Phoniatric management in cerebral language mapping under awake craniotomy condition

Abstract

Introduction: Intraoperative cortical mapping in gliomas improves survival as it is associated to more extensive tumor resection and fewer neurological deficits. The phoniatrician has the aim of assessing language before, during and after the surgery and indicating the appropriate therapy. Material and methods: A descriptive study that includes all patients that have been operated from brain tumorresection with awake craniotomy, and have been assessed by the Phoniatrics Area of a Tertiary referral hospital from 204 to 2018. Grade of participation and language are assessed in the first visit. Furthermore, exercises to be done during surgery are practiced by the patient: Number counting, Boston naming test, Token test, word repetition and image description. The remaining language areas are assessed with the aphasia Boston Test. During language mapping and tumor resection, the patient must perform the same tests. Whenever an error is detected, the neurosurgeon is informed. One week and three weeks after the surgery, the patient undergoes the same assessment. If language impairment is noticed, speech therapy is started. Results: 11 patients diagnosed of brain tumor with magnetic resonance. One patient is ineligible because of severe language impairment and 4 patients have mild language impairment. At the postoperative period, 6 patients without previous language disorder, remain with unaffected language. 4 patients have aphasia, so speech therapy is started, reporting improvement in 3 patients. Conclusion: Phoniatric management in awake brain tumor surgery allows detecting eligible patients for language mapping during the surgery and getting maximum tumor resection with minimum deficits. When language disorders occur, phonatric intervention focuses on restoring language function.