Subcortical language localization using sign language and awake craniotomy for dominant posterior temporal glioma resection in a hearing-impaired patient

Abstract

Intraoperative direct cortical stimulation (DCS) is the gold standard technique to maximize the extent of resection of tumors located in eloquent areas. To date, there are three cases reported of awake mapping for language centers in deaf patients who could communicate only with sign language. We present the case of DCS in a deaf patient who could communicate vocally, native to American Sign Language and English, that underwent intraoperative awake mapping. DCS showed similar disruption of expressive phonology to both pictorial and gestural stimuli, confirming that sign language follows the same pattern as oral language.

Awake surgery for a deaf patient using sign language: A case report

“…The previous studies on deaf signers reported that language organization was similar to that in patients without deafness [ 2 , 8 , 10 - 12 ], whereas other studies suggest that some differences between deaf and non-deaf signers in the parietal lobules are predominantly important for sign-language processing. [ 7 , 10 ] In addition, a recent detailed study by Leonard et al .…”

“…Four previous studies have reported cases of awake craniotomy using sign language in patients with hearing impairment for glioma resection. [ 1 , 8 , 11 , 12 ] All these studies reported that awake craniotomies and intraoperative tasks were safely performed with the help of a sign language interpreter. Moreover, these patients did not present any new postoperative neurological deficits.…”

“…Moreover, these patients did not present any new postoperative neurological deficits. Awake craniotomies for prelingual[ 1 , 12 ] and postlingual deaf patients[ 8 , 11 ] were performed in these reports, during which number counting,[ 1 , 11 , 12 ] visual object naming,[ 1 , 8 , 11 , 12 ] continuous motor function testing,[ 1 ] text reading,[ 12 ] repetition,[ 12 ] and the N back memory test[ 11 ] were used as intraoperative tasks.…”

“…is similar to our case in that the patient learned to speak vocally. [ 8 ] Intraoperative tasks during awake craniotomy were easier to perform because the patient could speak the language. Recent advances in managing prelingual deaf signers enable patients to learn signs and speak.…”

Preoperative validation of edema-corrected tractography in neurosurgical practice: translating surgeon insights into novel software implementation

“…Moreover, when the slider is combined with automated methods for clustering tracts of interest, the negative impact of artifactual tracts are further diminished by the anatomical constraints imposed at the clustering step. Nevertheless, the thresholding and tract visualization process for edematous pathologies should be guided solely at the surgeon’s discretion to evaluate the sensitivity of the algorithm within the context of the surgical intervention being planned and the patient’s functional status prior to surgery ( 40 , 41 ).…”