Postoperative writing impairment in glioma patients undergoing awake craniotomy

Awake craniotomy is increasingly used as the criterion standard for glioma resection in the perisylvian region to preserve language function. Perioperative language assessment of patients with glioma who underwent awake surgery was conducted to examine the characteristics of language impairment, including written language. The present study retrospectively analyzed cases of glioma involving language areas in patients who underwent awake craniotomy between April 2021 and December 2024. Background of the patients, surgical outcomes, and perioperative Japanese language functions, including speaking, listening, reading, and writing, were assessed using the Standard Language Test for Aphasia (SLTA). We collected data from 8 patients who underwent awake craniotomy, including 1 bilingual patient (Japanese and Vietnamese). An object naming task was used for intraoperative mapping in all cases. Pathological diagnoses included 4 low-grade gliomas and 4 glioblastomas. Subtotal resection was achieved in 2 cases, partial resection in 4 cases, and biopsy was performed in 2 cases. Postoperative assessments indicated both improvement and deterioration in language function across major domains, except for reading. Writing function declined in 3 of 5 patients with SLTA deficits. Younger patients and those without contrast-enhancing mass lesions showed a greater tendency toward writing deterioration, although this was not significant. Nevertheless, all patients eventually demonstrated improvement in writing function. Careful evaluation of not only speech, but also writing may be important, especially in younger patients and those without contrast-enhancing tumors. Incorporating attention to writing during awake mapping may help preserve broader language function and improve quality of life.