gms | German Medical Science

Objective: Intraoperative neurophysiologic language mapping is an established procedure in patients operated on for tumors in the area of the language cortex. The aim of the present study was to analyze the impact of individually tailored paradigms for intraoperative language mapping on functional outcome.

Methods: In 15 patients with left fronto-temporal tumors neurolinguistic testing was performed preoperatively using the Aachen Aphasia Test, which consists of five subtests. In case of substandard performance the respective subtype of aphasia was defined as language at risk (LAR). Intra-operatively, cortical and subcortical language mapping was performed using standard confrontation naming as well as individually tailored paradigms specifically testing for LAR. Postoperatively, functional outcome was assessed by Aachen Aphasia Test on day 7 and after 3 months.

Results: Preoperatively, Aachen Aphasia Test revealed LAR in 7 out of 15 patients. Intraoperatively, cortical LAR representation was identified in 5 out of those 7 patients. Postoperatively, a worsening of language function was observed in 6 patients. In all cases the observed impairment was a worsening of a preexisting aphasia. Notably, in all cases these language impairments recovered within 3 months.

Conclusions: Preoperative aphasia is a risk factor for postoperative language impairment. This impairment predominantly affects the pre-existing subtype of aphasia. Specifically testing for LAR intraoperatively, assuming close proximity of this function to the tumor, may be beneficial. In the present series no permanent language impairment occurred. A larger series is needed to confirm this hypothesis.