Language testing in awake craniotomy for brain tumor resection: A survey of current perioperative practice in the United Kingdom.

Abstract

Background: Language testing and mapping procedures are considered the gold standard for safe tumor resection and preservation of language and communication in patients with tumors located in an area eloquent for language, especially in the presence of low-grade gliomas. However, the current status of language testing in awake craniotomy in the United Kingdom is unknown. The main aim of this study was to describe the language testing practices in awake brain surgery across the United Kingdom.

Methods: An online survey was addressed to medical practitioners working with brain tumor patients during the phases of language testing. Questions inquired about the tests and approaches for language testing before, during, and after the surgery. The survey also explored the management of bilingual (for the sake of simplicity, the term bilingual is used throughout the article to refer to patients who speak 2 or more languages) brain tumor patients and gathered personal perspectives from clinicians.

Results: Responses were obtained from 37 clinicians. Speech and language therapists and neuropsychologists administered language tests to patients, and those with sufficient language skills for completing intraoperative tests were eligible for awake mapping. A combination of standardized language batteries and homemade tasks were used for language testing, leading to variability in testing practices across institutions. For language mapping, the most popular tasks were picture naming, sentence completion, and repetition. Object and action naming were used across both the monolingual and bilingual patient groups. The timing of postoperative assessments varied according to patient needs and clinician availability. Bilingual patients were evaluated with interpreters and limited materials, compared to monolinguals.

Conclusions: The provision of awake craniotomy language testing presents differences across UK-based institutions. Responders advocate for more comprehensive, updated, and inclusive materials to facilitate language testing in modern patient cohorts spanning a wide range of linguistic skills and foreign languages.