Article
Developing a standardised grading for intraoperative language mapping based on preoperative language abilities and language eloquence classification
Entwicklung eines standardisierten Einstufungsverfahrens für intraoperative Sprachkartierungen basierend auf präoperativen Sprachfähigkeiten und einer Spracheloquenz-Klassifizierung
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Published: | May 25, 2022 |
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Outline
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Objective: Awake surgery is the gold standard to preserve language function in patients with language eloquent brain tumors. However, some patients are not eligible for awake surgery. A thorough assessment of preoperative language deficits could provide critical information about patients' intraoperative performance capability. This study analyzed whether language errors, aphasia severity or a standardized classification of language eloquence can predict suitability for intraoperative awake language mapping.
Methods: A speech and language therapist blinded to surgery type assessed language abilities based on a baseline object naming task of routinely implemented preoperative language mapping. We carried out classification of language eloquence (0-9 points) depending on cortical and subcortical tumor location and clinical history. Subsequently, we related these variables to the type of surgery.
Results: 211 patients (Mage=56.6, SDage=15.2, 56.9% males) receiving preoperative language mapping between 5/2018 and 1/2021 were prospectively enrolled. While none of the language errors or categories predicted surgery type, language eloquence correlated with rated aphasia level (rs=0.358, p<0.001) and awake vs. non-awake surgery (r=0.278, p<0.001). 75.9% of patients receiving an awake surgery had a language eloquence ≥5. Age (p<0.001) predicted surgery type, but ROC analyses suggested that this was not a sufficient indicator for awake surgery.
Conclusion: As shown by the correlation of language eloquence with type of surgery and rated aphasia severity, the combination of detailed preoperative language assessment with cortical, subcortical and clinical language eloquence could allow a systematic and standardized grading of awake surgery indication.