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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Misidentification of involuntary and unpredictably manifesting speech motor symptoms as language-relevant during stimulation-based language mapping in glioma patients who stutter

Fehlidentifizierung unwillkürlicher und unvorhersehbar auftretender sprechmotorischer Symptome als sprachrelevant bei stimulations-basierten Sprachkartierungen stotternder Gliom-Patienten

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  • presenting/speaker Leonie Kram - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Beate Neu - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Axel Schröder - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Sandro M. Krieg - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland; Klinikum rechts der Isar der TU München, TUM Neuroimaging Center, München, Deutschland
  • Sebastian Ille - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland; Klinikum rechts der Isar der TU München, TUM Neuroimaging Center, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV187

doi: 10.3205/22dgnc181, urn:nbn:de:0183-22dgnc1819

Published: May 25, 2022

© 2022 Kram 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: Stimulation-based pre- and intraoperative language mapping approaches rely on identifying a causal link between stimulated cortical site and language function. However, stuttering, a speech motor impairment eliciting involuntary repetitions, prolongations or (in-)audible pauses, confounds the identification of stimulation-induced disruptions of language function. This study ascertained the impact of stuttering on the results of preoperative language mappings.

Methods: A trained speech and language therapist identified patients who stuttered based on video recordings of an object naming task routinely used for preoperative language mapping. Two operators of a nTMS system (navigated transcranial magnetic stimulation) with different degrees of experience analyzed the stimulation exams of the patients who stutter. Finally, we compared the percentage of stuttering events mis-classified as stimulation-induced language errors between TMS operators for each patient individually.

Results: Post-hoc analyses of baseline video recordings revealed that 2.6% of 77 asleep surgery and 11.5% of 26 awake surgery patients with histologically confirmed glioma, undergoing preoperative language mapping between 05/2018 and 01/2021, presented with a stutter. In five patients who stuttered, the highly experienced TMS operator classified on average 48.4% (range: 18.2-100.0%) of isolated stuttering events as stimulation-induced language relevant sites, the less experienced operator 64.8% (range: 35.3-100.0%).

Conclusion: These randomly manifesting stuttering symptoms had a major and direct impact on the results of the language mapping and were frequently misidentified as language-relevant cortical sites. Thus, it is highly important to differentiate these speech errors as this could have a direct effect on the surgical approach and functional outcome for brain tumor patients who stutter.