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'Surgery Needs to Preserve Brain Tumour Patients' Speech in Native Language’

'Surgery Needs to Preserve Brain Tumour Patients' Speech in Native Language’

As part of the HSE April Conference, Olga Dragoy, Head of HSE Center for Language and Brain (Neurolinguistics Laboratory), presented some of the cutting-edge methods of preventing speech disorders in Russian-speaking patients with brain pathology, including the first Russian-language intraoperative naming test developed by the Center. All test materials and instructions are available for free and can be used in clinical practice.

Speech mapping during craniotomy jointly by the neurosurgeon and neurolinguist with the purpose of preserving the patient's speech functions is common practice throughout the world. Normally, such neurosurgery involves intraoperative awakening. The patient is under anaesthesia while the surgeon accesses the brain tissue; then the patient is temporarily awakened for the mapping of their speech zones by means of electrical stimulation, and then the patient is anaesthetised again for the neurosurgeon to complete the operation. Sometimes, this type of surgery is performed on conscious patients under local anaesthesia throughout the operation. During both types of operations, the surgeon applies electrical stimulation to different brain regions, while the neurolinguist presents the patient with a speech task. If the patient stops performing the task, it signals that the neurosurgeon is stimulating an area responsible for a particular speech function, which is then outlined to avoid its resection.

The neurolinguist's role is essential, as they have the expertise to determine what kind of task needs to be presented in each specific case, and it is often the neurolinguist who designs speech tests tailored to the patient's needs. On one hand, such tests should be sufficiently sensitive to enable precise detection of critical speech regions, and on the other hand, they should allow complete removal of the tumour. ‘To enable precise localisation of speech substrate and subsequent safe resection of the adjacent tumour, asking the patient to count to ten or call the days of the week is never enough, although this unfortunate practice persists in some clinics,’ says Dragoy. ‘It has long been proven that different areas of the brain are involved in generating spontaneous and automated speech.’

A team of HSE neurolinguists have designed and standardised a tool for accurate mapping and preservation of speech regions in Russian-speaking patients with brain tumours. This is the first Russian-language intraoperative naming test successfully used during brain tumour resection involving patient awakening (Intraoperational Naming Test - Materials.zip).

While the procedure is simple – the patient is presented with pictures and asked to name them – it involves multiple functions characteristic of natural speech generation, such as semantic processing, word search, actualisation of associated grammatical information, and utterance. This test contains action-naming as well as object-naming tasks, providing for accurate localisation of brain regions responsible for different aspects of speech. All test materials and instructions are available for free and can be used in clinical practice.

According to Dragoy, it is particularly important to draw this test to the attention of medical professionals internationally, since many Russian patients travel to other countries for brain surgery.

‘Without discussing the quality of medicine in Russia and abroad, I would strongly suggest that Russian-speaking personnel should be present and Russian-language diagnostic tools should be used during craniotomy in patients whose native language is Russian,’ she stressed. ‘Such tools have been developed in our laboratory and successfully applied in major clinics, such as Burdenko Neurosurgery Institute and Pirogov National Medical and Surgical Centre in Moscow and the Federal Neurosurgical Centre in Novosibirsk.’

 

See also:

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