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. 2023 Mar 26;15(3):e36718.
doi: 10.7759/cureus.36718. eCollection 2023 Mar.

Intraoperative Testing During the Mapping of the Language Cortex

Shabab S Kabir  1   2 , Faisal R Jahangiri  3   4   2   1 , Callista Rinesmith  1 , Cristobal S Vilches  1 , Swati Chakarvarty  1   2
Affiliations

Intraoperative Testing During the Mapping of the Language Cortex

Shabab S Kabir et al. Cureus. .

Erratum in

Abstract

Intracranial lesions, particularly in the language-eloquent areas of the brain, can affect one's speaking ability. Despite advances in surgery, the excision of these lesions can be challenging. Intraoperative neurophysiological monitoring (IONM) during awake craniotomies can help identify language-eloquent areas and minimize postoperative impairments. Preoperative language testing is performed to establish a baseline before intraoperative language testing. This involves subjecting patients to predetermined tasks in the operating room to evaluate their phonological, semantic, and syntactic capabilities. The current state and future directions of intraoperative language testing procedures are discussed in this paper. The most common intraoperative tasks are counting and picture naming. However, some experts recommend utilizing more nuanced tasks that involve regions affected by infrequently occurring tumor patterns. Low-frequency bipolar Penfield stimulation is optimal for language mapping. Exception cases are discussed where awake craniotomies are not feasible. When dealing with multilingual patients, the patient's age of learning and skill level can be accounted for in terms of making informed task choices and mapping techniques to avoid any damage to language areas.

Keywords: awake craniotomy; cortical stimulation; ecog; intraoperative language testing; ionm; language mapping; motor mapping; neuromonitoring; penfield; taniguchi.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Magnetic resonance image (MRI) showing a tumor in the left cortical region.
Figure 2
Figure 2. Monopolar ball tip stimulation probe.
Hand-held monopolar ball tip stimulation probe used for Taniguchi method direct cortical stimulation. Source: Kabir SS, Rinesmith C, Vilches C, Chakarvarty S, Jahangiri FR: Language mapping of the brain. Introduction to neurophysiology. Jahangiri FR (ed): Kendall Hunt Publishing Company, Dubuque, IA; 2023. 303 [12]
Figure 3
Figure 3. Bipolar ball tip stimulation probe.
Hand-held bipolar ball tip stimulation probe used for Penfield method direct cortical stimulation. Source: Kabir SS, Rinesmith C, Vilches C, Chakarvarty S, Jahangiri FR: Language mapping of the brain. Introduction to neurophysiology. Jahangiri FR (ed): Kendall Hunt Publishing Company, Dubuque, IA; 2023. 303 [12]
Figure 4
Figure 4. Cortical grid electrode.
Schematic representations of 64-contact (8×8) cortical grid electrode. Source: Kabir SS, Rinesmith C, Vilches C, Chakarvarty S, Jahangiri FR: Language mapping of the brain. Introduction to neurophysiology. Jahangiri FR (ed): Kendall Hunt Publishing Company, Dubuque, IA; 2023. 303 [12]
Figure 5
Figure 5. Securing the patient's head.
The patient is under sedation, and the head is secured with a three-pin Mayfield holder to the operating table.
Figure 6
Figure 6. Picture naming.
Picture for naming various objects (tree, volleyball, car, and rabbit).
Figure 7
Figure 7. Language areas of the brain.
Brain image with the consolidation of the areas involved with language. Source: Kabir SS, Rinesmith C, Vilches C, Chakarvarty S, Jahangiri FR: Language mapping of the brain. Introduction to neurophysiology. Jahangiri FR (ed): Kendall Hunt Publishing Company, Dubuque, IA; 2023. 310 [12]
See this image and copyright information in PMC

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