"False friends" in Language Subcortical Mapping: A Systematic Literature Review

Area of Science:

• Neuroscience
• Neurosurgery
• Linguistics

Background:

• Subcortical brain mapping in awake glioma surgery is crucial for optimizing resection extent and minimizing neurological deficits.
• Accurate interpretation of intraoperative responses is essential for successful awake mapping.
• This review aims to map language networks and identify misleading responses ('false friends') in subcortical mapping.

Approach:

• A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted.
• Data extraction focused on expected responses, common tests, and potential 'false friends' for key white matter bundles.
• Sixty-seven papers were analyzed out of an initial 224 to create a comprehensive map.

Key Points:

• The study maps principal white matter bundles involved in language networks during awake surgery.
• It details common tests and expected responses for tracts like the arcuate fascicle and uncinate fascicle.
• Potential 'false friends' are identified, including false positives (early interruption) and false negatives (risky removal).

Conclusions:

• This paper critically reviews the current state of subcortical awake mapping for glioma surgery.
• It highlights practical 'false friends' encountered at critical language network crossroads.
• Understanding these misleading responses is vital for improving surgical outcomes and patient safety.