Canal-U

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.

An awake craniotomy is an operation performed in the same manner as a conventional craniotomy but with the patient awake during the procedure. This is a preferred technique for operations to remove lesions close to, or involving, eloquent language cortex. Direct intraoperative electrical stimulation mapping (ESM) allows testing patient’s motor and language functions continuously throughout the operation. The overall aim is to preserve the patient’s language skills (Ojemann, Ojemann, Lettich, & Berger, 1989). This technique has been popularized for epilepsy surgery (Ojemann, 1987) but also allows most of brain tumours to be aggressively resected without any long-term language deficit (Sanai, Mizadeh, & Berger, 2008). 
For bilingual and multilingual patients, brain activation (see review in Indefrey, 2006) and ESM studies (e.g. Giussani et al. 2007; Lucas et al. 2004) have shown that different languages may be localized, at least partially, in distinct microanatomical systems located within the same gross anatomical areas. 
We report 3 case studies, for which a comprehensive assessment of languages they were fluent in was conducted pre-, intra-, and post-operatively, to preserve their communication skills and quality of life:
- A French-English-Slovakian-Spanish quadrilingual (PP); 
- A French-English-Occitan trilingual (MF); 
- An Arabic-Spanish-French trilingual (WA).

Two patients (PP and MF) had a left premotor WHO grade II glioma, and one patient (WA) had a left premotor cortical dysplasia. 
Oral language skills were assessed pre- and post-operatively with selected parts of the Bilingual Aphasia Test (BAT) (Paradis et al. 1987) in the languages they currently use: French-English for PP, French-Occitan for MF, and Arabic-Spanish-French for WA. Naming tasks were constructed in the same languages. Pictures were selected from the CRL-IPNP corpus (Szekely et al., 2005) with the exclusion of all pictures which elicited cognates or compound words, or which were culturally not adapted. The selected pictures were matched as far as possible for length across languages and frequency. Only pictures that the patient named correctly in each language were retained for intraoperative testing. Additionally, a switch task was constructed for each patient involving the two most important languages. The blocked naming tasks in two languages and the switch task were used for ESM during surgery. These were also used for post-operative testing, as well as the BAT. 
We will present pre- and postoperative behavioral data as well as brain mapping data and discuss their relevance with respect to the neural representation of languages in multilingual speakers.