THE IMPACT OF DEDICATED SPEECH THERAPY IN AN AWAKE CRANIOTOMY PATHWAY FOR PATIENTS WITH DOMINANT HEMISPHERE HIGH GRADE GLIOMAS

Abstract AIMS A previous audit over a 2-year period at The Walton Centre showed a 25% risk of worsening speech and lan- guage deficits and increased length of stay for dominant hemisphere high grade glioma (HGG) patients operated on asleep compared to non-dominant sided HGG patients. A business case acquired funding for a speech and language therapy (SLT) post for HGG awake craniotomies. In conjunction, an awake craniotomy pathway was developed. Aim: To assess the impact of a dedicated pathway, including speech and language therapy, on outcomes for patients undergoing awake craniotomy for dominant hemisphere HGGs over an 11-month period. METHODS Prospective data from Feb 2024 were collected. Data included timing from referral to surgery, pre and post- operative dysphasia severity, length of stay, community speech and language therapy referral requirement, and qualitative patient feedback. RESULTS A streamlined awake craniotomy pathway was implemented for 10 patients with a high-grade glioma who all had preexisting speech and/or language deficits. The pathway included multidisciplinary team meetings, sur- geon encouragement and planning, a one-stop clinic review, urgent imaging provision, and patient education materials. Intraoperative, inpatient, and outpatient speech and language therapy assessments were conducted. Postoperatively, no patients had worsening speech or language deficits, with 30% showing improvement in re- ceptive difficulties and 60% demonstrating improvement in expressive difficulties. The mean length of stay decreased from 8 to 4.3 days, and patient feedback was positive. CONCLUSION A dedicated awake craniotomy pathway for HGG patients can improve patient outcomes in terms of preserv- ing speech and language and reducing length of stay in hospital. Patients are providing positive feedback for multidisciplinary team consistency throughout the entire pathway.