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Updated: May 5, 2026
Translational Brain Mapping at the University of Rochester Medical Center: Preserving the Mind Through Personalized Brain Mapping
Published on: August 12, 2019
Functional cortical mapping and structural subcortical anatomy predicts intra-operative speech arrest: a
Josephine Jung1, Kapil Rajwani2, Ana Mirallave-Pescador3
1Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Neurosciences Clinical Trials Unit, King's College Hospital NHS Foundation Trust, London, UK; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.
Objective:
Cortical speech mapping using navigated Transcranial Magnetic Stimulation (nTMS) has a variable positive predictive value (PPV) when compared with intraoperative direct electrical stimulation.
Methods:
This is a single centre prospective study of all patients undergoing pre-operative nTMS and tractography (frontal aslant tract (FAT) and arcuate fasciculus (AF)) for awake surgery between October 2018 and November 2023. We reviewed operative notes for speech arrest, collected data on demographics, histopathology and pre-/post-operative language assessment.
Results:
57 patients were included (27 female, 30 male) with a mean age of 46 years. 89.5 % were right-handed. 59.6 % of patients had surgery for isocitrate dehydrogenase (IDH)-mutant glioma (n = 34). Intra-operative speech arrest was located at opIFG (n = 32), vPrG (n = 19), pMFG (n = 5) and mPoG (n = 1). In 87.7 % of cases (n = 50) intra-operative speech arrest was colocated with nTMS and tractography. This was statistically significant especially in tumours involving opIFG (n = 21) and improved accuracy of locating intra-operative speech arrest when compared with using nTMS or tractography alone (p < 0.01). This was also true for IDH-wildtype tumours (triple colocation n = 14, other modalities n = 6, p < 0.05).
Conclusions:
Preoperative cortical-subcortical integration is paramount for the prediction of intra-operative speech arrest.
Significance:
nTMS-FAT-AF trilocation is a useful tool in predicting intra-operative speech arrest.
