gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Awake craniotomy for intra operative cortical stimulation of language relevant areas: clinical and neurolinguistic results of a prospective, longitudinal evaluation of 153 patients

Intraoperative direkte Kortex-Stimulation von sprachrelevanten Arealen unter Lokalanästhäsie: prospektive, longitudinale Evaluation von neurolinguistischen Ergebnissen in 153 Patienten

Meeting Abstract

  • corresponding author M. Ruge - Klinik für Neurochirurgie, Ludwig-Maximilians Universität, München
  • J. Ilmberger - Klinik für Physikalische Medizin und Rehabilitation, Abteilung Neuropsychologie, Ludwig-Maximilians Universität, München
  • F. Kreth - Klinik für Neurochirurgie, Ludwig-Maximilians Universität, München
  • H. Reulen - Klinik für Neurochirurgie, Ludwig-Maximilians Universität, München
  • J. Tonn - Klinik für Neurochirurgie, Ludwig-Maximilians Universität, München

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.04.01

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Ruge et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Awake craniotomy with intra-operative direct cortical stimulation is considered the gold standard for identification of language relevant sites. Although previous studies have demonstrated the feasibility and usefulness of this method, detailed neurolinguistic outcome data and their association with risk factors for impaired postoperative language functioning have not been reported. The current prospective longitudinal study presents for the first time pre-, intra-, and postoperatively obtained neurolinguistic data and the prognostic impact of clinical and initial neurolinguistic scores on outcome measurements.

Methods: Patients ≥15 years with untreated or recurrent lesions within/near to suspected language-relevant areas were considered eligible. A detailed neurolinguistic testing was performed before surgery, within the first month and within one year after treatment (Aachener Aphasie Test). After intra-operative stimulation and concomitantly performed neurolinguistic testing language relevant areas were marked for optimal treatment planning. Prognostic factors for postoperative language impairment were obtained from multivariate logistic regression models.

Results: Between 1991-2005 153 patients (mostly with glioma) were included. Awake craniotomy and the stimulation procedure were possible in all patients. Language-related areas could be identified in 93.4% and the surgical approach and/or extend of resection were adjusted to these findings in 94.9% and 89.2%, respectively (as documented by the surgeon). Pre-operative testing revealed aphasic disturbances in 16.9%, early post-operative testing in 37% (p<0.001), and delayed testing in 15.6% of the patients (p>0.05). Aphasic disturbances were mostly mild. Significant predictors for an early post operative language impairment were 1. pre-operative aphasia, 2. suboptimal (but still normal) scores in the naming subtest, 3. language positive stimulation sites within the lesion, and 4. intraoperative complications. Patients with fontal lesions had significant better results (p<0.01).

Conclusions: Direct cortical stimulation of language relevant areas is feasible and safe. Surgical strategy and extend of resection is markedly modified according to the stimulation results. Early post-operative deterioration of language functioning resolved mostly over time. A standardized prospective evaluation of language function allows the identification of patients at risk.