[Microsurgical resection of dominant hemisphere gliomas with intraoperative speech mapping by a staff neurologist].

Abstract

Intraoperative awakening with speech mapping is used to minimize the risk of irreparable neurological deficit in patients with tumors located near speech zones. However, the lack of staff neurolinguist or neuropsychologist in the majority of neurosurgical departments is one of the limiting factors.

Objective: To analyze surgical treatment of patients with glial tumors near speech and motor centers using intraoperative awakening with speech mapping by staff neurologist.

Material and methods: We analyzed postoperative outcomes in 15 patients with dominant hemisphere gliomas of functionally significant areas between 2020 and 2024. All surgeries were accompanied by multimodal neurophysiological monitoring including intraoperative awakening and mapping by staff neurologist without neuropsychologist or neurolinguist. Intraoperative contrast-enhanced MRI was performed in 3 (20.0%) patients (T2WI and T1WI). Postoperative MRI was performed on the first postoperative day in all patients for objective assessment of resection quality.

Results: Total resection was achieved in 13 (86.7%) cases, subtotal - in 2 (13.3%) cases. In 11 (73.3%) patients, no postoperative neurological deficit was detected. Three (20.0%) patients had transient speech impairment with regression throughout a month. Persistent deficit developed in 1 (6.7%) patient.

Conclusion: Standardized speech mapping methods and staff neurologist for cortical mapping during resection of gliomas near functionally significant speech zones maintain high extent of resection without higher risk of permanent speech disorders. Widespread speech mapping by staff neurologists of neurosurgical departments will increase the number of function-preserving surgeries in all regions of the Russian Federation.