Language Mapping with Verbs and Sentences in Awake Surgery: A Review

Abstract

Intraoperative language mapping in awake surgery is typically conducted by asking the patient to produce automatic speech and to name objects. These tasks might not map language with sufficient accuracy, as some linguistic processes can only be triggered by tasks that use verbs and sentences. Verb and sentence processing tasks are currently used during surgery, albeit sparsely. Medline, PubMed, and Web of Science records were searched to retrieve studies focused on language mapping with verbs/sentences in awake surgery. We review the tasks reported in the published literature, spell out the language processes assessed by each task, list the cortical and subcortical regions whose stimulation inhibited language processing, and consider the types of errors elicited by stimulation in each region. We argue that using verb tasks allows a more thorough evaluation of language functions. We also argue that verb tasks are preferable to object naming tasks in the case of frontal lesions, as lesion and neuroimaging data demonstrate that these regions play a critical role in verb and sentence processing. We discuss the clinical value of these tasks and the current limitations of the procedure, and provide some guidelines for their development. Future research should aim toward a differentiated approach to language mapping - one that includes the administration of standardized and customizable tests and the use of longitudinal neurocognitive follow-up studies. Further work will allow researchers and clinicians to understand brain and language correlates and to improve the current surgical practice.

Presurgical language fMRI: Mapping of six critical regions

“…Less is also currently known about the ability to predict deficits in some higher‐order aspects of language function, such as grammar, postsurgically. There is evidence that non lexico‐semantic aspects of language such as grammar may have a partially distinct neuroarchitecture in epilepsy and tumor patients [Ojemann and Mateer, ] and preliminary evidence that considering grammar as part of evaluation may improve the utility of clinical mapping paradigms [Połczyńska et al, ; Rofes and Miceli, ]. More broadly, this fMRI‐based approach focuses on cortical structures and does not explicitly consider the connections between these regions, or subcortical involvement, and it is imperative that these be considered in planning.…”

Language neuroplasticity in brain tumour patients revealed by magnetoencephalography

“…Brain tumour surgery aims to prolong survival by removing pathological tissue, while avoiding deficits (H. Duffau, 2007). This approach requires the use of tests that are sensitive enough to capture subtle impairment (Brownsett et al, 2019;De Witte et al, 2015; see also Rofes & Miceli, 2014;Sierpowska et al, 2017). Protocols often make use of standard neuropsychological tests, which are sensitive to impairments in the moderate to severe range, such as those seen in stroke-induced aphasia.…”

Monitoring cognition during awake brain surgery in adults: A systematic review

“…Tests that require a yes/no answer are therefore unsuitable. Rofes and Miceli (2014) give a detailed description of the design of intraoperative tasks specific for language mapping. Besides language-specific recommendations, they also state that tasks should be short (both in presentation of stimuli and in response from patients) and that the tasks should be sensitive enough to detect subtle changes.…”

“…There was much attention paid to preservation of language and motor functions (Grossman & Ram, 2013). Several reviews are available specifically addressing language mapping (e.g., De Witte & Mariën, 2013;Rofes & Miceli, 2014).…”