PO74EFFECTS OF LANGUAGE MAPPING AND INTRA-OPERATIVE SPEECH AND LANGUAGE THERAPY (SALT) ON AWAKE CRANIOTOMY TUMOUR RESECTIONS: A SINGLE CENTRE EXPERIENCE

Abstract

INTRODUCTION: Language mapping during awake craniotomy is commonly used to guide tumour resection, but there is little description of its outcome. We present a series of 22 patients who underwent awake craniotomies with language mapping for glioma resection between 2007 and 2015. METHOD: Patients who had awake craniotomies with language mapping at a single centre were identified and included in this retrospective study. Details of patient demographics, tumour characteristics, treatment, speech and language assessments (SALT) and outcomes were recorded and analysed. 10 of these patients were also noted to have undergone pre-operative functional MRI (fMRI) with motor and language mapping. RESULTS: The majority were primary gliomas (16), of which 8 were WHO Grade 1-2. 5 out of the 6 recurrent cases were Grade 3-4. 9 were astrocytomas, and the rest were oligodendrogliomas (3), mixed astrocytoma/oligodendroglioma (6), and glioblastomas (4). Pre-operative SALT assessment identified language disorders in 11 patients. Intra-operative language mapping with direct cortical stimulation (DCS) was negative in 7 patients, and extent of tumour resection was guided by positive mapping in 14 patients. Post-operatively, 12 patients' speech remained unchanged, 8 developed worsening speech, and 2 had improved speech. Patients with a pre-operative fMRI were noted to have mildly lower rate of post-operative speech or neurological deficits compared to those who did not (20% vs 33% respectively). CONCLUSION: From our experience and this series, language mapping during awake craniotomies is a helpful tool for safer surgery without increasing complication rate. The addition of pre-operative fMRI may further reduce post-operative speech deficits.