Diagnostic work up for language testing in patients undergoing awake craniotomy for brain lesions in language areas

Abstract

Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. Pre- and intra operative testing was accomplished with 8 tests. Intraoperative evaluation was accomplished when patients were fully cooperative (Ramsey < 3). Postoperative evaluation was scheduled at early (within 21 days) and long-term follow-up (3-6 months). Twenty consecutive patients were prospectively recruited. Preoperative language testings were normal in 9 patients (45%), showed mild to moderate language deficit in 8 (40%) and severe language deficit or aphasic disorders in 3 (15%). Broca's area was identified in 15 patients, in all cases by counting arrest during stimulation and in 12 cases by naming arrest. In this article we describe our experience using a language testing work up to evaluate - pre, intra and postoperatively - patients undergoing awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew.

Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

“…The detailed screening, eligibility assessment and inclusion process is shown in Fig 1 . We included a total of forty-seven studies [ 10 , 17 – 62 ] in our SR. One author was personally contacted, and provided us more information about their used anaesthesia technique [ 10 ].…”

“…Data of the study characteristics are shown in Table 1 . A total of fourteen case series [ 10 , 17 , 19 , 20 , 23 , 28 , 39 , 41 , 44 , 47 , 51 , 53 , 54 , 60 ] thirteen prospective studies [ 18 , 21 , 22 , 25 – 27 , 30 , 33 , 35 , 38 , 52 , 55 , 61 ], seventeen retrospective studies [ 24 , 29 , 31 , 34 , 37 , 40 , 42 , 43 , 45 , 46 , 48 – 50 , 57 – 59 , 62 ], two RCTs [ 32 , 56 ], and one pseudo-RCT [ 36 ] comprising 5945 AC procedures in 5931 patients were analysed ( Table 1 ). Of note, during the data extraction process it appeared that nine studies [ 20 , 22 , 27 , 31 , 42 – 46 ] partially repor...…”

“…Additionally the reference lists of the included articles were scanned for further eligible studies. One author was contacted, to provide additional study information [ 10 ].…”

Anesthesia for awake craniotomy: An update

“…Finally, because complications are common during awake craniotomy, prompt crisis management, team communication and experienced anesthetic and surgical teams are important to maximize the utility and safety of this procedure. [27][28][29][30][31][32][33][34][35][36][37][38][39][40] Ethical disclosures…”

Anestesia para craneotomía en el paciente despierto: una actualización

“…Un perfecto control de la anestesia y la realización meticulosa de los procedimientos de mapeo son esenciales para lograr la mayor precisión con los resultados de la localización cerebral. Por último, puesto que es común que se presenten complicaciones durante la craneotomía en el paciente despierto, la comunicación y un equipo integrado por cirujanos y anestesiólogos expertos son importantes para maximizar la utilidad y la seguridad de este procedimiento [27][28][29][30][31][32][33][34][35][36][37][38][39][40] .…”