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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Subcortical monopolar language mapping during awake surgery

Subkortikales, monopolares Sprachmapping bei Tumoroperationen unter Wachbedingungen

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  • presenting/speaker Franziska Meinert - Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Neurosurgery, Oldenburg, Deutschland
  • Annett Benner - Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Neurosurgery, Oldenburg, Deutschland
  • Benjamin Zimmermann - Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Neurosurgery, Oldenburg, Deutschland
  • Max Schrammel - Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Neurosurgery, Oldenburg, Deutschland
  • Patrick Dömer - Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Neurosurgery, Oldenburg, Deutschland
  • Thomas Picht - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Katharina Faust - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Wiebke Aumann - Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Neurosurgery, Oldenburg, Deutschland
  • Christian Heinen - Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Neurosurgery, Oldenburg, Deutschland
  • Johannes Woitzik - Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Neurosurgery, Oldenburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP199

doi: 10.3205/21dgnc480, urn:nbn:de:0183-21dgnc4804

Published: June 4, 2021

© 2021 Meinert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Intraoperative subcortical language mapping is traditionally performed with bipolar stimulation, which is characterized by frequent interruptions of the operative flow and intermittent mapping of the tumor cavity point by point. To overcome these limitations, we performed a continuous subcortical mapping using a monopolar suction device previously reported for motor tract mapping.

Methods: We present a consecutive case series of 15 patients with glial tumors (4 low grade/ 11 high grade) located in speech eloquent areas, who underwent awake surgery with neuropsychological support. Subcortical monopolar language mapping was performed with the Suction Probe by Raabe et. al. (short train, interstimulus interval 4 msec, pulse duration 500 μsec). Stimulation intensity, evoked temporary speech deficit as well as pre- and postoperative neurological findings were recorded.

Results: Thirteen of 15 procedures were technically successful. Two patients were not cooperative enough for awake surgery. Stimulation intensity ranged from 1 to 10 mA. Intraoperative temporary language errors (a.e. anomia, paraphasia) were evoked in 9 cases (82%) and a temporary total speech arrest in 3 (27%) cases. No seizure occurred during surgery. Gross total resection was achieved in 7 (47%), subtotal resection in 3 (20%) and partial resection in 5 (33%) cases. Postoperative language function deteriorated temporarily in only 2 patients.

Conclusion: Our preliminary data encourage the use of continuous dynamic monopolar language mapping as feasible and safe for localizing speech eloquent fibers adjacent to tumor boundaries.