The neurolinguistic approach to awake surgery reviewed

Area of Science:

• Neurosurgery
• Neurolinguistics
• Cognitive Neuroscience

Background:

• Direct electrical stimulation (DES) is increasingly utilized in surgeries involving critical language areas.
• While DES is advocated for positive postoperative linguistic outcomes, detailed documentation of applied neurolinguistic methods in awake surgery is scarce.
• This review critically examines current neurolinguistic procedures in awake surgery studies.

Purpose of the Study:

• To provide an overview of language mapping techniques used in brain tumor surgery.
• To analyze studies on linguistic testing and outcomes in awake surgery.
• To discuss the timing, tasks, stimuli, and indications for awake surgery.

Main Methods:

• Extensive literature review of language mapping techniques in brain tumor surgery.
• Analysis of studies focusing on linguistic testing and outcomes in awake surgery.
• Discussion of assessment timing, linguistic tasks, stimuli, and indications for awake surgery.

Main Results:

• Intraoperative DES is the gold standard for language mapping, complemented by pre- and postoperative non-invasive methods.
• Standardized linguistic test batteries are common in pre- and postoperative assessments.
• Intraoperative assessments primarily use naming and number counting, often lacking detailed stimuli information or standardized protocols for various linguistic levels.

Conclusions:

• Awake surgery with DES is valuable for preserving linguistic functions in critical brain regions.
• A lack of well-balanced, standardized linguistic protocols hinders reliable identification of critical language zones.
• Implementing a standardized linguistic protocol could enhance intraoperative comfort, improve outcomes, and increase quality of life.