LANGUAGE ASSESSMENT DURING BRAIN SURGERY FOR TUMORS UNDER LOCAL ANESTHESIA (MINI INTRAOPERATIVE LANGUAGE TEST - MILT)

• Grant number: 25/10229-2
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• Start date: July 01, 2025
• End date: June 30, 2029
• Field of knowledge: Health Sciences - Medicine - Psychiatry
• Principal Investigator: Guilherme Alves Lepski
• Grantee: Giovanna de Oliveira Santos e Souza
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated research grant: 18/18900-1 - Innovations in human and non-human animal communities, AP.SPEC

Abstract

Currently, studies on language and the brain are continuously revising the areas associated with its function in both hemispheres. Associative and subcortical areas are the primary regions responsible for functional and structural changes in language. It is now considered that the form and the sensorimotor resources used during the encoding of memories associated with world representation can spatially and structurally modify the positioning of elements related to language. This highlights the need for concise and functional language assessment batteries that enable the mapping and monitoring of areas to be removed during surgery. Surgical approaches, particularly in the left hemisphere, pose a significant challenge, as existing protocols are lengthy, extend surgical time, and increase perioperative and postoperative risks. Furthermore, the existing batteries are not validated for the Portuguese language. In this context, the main objective of this project is to develop an assessment and monitoring battery for language components. This battery will include sufficient stimuli to create multiple versions, which will be applied preoperatively, intraoperatively, and postoperatively. The intraoperative battery (MILT) will be a reduced version of the larger battery and will be directly linked to a scoring system that guides the surgical decision-making process regarding whether to invade a particular area during tumor resection. The intraoperative scale used will primarily contribute to the development of an aphasia risk scale and, secondarily, a 'map' associating stimulated cortical areas with specific language deficits. This map will serve as a guide for future surgeries performed by our team and other colleagues. Similar assessment batteries have already been developed by researchers in other countries, such as the United States, Japan, and various European nations. In general, these batteries are lengthy, not associated with a language deficit risk scale, and require at least 1 hour and 30 minutes for intraoperative application. Any alteration during mapping typically leads the surgeon to spare the area in question without a clear understanding of the associated risk of resection. Consequently, the degree of resection in these cases is always lower than in non-eloquent areas, which significantly compromises the oncological prognosis. Our goal is to develop a battery tailored to the Brazilian population, incorporating the characteristics of Brazilian Portuguese, aimed at identifying eloquent areas during surgery in a quick and effective manner, with the potential for association with a language deficit risk score. The intraoperative battery will be a reduced version of a more extensive battery used preoperatively and postoperatively to evaluate each patient's progress and to test a control group of healthy adults. This approach could eventually be adapted to other languages, with interest from partner groups in the United States (California, UCSF), the Netherlands (Radboud University), Russia, and Argentina.