Cortical mapping in multilinguals undergoing awake brain surgery for brain tumors: Illustrative cases and systematic review

• Published in: Neuropsychologia Vol. 179; p. 108450
• Main Authors: Pascual, Juan Silvestre G., Khu, Kathleen Joy O., Starreveld, Yves P.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 28.01.2023
• Subjects: Adult; Awake craniotomy; Brain mapping; Brain Mapping - methods; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Brain tumors; Broca Area; Female; Glioma - diagnostic imaging; Glioma - pathology; Glioma - surgery; Humans; Male; Middle Aged; Multilingual brain mapping; Multilingualism; Wakefulness; Awake craniotomy; Multilingual brain mapping; Brain tumors; Brain mapping
• ISSN: 0028-3932; 1873-3514
• DOI: 10.1016/j.neuropsychologia.2022.108450

Awake brain mapping in multilingual patients with brain tumors presents unique challenges to the neurosurgeon. Knowledge of potential eloquent sites is vital to preserve language function. We present two cases of pars opercularis glioma and perform a systematic review in accordance with PRISMA guidelines. Our review yielded 7 studies, with a total of 25 multilingual brain tumor patients who underwent awake brain mapping. The age ranged from 25 to 62 years. Majority were female (56.5%). Most (52%) were trilingual, while 20% were quadrilingual and 28% were pentalingual. All tumors were left-sided, mostly in the frontal lobe. These were predominantly gliomas. Extent of resection was gross total in 61%. The brain mapping findings were heterogeneous. Some authors reported a greater number of cortical sites for the first language compared to others. Others found that the first and second languages shared cortical sites whereas the third and subsequent languages were located in distant sites. The peri-Sylvian area was also found to be involved in language that was learned at an earlier age. Subsequent languages thus involved more distant sites. A larger number of cortical areas were also activated for languages that were learned later in life. In terms of language disturbance and recovery, there were mixed results. Cortical mapping in multilingual brain tumor patients showed heterogeneity in terms of the location and number of language areas in the face of pathology. These findings may influence neurosurgical and oncological management of tumors in the speech area but emphasize the need to tailor surgical approaches and intraoperative testing to the patient. •We report 2 cases of multilinguals who underwent awake brain mapping with direct cortical stimulation; and review the literature•Most saw that first language was stimulated around traditional peri-Sylvian cortical areas; subsequent languages tended to be more varied.•Subcortical white matter more robust in language function.