340 Simultaneous Preservation of Language and Executive Function in the Dominant Hemisphere. (1st April 2022)

• Record Type: Journal Article
• Authors: Aabedi, Alexander A.; Grant, Lauren; Kaur, Jasleen; Kakaizada, Sofia; Andrews, John P.; Weissman, Daniel; Brang, David; Hervey-Jumper, Shawn L.
• Is Part Of: Neurosurgery. Volume 68(2022)Supplement 1
• Page Start: 78
• Page End: 79
• Publication Date: 2022-04-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000001880_340
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: Although awake brain mapping is the gold-standard for the preservation of neurological function in patients with tumors in eloquent regions, it is resource-intensive, costly, and exposes patients to additional perioperative risks. Therefore, the tasks used to map out the brain should be carefully selected and limited to cognitive processes that will be permanently impaired if those brain regions are violated. Impairments in language and executive function are common after tumor resection and are associated with decreased survival. However, mapping of each of those functions separately is often infeasible and antithetical to the delivery of high-value care. METHODS: Each participant underwent awake craniotomy with intraoperative mapping using a single lexical retrieval task. Linear mixed-effects modeling was used to assess for a return to preoperative functional levels in language and executive function at preoperative, two days postoperative, and greater than one-month postoperative intervals. RESULTS: Participants had lesions in regions that placed them at risk for long-term functional impairments including the perisylvian language network and anterior cingulate gyrus. In the immediate postoperative setting, participants had substantial declines in language and overall executive function performance. However, at longer (i.e., >1 month) testing intervals, performance on both domains returned to baseline levels. Longitudinal changes in picture naming performance were predictive of changes in a measure of executive function that indexes cognitive flexibility. CONCLUSION: In patients undergoing resection of brain tissue in the dominant hemisphere, separate mapping of language and executive functions may not be necessary so long as a task that reliably recruits both is implemented during awake brain mapping.