B – 11 Awake intracranial language mapping in Toishanese-speaking patient with left frontal tumor

Abstract Objective Language mapping during awake craniotomies is crucial for patients undergoing resections near eloquent cortex, maximizing safe resection and minimizing post-operative complications. Language testing was complicated as the patient’s native language is Toishanese (understands Cantonese) and a Toishanese interpreter was not available. Method A 42-year-old man presented to ED following a generalized seizure. MRI revealed a left frontal glioma. Inpatient baseline testing conducted with the assistance of a Cantonese-speaking interpreter focused on establishing an understanding of Toishanese-specific picture naming and to build rapport between patient and interpreter. Given the proximity of the lesion to Broca’s area, we planned for intracranial mapping. Results Baseline testing revealed mild dominant frontotemporal dysfunction. During left frontal awake craniotomy, patient underwent continuous neuromonitoring. Primary speech area was mapped with the assistance of the same interpreter. After the planned trajectory to the lesion was localized, the overlying and adjacent cortex was stimulated revealing no speech arrest. He underwent corticectomy in the middle frontal gyrus while monitoring his expressive speech. At the deep inferior margin, mild anomia was observed; however, he continued naming objects, counting, and conversing throughout resection. Speech function remained stable while the remaining lesion was excised and continued to be intact post-operatively. Formal neuropsychological re-evaluation has not yet been completed. Conclusion Cortical functional mapping is an essential and highly complex procedure that relies on the use of the patient’s primary language. Despite the absence of an appropriate interpreter, the ability to conduct mapping utilizing similar languages and completing comprehensive baseline testing for optimal patient care may still be possible.