| Summary: | 博士 === 國立臺灣大學 === 醫學工程學研究所 === 106 === Objective: Awake craniotomy combined with intraoperative stimulation mapping (ISM) and monitoring pursues the balance between extensive tumor resection and preserving postoperative language function. During ISM, the awake patient performs intraoperative linguistic tasks while suppressed-electrical stimulation is applying on the regional brain. However, few studies have evaluated the efficacy of intraoperative linguistic testing based on language outcomes and the dilemma that exists in patients whose tumor resection was restricted due to signs of linguistic disturbance observed during awake brain surgery. Therefore, in our first series study, we devised a novel intraoperative task and hypothesized that it can be easily applied in ISM and can preserve the language function of patients after surgery. In our second series study, we quantified the change in postoperative language function by comparing it with the intraoperative linguistic performance to understand the degree to which the recovery of language impairment caused by tumor resection can be achieved through spontaneous neuroplasticity. Methods: We used the modified short form of the Boston Diagnostic Aphasia Examination (sfBDAE) to assess preoperative and postoperative language functions. In the first series study, our novel and comprehensive naming task, which was modified using the stimulus sets of the sfBDAE, included objects, actions, colors, numbers, English letters, Chinese words, and shapes, and was employed in ISM. We analyzed the trend of the changed language function in line charts and compared the change in linguistic measurements by using a paired t test. In the second series study, a visual object naming test called the Dénomination d’objet 80 (DO 80) as well as a semantic-association test called the Pyramids and Palm Trees Test (PPTT) were used for intraoperative linguistic testing. The DO 80 and PTT were performed alternatively during the subcortical functional monitoring of tumor resection. Pearson’s correlation and multiple linear regression were used to analyze the correlation between the accuracy rates of the intraoperative linguistic tasks in the terminal stage of tumor resection and the scores of the postoperative sfBDAE subtests. A Receiver Operating Characteristic (ROC) analysis was used to define the cut point of the accuracy rates to predict postoperative language deficits. Results: In the first series study, the patient’s language function was either preserved after surgery or exhibited significant improvement over time. The trend of functional recovery varied in the complex ideational material, word discrimination, and repeating phrases subtests. In the second series study, both the intraoperative DO 80 and PPTT revealed a significant correlation with the postoperative sfBDAE domain scores (p < 0.05), with a higher correlation observed in the PPTT. A linear regression model demonstrated that only the PPTT could be included to predict the postoperative sfBDAE domain scores, with the explanatory power ranging from 0.51 to 0.89 (all p < 0.01). The ROC analysis demonstrated that the cutoff value for the accuracy rate in the PPTT was 0.75, yielding a sensitivity of 80% and specificity of 100%. Conclusion: The modified sfBDAE can indicate preoperative variations in language function, and the novel and comprehensive naming task used in this study can be applied in ISM and can preserve or improve linguistic outcomes. In addition, the PPTT is a feasible tool for intraoperative linguistic evaluations to predict postoperative language outcomes. Tumor resection should be limited when the accuracy rate of the PPTT approaches the cutoff value of 0.75. We therefore suggest using more comprehensive intraoperative tasks in ISM and intraoperative monitoring as well as the numerical accuracy rate proposed in this study for intraoperative linguistic monitoring.
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