Abstract

BACKGROUND
Awake craniotomy with cortical stimulation is the standard for language mapping in patients with tumors near or within the language cortex. Reliable identification of the speech cortex is difficult, however, and adjunctive pre- and intraoperative techniques have inconsistent reliability.
OBJECTIVES
We describe a technique based on direct cortical stimulation which localizes speech areas by correlating vocal cord activation in the anesthetized patient with speech arrest in the awake patient.
METHODS
Direct cortical stimulation is applied to the patient and the vocal cords are visualized by fiberoptic endoscopy. The cortical site that produces vocal cord activation is identified. Once the patient is awakened, cortical stimulation is repeated and sites that produce speech arrest are identified.
RESULTS
We have performed this technique in 3 patients and have consistently correlated vocal cord activation with speech arrest in all patients. These areas of activation also correlate with areas of functional MRI BOLD activation obtained from the expressive language paradigms.
CONCLUSIONS
Colocalization of the site of vocal cord activation in the asleep patient to the site of speech arrest in the awake patient represents an adjunct for defining speech areas. This technique is useful for patients unable to tolerate awake craniotomy.

Links

Publisher Full Text

Authors

Schapiro R, Ferson D, Prabhu SS, Tummula S, Wefel J, Rao G

Institution

Department of Neurosurgery, M.D. Anderson Cancer Center, Houston, TX 77030, USA.

Source

Stereotactic and functional neurosurgery 90:2 2012 pg 118-23

MeSH

Adult
Brain Mapping
Brain Neoplasms
Cerebral Cortex
Craniotomy
Female
Glioma
Humans
Magnetic Resonance Imaging
Neuropsychological Tests
Speech

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22398728