Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
J Neurooncol. 2018 Aug;139(1):215-223. doi: 10.1007/s11060-018-2863-z. Epub 2018 Apr 10.
Awake craniotomy pursues a balance between extensive tumor resection and preservation of postoperative language function. A dilemma exists in patients whose tumor resection is restricted due to signs of language impairment observed during awake craniotomy. In order to determine the degree to which recovery of language function caused by tumor resection can be achieved by spontaneous neuroplasticity, the change in postoperative language function was compared to quantified intraoperative linguistic performance.
The modified, short-form Boston Diagnostic Aphasia Examination (sfBDAE) was used to assess pre- and postoperative language functions; visual object naming (DO 80) and semantic-association (Pyramid and Palm Tree Test, PPTT) tests assessed intraoperative linguistic performance. DO 80 and PPTT were performed alternatively during subcortical functional monitoring while performing tumor resection and sfBDAE was assessed 1-week postoperatively.
Most patients with observed language impairment during awake surgery showed improved language function postoperatively. Both intraoperative DO 80 and PPTT showed significant correlation to postoperative sfBDAE domain scores (p < 0.05), with a higher correlation observed with PPTT. A linear regression model showed that only PPTT predicted the postoperative sfBDAE domain scores with the adjusted R ranging from 0.51 to 0.89 (all p < 0.01). Receiver operating characteristic analysis showed a cutoff value of PPTT that yielded a sensitivity of 80% and specificity of 100%.
PPTT may be a feasible tool for intraoperative linguistic evaluation that can predict postoperative language outcomes. Further studies are needed to determine the extent of tumor resection that optimizes the postoperative language following neuroplasticity.
清醒开颅术旨在平衡广泛的肿瘤切除和术后语言功能的保留。在清醒开颅术中观察到语言障碍迹象而限制肿瘤切除的患者存在困境。为了确定肿瘤切除引起的语言功能恢复程度可以通过自发神经可塑性实现，将术后语言功能的变化与量化的术中语言表现进行比较。
使用改良的波士顿诊断性失语症检查（sfBDAE）评估术前和术后的语言功能；视觉物体命名（DO 80）和语义联想（金字塔和棕榈树测试，PPTT）测试评估术中语言表现。在进行肿瘤切除的同时进行皮质下功能监测时交替进行 DO 80 和 PPTT，术后 1 周评估 sfBDAE。
在清醒手术中观察到语言障碍的大多数患者术后语言功能均有改善。术中 DO 80 和 PPTT 均与术后 sfBDAE 域评分显著相关（p<0.05），与 PPTT 的相关性更高。线性回归模型显示，只有 PPTT 可以预测术后 sfBDAE 域评分，调整后的 R 范围从 0.51 到 0.89（均 p<0.01）。受试者工作特征分析显示，PPTT 的截断值具有 80%的敏感性和 100%的特异性。
PPTT 可能是一种可行的术中语言评估工具，可以预测术后语言结果。需要进一步研究确定肿瘤切除的程度，以优化神经可塑性后的术后语言功能。
