Linguistic procedure in ‘awake neurosurgery’

Samenvatting

By means of a metaphoric introduction on the linguistic evaluation during awake neurosurgery, we show that the purpose of the procedure is total tumour removal (particularly gliomas) without causing morbidity or handicap. In-depth linguistic evaluations, mainly based on a selection of PALPA, AAT and specific “home-made” language tasks, are performed in the preoperative phase to obtain anatomoclinical correlations (functional and structural MRI results and linguistic findings). Pre-operatively, it is of utmost importance to evaluate the patient’s abilities (psychological status) to undergo an awake surgical intervention. In addition, the patient should be trained by means of a detailed scenario of instructions to make him familiar with the intra-operative procedures. The operative linguistic evaluation is based on an individual adaptation (filter) of linguistic test results. During this evaluation, the neurosurgeon stimulates the cortex with a bipolar stimulator. An intensive cooperation between the patient, the aphasiologist and the neurosurgeon is achieved under anesthesiological control. During the procedure a second aphasiologist constructs a colour map of the results. Spontaneous speech is the proof of the pudding in this procedure. Post-operative linguistic evaluations according to a standard protocol are repeated after one week, 6 months and 1 year and 6 months. This specific language procedure seems to offer unique opportunities to reduce the risk of permanent language impairments during an awake craniotomy in functionally important language areas. Follow-up and long-term evaluation of language functions refines the insight in the linguistic and non-linguistic sequellae.