'Over 12 Years, We Have Participated in Nearly 1,000 Awake Surgeries'
HSE University hosted the 13th Summer Neurolinguistics School, organised by the Centre for Language and Brain with support from the HSE Faculty of Humanities. The programme focused on collaboration among neurolinguists, neurosurgeons, and neurophysiologists in the operating room, standardisation of linguistic paradigms, and practical approaches to preserving patients’ language function.
Why a Linguist in the Operating Room?
From the very first lectures, the school addressed a fundamental question: why is a linguist needed in the operating room? Drawing on examples from clinical practice, the speakers demonstrated that intraoperative language assessment is not merely an addition to standard treatment procedures but an essential component of safe tumour resection. Coordinated collaboration among a neurosurgeon, a neurophysiologist, and a linguist makes it possible to accurately identify functional brain areas and adjust resection boundaries in a way that preserves critical regions, neural pathways, and blood vessels, thereby minimising the risk of postoperative language impairment.
In her talk, Olga Dragoy, Director of the Centre for Language and Brain, traced the evolution of ideas about the neuroanatomy of language and highlighted the considerable individual variability of language-related brain regions. She stressed that effective preoperative planning begins with an understanding of the patient's unique language organisation and requires the involvement of a neurolinguist throughout the entire diagnostic process—from preoperative mapping to intraoperative assessment and postoperative monitoring.
'The first operation involving researchers from the Centre for Language and Brain was performed in 2014, and over the past 12 years we have participated in nearly 1,000 awake surgeries. We develop protocols that help preserve patients’ language function and improve their quality of life, bringing these protocols into routine clinical practice,' said Prof. Dragoy.
According to neurophysiologist Mikhail Sinkin, Head of the Department of Medical Neurotechnology at Pirogov University, the role of linguists extends beyond individual operations and includes the development of reproducible protocols and sensitive tasks that can be widely implemented by clinicians across different centres.
Neurosurgeon Andrey Zuev, Head of the Department of Neurosurgery at the Pirogov National Medical and Surgical Centre, discussed the practical realities of intraoperative mapping. He explained that while preoperative imaging methods help plan the surgical route for tumour resection, they do not provide absolute certainty. As a result, intraoperative language testing performed by a linguist in the operating room remains critical. He compared tumour resection to walking through a minefield and emphasised the importance of carefully avoiding functional areas while preserving neural pathways and blood vessels.
Alina Minnigulova, Research Fellow at the Centre for Language and Brain, spoke about the role of associative tracts in speech production and comprehension. She explained that, in addition to cortical regions, white matter bundles play a crucial role by connecting different areas of the cerebral cortex, and that damage to these pathways can lead to specific language disorders.
'Restoration of tracts is possible in cases of limited lesions; however, their function may also be reorganised through compensation by other pathways or their contralateral homologues, particularly in cases of long-standing disease,' the researcher explained.
Olga Buivolova, Research Fellow at the Centre for Language and Brain, presented a comparative analysis of postoperative language syndromes and aphasias in stroke. She noted that stroke typically results in well-defined, classifiable syndromes, whereas language disorders following tumour resection tend to be more heterogeneous and more often reversible. She also discussed the relationship between different types of dementia and language impairments, emphasising the need for a differentiated approach to diagnosis and rehabilitation.
Practical Solutions
The practical principles of developing neurolinguistic tasks and criteria for their sensitivity were discussed using examples of test adaptation for different languages and varying degrees of impairment severity. The second day of the Summer School began with a presentation by Maria Prokopeva, Junior Research Fellow at the Centre for Language and Brain, who introduced the LIS (Linguistic Intraoperative Support) software and its multilingual adaptation, describing in detail the structure of intraoperative testing as well as the procedures for preoperative, intraoperative, and postoperative assessment of language function.
Practical mapping tools such as fMRI, transcranial magnetic stimulation (TMS), and the Wada test were discussed as complementary methods for preoperative diagnosis.
'Using fMRI requires careful attention to both protocols and statistics due to ongoing background brain activity,' noted Ekaterina Pechenkova, Head of the HSE Laboratory for Cognitive Research. In her presentation, she discussed the requirements for preoperative fMRI mapping and emphasised the need for neuropsychologists to be involved in adapting tasks to the individual patient in order to obtain reliable maps of functional brain areas.
Anna Komissarenko, Junior Research Fellow at the Centre for Language and Brain, shared her experience of preoperative TMS mapping and discussed the Axilum robotic system as well as empirical data on selecting optimal stimulation parameters for language mapping tasks. She noted that TMS demonstrates high sensitivity and can often serve as an alternative when intraoperative mapping is not possible.
Irina Provlotskaya, Research Assistant at the Centre for Language and Brain, presented an updated Wada test protocol, highlighting its diagnostic value for determining language and memory lateralisation as well as the practical nuances of the procedure.
'The Wada test is a neurosurgical procedure used to temporarily shut down one hemisphere of the brain. An anaesthetic is injected alternately into the carotid artery to selectively inactivate either the right or the left hemisphere. This makes it possible to determine which cognitive functions are supported by each hemisphere. As a result, the Wada test allows clinicians to assess the lateralisation of language and memory functions,' explained the researcher.
Yevgeny Shaposhnikov, graduate of the Faculty of Fundamental Medicine at Moscow State University, compared resting-state fMRI with task-based fMRI. He noted that the results are partially comparable; however, the overlap between networks visualised by the two methods is only moderate, which calls for careful interpretation when mapping language networks.
Tatyana Bolgina, Junior Research Fellow at the Centre for Language and Brain, presented the development of three fMRI paradigms of varying levels of complexity.
'Our objective was to design paradigms that would elicit comparable brain activation while being easier to perform. It is important that they can be used in patients with varying degrees of language impairment,' the speaker noted.
Ekaterina Rodionova, Research Assistant at the Centre for Language and Brain, presented the neural correlates of language function in elderly individuals based on structural MRI, showing that deterioration in lexical access is associated with atrophy of the middle and inferior temporal gyri. These findings support the potential of language-based tasks for early screening of neurodegenerative processes.
Ksenia Radusheva, Research Assistant at the Centre for Language and Brain, made the final presentation of the Summer School. She focused on predicting post-stroke language recovery based on the characteristics of white matter tracts. Analysis of metrics such as tract volume, fibre density, fractional anisotropy, and diffusion parameters reveals that the integrity of these pathways is directly related to the likelihood of successful recovery, and that alongside the arcuate fasciculus, other tracts play a significant role.
The Summer School concluded with a live poster session, where participants not only explored the theoretical foundations of the presented methods but also gained hands-on experience with language diagnostic tools developed by the centre, testing their functionality and interfaces. In her concluding remarks, Summer School organiser Anna Komissarenko outlined the next steps: standardisation of protocols, training of specialists, and multicentre research aimed at replicating best practices and making awake surgery safer and more widely accessible.
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