Intra-operative mapping and language protection in glioma

Abstract

The demand for acquiring different languages has increased with increasing globalization. However, knowledge of the modification of the new language in the neural language network remains insufficient. Although many details of language function have been detected based on the awake intra-operative mapping results, the language neural network of the bilingual or multilingual remains unclear, which raises difficulties in clinical practice to preserve patients’ full language ability in neurosurgery. In this review, we present a summary of the current findings regarding the structure of the language network and its evolution as the number of acquired languages increased in glioma patients. We then discuss a new insight into the awake intra-operative mapping protocol to reduce surgical risks during the preservation of language function in multilingual patients with glioma.

Resection of high-grade glioma involving language areas assisted by multimodal techniques under general anesthesia: a retrospective study

“…This study was approved by the ethics committee of Chinese People’s Liberation Army General Hospital. Anonymous data of patients were included according to the following inclusion criteria: (1) supratentorial HGG confirmed by pathology [ 19 , 20 ]; (2) patients > 6 years old; (3) the distance ≤ 2 cm between the tumor and traditional language regions (Broca area/Wernicke area/dorsal premotor cortex and/or arcuate fasciculus) on preoperative MRI [ 21 – 24 ]; (4) resection assisted by neruonavigation alone or by multimodal techniques under GA; (5) pre/postoperative language function were assessed completely. The patients were excluded according to the criteria: (1) infratentorial HGG; (2) under 6 years old; (3) resection under AC; (4) biopsy alone (5) lost to follow-up.…”

Molecular pathology and clinical implications of diffuse glioma

“…The main aims of surgery are: (1) to perform histopathological and molecular pathology assessment that will guide postoperative adjuvant therapy, such as chemotherapy, radiation therapy, and immunotherapy; (2) to relieve the effect of tumor occupation; (3) to delay the malignant progression of tumor and improve prognosis; and (4) to alleviate glioma-related neurological deficits, including headache, postoperative glioma-related epilepsy, and other side effects. [ 31 ] An earlier surgical resection is important for an improved prognosis of patients. Accumulated evidence have suggested that early surgical resection can prolong the overall survival of patients with glioma, delay malignant progression, and avoid neurological deficits.…”

“…To improve the accuracy of surgical resection and preserve fundamental neurological functions, such as motor, sensory, and language functions, the performance of awaken craniotomy is recommended. [ 31 ] Both positive and negative mapping strategies, identifying areas that are associated or not associated with neurological functions, respectively, have been recommended in awaken craniotomy. However, it is still controversial whether positive or negative mapping should be used in craniotomy.…”

“…(3) to delay the malignant progression of tumor and improve prognosis; and (4) to alleviate glioma-related neurological deficits, including headache, postoperative glioma-related epilepsy, and other side effects. [31] An earlier surgical resection is important for an improved prognosis of patients. Accumulated evidence have suggested that early surgical resection can prolong the overall survival of patients with glioma, delay malignant progression, and avoid neurological deficits.…”