Balancing task sensitivity with reliability for multimodal language assessments

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  • 1 Department of Neurological Surgery, University of California, San Francisco, California; and
  • | 2 Department of Psychology, University of Michigan, Ann Arbor, Michigan
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OBJECTIVE

Intraoperative tasks for awake language mapping are typically selected based on the language tracts that will likely be encountered during tumor resection. However, diminished attention and arousal secondary to perioperative sedatives may reduce a task’s usefulness for identifying eloquent cortex. For instance, accuracy in performing select language tasks may be high preoperatively but decline in the operating room. In the present study, the authors sought to identify language tasks that can be performed with high accuracy in both situational contexts so the neurosurgical team can be confident that speech errors committed during awake language mapping result from direct cortical stimulation to eloquent cortex, rather than from poor performance in general.

METHODS

We administered five language tasks to 44 patients: picture naming (PN), text reading (TR), auditory object naming (AN), repetition of 4-syllable words (4SYL), and production of syntactically intact sentences (SYNTAX). Performance was assessed using the 4-point scale of the quick aphasia battery 24 hours preoperatively and intraoperatively. We next determined whether or not accuracy on each task was higher preoperatively than intraoperatively. We also determined whether 1) intraoperative accuracy on a given task predicted intraoperative performance on the other tasks and 2) low preoperative accuracy on a task predicted a decrease in accuracy intraoperatively.

RESULTS

Relative to preoperative accuracy, intraoperative accuracy declined on PN (3.90 vs 3.82, p = 0.0001), 4SYL (3.96 vs 3.91, p = 0.0006), and SYNTAX (3.85 vs 3.67, p = 0.0001) but not on TR (3.96 vs 3.94, p = 0.13) or AN (3.70 vs 3.58, p = 0.058). Intraoperative accuracy on PN and AN independently predicted intraoperative accuracy on the remaining language tasks (p < 0.001 and p < 0.01, respectively). Finally, low preoperative accuracy on SYNTAX predicted a decrease in accuracy on this task intraoperatively (R = 0.36, p = 0.00002).

CONCLUSIONS

While TR lacks sensitivity in identifying language deficits at baseline, accuracy on TR is stable across testing settings. Baseline accuracy on the other four of our five language tasks was not predictive of intraoperative performance, signifying the need to repeat language tests prior to stimulation mapping to confirm reliability.

ABBREVIATIONS

AN = auditory object naming; PN = picture naming; QAB = quick aphasia battery; SYNTAX = production of syntactically intact sentences; TR = text reading; 4SYL = repetition of 4-syllable words.

Supplementary Materials

    • Supplemental Table 1 (PDF 411 KB)

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Contributor Notes

Correspondence Shawn L. Hervey-Jumper: University of California, San Francisco, CA. shawn.hervey-jumper@ucsf.edu.

INCLUDE WHEN CITING Published online May 28, 2021; DOI: 10.3171/2020.10.JNS202947.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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