Authors (including presenting author) :
Florence CY YIP (1), Jacky KN MO (2), Adrian YH Cheung (3), Sara WY Li (4), Ripley Wong (1)
Affiliation :
(1)Speech Therapy department, Queen Mary Hospital (2)Speech Therapy department, Tung Wah Hospital (3)Speech Therapy department, Tung Wah Group of Hospitals Fung Yiu King Hospital (4)Speech Therapy department, MacLehose Medical Rehabilitation Center
Keyword 1: :
language mapping
Keyword 2: :
awake crainotomy
Keyword 3: :
neurosurgery
Introduction :
Direct electrical stimulation with language mapping tasks enable surgeon to identify critical cortical and subcortical language areas and pathways, which cannot be resected without significant post-operative language deficit. A comprehensive and specific language mapping protocol is crucial to assist neurosurgeons to Identify the eloquent language areas during operation while avoid misinterpretation of language responses. Successful mapping minimizes the risk for affecting post operative functional communication outcome. There is standardized language mapping protocol available in Dutch and other tasks that are proposed to be used in awake craniotomy surgery. However, no Cantonese/ Chinese version available currently. This study develops and validates a new locally developed neurolinguistic test battery for pre, intra, and postoperative use in awake brain surgery.
Objectives :
This study aims to 1) develop language and phonological tasks that are sensitive to be used during direct electrical stimulation in awake craniotomy surgery operated on tumours in eloquent areas. 2) This study aims to collect normative data for the test battery in a healthy control population and patients with unoperated brain tumours.
Methodology :
The study employed a two-phase validation approach. Phase 1 (n=7 healthy controls): Five practicing speech therapists evaluated task appropriateness and linguistic validity; stimuli with >50% failure rates in healthy controls were deleted. Phase 2 (n=51 healthy controls): A comprehensive normative study was conducted on cognitively intact native Cantonese speakers (mean age 31.82 years, SD=9.15; 74.5% female; median education 20 years). The CCLAP comprises 10 tasks: 8 for intra-operative direct electrical stimulation mapping (≤4 seconds response time) including confrontation naming (150 items), Pyramids and Palm Trees Test (35 items), read aloud (72 items), action naming (67 items), repetition (293 items across disyllabic/trisyllabic word and non-word categories), verb generation (52 items), verbal comprehension (30 items), and syntax production (59 items); plus 2 extended tasks for pre/post-operative assessment: passage reading fluency and passage comprehension.
Result & Outcome :
Following Phase 1 stimulus adjustment, stimulus refinement was achieved: naming task (22.1% deletion rate), action naming (4.3%), repetition (18.0%), verb generation (23.5%, highest deletion rate), and syntax production (10.6%). Phase 2 healthy controls demonstrated high overall performance with median accuracy ranging from 91.18%-100.00% across subtests. Sex differences were minimal across measures (Mann-Whitney U, p>.05). Percentile-based normative cut-off scores were established (percentile 7 = clinical impairment; percentile 2 = pathological impairment).
