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Updated: Aug 1, 2025

Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping

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Published on: March 24, 2023

Intraoperative Testing During the Mapping of the Language Cortex.

Shabab S Kabir^1,2, Faisal R Jahangiri^3,4,2,1, Callista Rinesmith¹

¹Neuroscience, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, USA.

|May 1, 2023

Summary

Intraoperative neurophysiological monitoring (IONM) during awake craniotomies helps preserve speech by mapping language areas. Advanced testing methods improve accuracy, especially for complex cases and multilingual patients.

Keywords:

awake craniotomy cortical stimulation ecog intraoperative language testing ionm language mapping motor mapping neuromonitoring penfield taniguchi

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Area of Science:

Neurosurgery
Neurology
Neurophysiology

Background:

Intracranial lesions near language areas pose surgical challenges.
Awake craniotomies with intraoperative neurophysiological monitoring (IONM) are crucial for preserving speech.
Preoperative language testing establishes a baseline for intraoperative assessments.

Purpose of the Study:

To review current intraoperative language testing procedures.
To discuss future directions in language mapping during surgery.
To highlight techniques for minimizing postoperative speech impairments.

Main Methods:

Intraoperative neurophysiological monitoring (IONM) during awake craniotomies.
Preoperative and intraoperative language testing (phonological, semantic, syntactic).
Low-frequency bipolar Penfield stimulation for language mapping.

Main Results:

Standard tasks like counting and picture naming are common.
Nuanced tasks may be necessary for rare tumor patterns.
IONM effectively identifies language-eloquent areas.

Conclusions:

IONM is vital for safe excision of intracranial lesions affecting speech.
Refined language mapping techniques enhance patient outcomes.
Special considerations are needed for multilingual patients.