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Cited by 1,065Glioma Diagnosis and TreatmentNeurobiology of Language and BilingualismIntraoperative Neuromonitoring and Anesthetic Effects

Functional Outcome after Language Mapping for Glioma Resection

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Sanai, Nader, Mirzadeh, Zaman, Berger, Mitchel S.·2008·New England Journal of Medicine
DOI 10.1056/nejmoa067819
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Abstract

BACKGROUND: Language sites in the cortex of the brain vary among patients. Language mapping while the patient is awake is an intraoperative technique designed to minimize language deficits associated with brain-tumor resection. METHODS: To study language function after brain-tumor resection with language mapping, we examined 250 consecutive patients with gliomas. Positive language sites (i.e., language regions in the cortex of the brain, 1 cm by 1 cm, which were temporarily inactivated by means of a bipolar electrode) were identified and categorized into cortical language maps. The tumors were resected up to 1 cm from the cortical areas where intraoperative stimulation produced a disturbance in language. Our resection strategy did not require identification of the stimulation-induced language sites within the field of exposure. RESULTS: A total of 145 of the 250 patients (58.0%) had at least one site with an intraoperative stimulation-induced speech arrest, 82 patients had anomia, and 23 patients had alexia. Overall, 3094 of 3281 cortical sites (94.3%) were not associated with stimulation-induced language deficits. A total of 159 patients (63.6%) had intact speech preoperatively. One week after surgery, baseline language function remained in 194 patients (77.6%), it worsened in 21 patients (8.4%), and 35 patients (14.0%) had new speech deficits. However, 6 months after surgery, only 4 of 243 surviving patients (1.6%) had a persistent language deficit. Cortical maps generated with intraoperative language data also showed surprising variability in language localization within the dominant hemisphere. CONCLUSIONS: Craniotomies tailored to limit cortical exposure, even without localization of positive language sites, permit most gliomas to be aggressively resected without language deficits. The composite language maps generated in our study suggest that our current models of human language organization insufficiently account for observed language function.

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  • Current surgical methods in neurooncology have led to significant advancements in patient outcome and the emergence of supramarginal resections.

    “Current surgical methods in neurooncology, including awake surgery, 80 cortical mapping, 28 and neurophysiological techniques, 13 have led to significant advancements in patient outcome and the emergence of supramarginal resections whereby tumor resections are extended to functional boundaries.54”

    From Graph theory analysis of complex brain networks: new concepts in brain mapping applied to neurosurgery (2016) · cites this paper as [80]

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Authors
Sanai, N., Mirzadeh, Z., & Berger, M. S.
Affiliations
University of California, San Francisco (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2008-01-03
Volume
358
Issue
1
Pages
18-27
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa067819
OpenAlex
W1989413447
Cited by
1,065
References
37
Citations by year
2026: 28 · 2025: 44 · 2024: 50 · 2023: 64 · 2022: 62 · 2021: 73 · 2020: 69 · 2019: 62 · 2018: 67 · 2017: 84 · 2016: 70 · 2015: 74 · 2014: 63 · 2013: 61 · 2012: 50
FWCI
21.93
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
  • Health Sciences › Medicine › Surgery › Intraoperative Neuromonitoring and Anesthetic Effects
Keywords
glioma, intraoperative language mapping, awake craniotomy, language localization, language deficits, speech arrest, anomia, alexia, tumor resection
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Anomia, Brain Mapping, Brain Neoplasms, Cerebral Cortex, Dominance, Cerebral, Dyslexia, Female, Glioma, Humans, Language, Language Tests, Male, Middle Aged, Postoperative Complications, Monitoring, Intraoperative

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