Hall, Matthew

Abstract BACKGROUND Intraoperative electrocorticography (ECoG) may aid localization of language function and help guide eloquent brain tumor resection. However, relevance of ECoG findings to language outcomes remains unclear. METHODS Fifteen patients with brain tumors (Mdn age=60; 67% high-grade glioma) underwent awake craniotomy and intraoperative language mapping. Time-frequency ECoG gamma activity was visualized in real-time followed by direct electrical stimulation (DES) across 3 paradigms (NeuroMapper Tasks: Object, Action, Auditory). Early and late ECoG gamma modulations and positive DES sites were co-registered with postoperative MRI. A subset (N=11) completed expressive language testing (Phonemic and Semantic Fluency, Confrontation Naming) prior to and <2 months following surgery. Correlational analyses and Mann-Whitney U tests examined relationships between test results and surgical impact upon expressive task-elicited gamma activity (Object and Action Naming). RESULTS Across tasks, positive DES sites were identified in 93% of cases (Auditory, 73%; Action, 71%, Object, 57%). No positive DES sites were resected. Early and/or late gamma activations were elicited in all patients, resected in 40%, and within 1 cm of surgical impact in 90%. Four patients (36%) showed reliable decline on at least 1 outcome, which was associated with Action Naming activity <1 cm of surgical impact (phi=.67, p=.035). On individual tests, Confrontation Naming and Phonemic Fluency decline were rare (9% and 18%), though Semantic Fluency declined in 36% of patients. Change in Semantic Fluency was associated with resection of Object Naming gamma sites (Z=-1.83, p=.044) and presence of Action Naming gamma features near surgical impact (Z=-2.25, p=.014). CONCLUSIONS Despite preservation DES sites and sparing of basic confrontation naming ability, verbal fluency declined in a substantial group of patients. Decline was associated with gamma features resected or near surgical impact. While preliminary, findings suggest task-based ECoG can augment DES in informing risk of surgically-acquired language decline.