DIRECT ELECTRICAL STIMULATION IN GLIOBLASTOMA PATIENTS UNDERGOING REPEAT AWAKE CRANIOTOMY

Neuro-Oncology ◽

10.1093/neuonc/now212.836 ◽

2016 ◽

Vol 18 (suppl_6) ◽

pp. vi198-vi198

Author(s):

William Gibb ◽

Nathan Kong

Keyword(s):

Electrical Stimulation ◽

Direct Evidence ◽

Awake Craniotomy ◽

Direct Electrical Stimulation ◽

Sensory Cortices

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The verb and noun test for peri-operative testing (VAN-POP): standardized language tests for navigated transcranial magnetic stimulation and direct electrical stimulation

Acta Neurochirurgica ◽

10.1007/s00701-019-04159-x ◽

2019 ◽

Vol 162 (2) ◽

pp. 397-406 ◽

Cited By ~ 2

Author(s):

Ann-Katrin Ohlerth ◽

Antonio Valentin ◽

Francesco Vergani ◽

Keyoumars Ashkan ◽

Roelien Bastiaanse

Keyword(s):

Electrical Stimulation ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Language Skills ◽

Word Retrieval ◽

Direct Electrical Stimulation ◽

Navigated Transcranial Magnetic Stimulation ◽

Single Word ◽

Language Mapping ◽

Language Tests

Abstract Background Protocols for intraoperative language mapping with direct electrical stimulation (DES) often include various language tasks triggering both nouns and verbs in sentences. Such protocols are not readily available for navigated transcranial magnetic stimulation (nTMS), where only single word object naming is generally used. Here, we present the development, norming, and standardization of the verb and noun test for peri-operative testing (VAN-POP) that measures language skills more extensively. Methods The VAN-POP tests noun and verb retrieval in sentence context. Items are marked and balanced for several linguistic factors known to influence word retrieval. The VAN-POP was administered in English, German, and Dutch under conditions that are used for nTMS and DES paradigms. For each language, 30 speakers were tested. Results At least 50 items per task per language were named fluently and reached a high naming agreement. Conclusion The protocol proved to be suitable for pre- and intraoperative language mapping with nTMS and DES.

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