De Witte Elke, Mariën Peter
Department of Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium.
Clin Neurol Neurosurg. 2013 Feb;115(2):127-45. doi: 10.1016/j.clineuro.2012.09.015. Epub 2012 Oct 2.
Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in critical language areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, the literature is only scantily documented with information about the linguistic methods applied in awake surgery. This article critically reviews the neurolinguistic procedures currently used in awake studies.
Based on an extensive review of the literature, an overview is given of the language mapping techniques applied in brain tumour surgery. Studies investigating linguistic testing and outcome in awake surgery were analysed. Information about the timing of the assessment(s), the linguistic tasks, the linguistic stimuli and the indication for awake surgery was also discussed.
Intraoperative DES remains the 'gold standard' for language mapping, but pre- and postoperative non-invasive mapping methods are important adjuncts. In the pre- and postoperative phase, standardised linguistic test batteries are generally used to assess language function. In the intraoperative phase, only naming and number counting are commonly applied. Most often no detailed information about the linguistic stimuli is provided and no standardised protocols measuring different linguistic levels have been described.
Awake surgery with DES is a useful tool for preserving linguistic functions in patients undergoing surgery in critical brain regions. However, no studies exist that apply a well-balanced and standardised linguistic protocol to reliably identify the critical language zones. The availability of a standardised linguistic protocol might substantially increase intraoperative comfort and might improve outcome and quality of life.
术中直接电刺激（DES）越来越多地用于在关键语言区域进行肿瘤手术的患者。尽管普遍认为DES对术后语言结果有积极影响，但关于清醒手术中应用的语言方法的文献记载很少。本文对清醒研究中目前使用的神经语言学程序进行了批判性综述。
在广泛查阅文献的基础上，概述了脑肿瘤手术中应用的语言映射技术。分析了研究清醒手术中语言测试和结果的研究。还讨论了评估时间、语言任务、语言刺激以及清醒手术适应症的相关信息。
术中DES仍然是语言映射的“金标准”，但术前和术后的非侵入性映射方法是重要的辅助手段。在术前和术后阶段，通常使用标准化的语言测试组合来评估语言功能。在术中阶段，通常只应用命名和数字计数。大多数情况下，没有提供关于语言刺激的详细信息，也没有描述测量不同语言水平的标准化方案。
对于在关键脑区接受手术的患者，采用DES的清醒手术是保留语言功能的有用工具。然而，目前尚无研究应用平衡且标准化的语言方案来可靠地识别关键语言区域。标准化语言方案的可用性可能会大幅提高术中舒适度，并可能改善手术结果和生活质量。
