Perioperative language assessment in multilingual patients undergoing awake surgery / Barbara Köpke

Perioperative language assessment in multilingual patients undergoing awake surgery / Barbara Köpke. In "Perspectives neuropsycholinguistiques sur l'aphasie - NeuroPsychoLinguistic Perspectives on Aphasia", colloque international organisé par l'Unité de Recherche Interdisciplinaire Octogone de l'Université Toulouse II-Le Mirail (France). Toulouse, 21-23 juin 2012.

Anawake craniotomy is an operation performed in the same manner asa conventionalcraniotomy butwith the patient awake during the procedure. This is a preferredtechnique for operations to remove lesions close to, or involving,eloquent language cortex. Direct intraoperative electricalstimulation mapping (ESM) allows testing patient’s motor andlanguage functions continuously throughout the operation. The overallaim is to preserve the patient’s language skills (Ojemann, Ojemann,Lettich, & Berger, 1989). This technique has been popularized forepilepsy surgery (Ojemann, 1987) but also allows most of braintumours to be aggressively resected without any long-term languagedeficit (Sanai, Mizadeh, & Berger, 2008). 
Forbilingual and multilingual patients, brain activation (see review inIndefrey, 2006) and ESM studies (e.g. Giussani et al. 2007; Lucas etal. 2004) have shown that different languages may be localized, atleast partially, in distinct microanatomical systems located withinthe same gross anatomical areas. 
Wereport 3 case studies, for which a comprehensive assessment oflanguages they were fluent in was conducted pre-, intra-, andpost-operatively, to preserve their communication skills and qualityof life:
- AFrench-English-Slovakian-Spanish quadrilingual (PP); 
- AFrench-English-Occitan trilingual (MF); 
- AnArabic-Spanish-French trilingual (WA).

Twopatients (PP and MF) had a left premotor WHO grade II glioma, and onepatient (WA) had a left premotor cortical dysplasia. 
Orallanguage skills were assessed pre- and post-operatively with selectedparts of the Bilingual Aphasia Test (BAT) (Paradis et al. 1987) inthe languages they currently use: French-English for PP,French-Occitan for MF, and Arabic-Spanish-French for WA. Naming taskswere constructed in the same languages. Pictures were selected fromthe CRL-IPNP corpus (Szekely et al., 2005) with the exclusion of allpictures which elicited cognates or compound words, or which wereculturally not adapted. The selected pictures were matched as far aspossible for length across languages and frequency. Only picturesthat the patient named correctly in each language were retained forintraoperative testing. Additionally, a switch task was constructedfor each patient involving the two most important languages. Theblocked naming tasks in two languages and the switch task were usedfor ESM during surgery. These were also used for post-operativetesting, as well as the BAT. 
Wewill present pre- and postoperative behavioral data as well as brainmapping data and discuss their relevance with respect to the neuralrepresentation of languages in multilingual speakers.