NCO-09THE EFFICACY OF THERAPEUTIC DISCOURSE ANALYSIS DURING BRAIN TUMOUR RESECTION IN AWAKE CRANIOTOMIES

Abstract

Intraoperative brain mapping techniques are utilized in neuro-oncology to maximize the extent of tumor resection, seizure control, and minimize operative morbidity.1 The advancement of our understanding of speech, language and oral motor movement has facilitated the application of progressively sophisticated methods of assessing higher level function intra-operatively. An anesthetic approach that does not require airway manipulation2 was used, thereby optimizing brain mapping conditions as well as the patient's ability to participate in therapeutic discourse tasks during brain tumour resection. With REB approval and informed consent, case-reviews were performed for five patients who had undergone awake re-do craniotomies. The standardized anesthetic protocol was based on the scalp block and dexmedetomidine infusion as the primary anesthetic agent.2 The SLP completed a preoperative assessment, brain mapping with the surgical team, ongoing therapeutic discourse during tumour resection and a postoperative assessment. All five patients had successful resection of the tumour. In each case, the SLP provided a systematic evaluation of speech, language, oral motor, and cognitive communication function. The surgical team identified that real-time speech assessment directed the surgical plan, not only during brain mapping but also during tumour resection facilitating optimal tumour resection and the preservation of eloquent cortex. Three patients demonstrated speech arrest during tumour resection in an area that was mapped to be safe and two patients had seizures. These deficits would not have been appreciated had tumour resection been performed with the patient sedated post brain mapping or if an anesthetic technique with instrumented airway was used. All patients scored equal to or above their baseline scores during the postoperative assessment. The patient's assessment, preparation and an integrated team-expertise are crucial to the success of the awake craniotomy. The support of the SLP minimizes postoperative neurological sequelae by providing ongoing intraoperative assessment throughout mapping as well as brain tumour resection.