Abstract
A main goal of awake surgery is to preserve language in order to facilitate return to work and maintain quality of life. Although spelling has become crucial in daily life, it has received little attention in awake surgery practice. We review assessments of spelling carried out in awake surgery studies, to inspect how current neurofunctional theories of spelling may guide pre-, intra- and post-operative neurosurgical practice. A systematic database search in Embase, Medline, PubMed and Web of Science identified studies reporting on spelling assessment in glioma patients undergoing awake surgery. Twenty-three studies were included, of which only 9 report details on spelling assessments. We evaluate the incidence of dysgraphia in glioma patients, the types of spelling errors as a function of tumor location, and the specificity of spelling sites with respect to other language functions. Post-operative dysgraphia arose in 26.9% of the patients with preserved pre-operative handwriting, and persisted in 45.0% of them at follow-up. Intra-operative stimulation interfered only with handwriting in 37.7% of the patients. A network of frontal, parietal and temporal regions was found to underlie central and peripheral spelling processes. Evidence on spelling performance in patients undergoing awake surgery for gliomas is surprisingly scarce. With the limitations inherent in the small number of observations, results converge with the neurofunctional knowledge accruing from studies of stroke cases. Such knowledge should be exploited in more thorough investigations of spelling skills in glioma patients. Implications for clinical and neuroscientific practice are discussed, as well as possible strategies to overcome current limitations.
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Notes
Throughout this manuscript the term spelling is used as an umbrella term, to refer to all output modalities requiring orthographic knowledge (handwriting, typing and oral spelling). Handwriting refers to the process of spelling with a hand-held pen/pencil. Typing refers to spelling by means of a keyboard. Oral spelling refers to the process of pronouncing aloud each letter of a to-be-spelled string.
In the literature, the terms orthographic output lexicon/orthographic long-term memory, phoneme-grapheme conversion/phonology-orthography conversion, graphemic buffer/orthographic buffer/orthographic working memory are used interchangeably. The terminology as presented in Fig. 1 is used in this review.
Throughout the review, we denote dictated stimuli in italics, and written strings in CAPITALS.
Since only word handwriting was assessed in the patient with insular glioma (Scarone et al. 2009), central errors may also be due to lexical damage in this case.
Abbreviations
- AG:
-
Angular gyrus
- DES:
-
Direct Electrical Stimulation
- IFG:
-
Inferior frontal gyrus
- IFOF:
-
Inferior fronto-occipital fasciculus
- ITG:
-
Inferior temporal gyrus
- MFG:
-
Middle frontal gyrus
- MTG:
-
Middle temporal gyrus
- PoCG:
-
Postcentral gyrus
- PreCG:
-
Precentral gyrus
- SFG:
-
Superior frontal gyrus
- SMA:
-
Supplementary motor area
- SMG:
-
Supramarginal gyrus
- SPL:
-
Superior parietal lobe
- STG:
-
Superior temporal gyrus
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Acknowledgements
Funding was provided by the European Commission within the action nr 2014—0685/001-001-EMJD (Framework Partnership Agreement 2012-2025) to FvI and by PAT (Provincia Autonoma di Trento) to GM. RB was partially supported by the Center of Language and Brain NRU Higher School of Economics, RF government grant, ag. No 14.641.31.0004.
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Example of search string
‘writing’/exp. OR ‘spelling’/exp. OR ‘written spelling’ OR ‘handwriting’/exp. OR graphem* OR letter* OR orthography* OR ‘written language’/exp. OR dysgraph* OR agraph* OR (‘writing’ OR ‘spelling’ OR ‘written language’ OR ‘written spelling’ OR orthograph* OR graphem* OR graphomotor OR allographic* OR phoneme-grapheme) NEAR/3 (disorder* OR deficit* OR difficult* OR disrupt* OR disturb* OR dysfunct* OR error* OR impair* OR trouble* OR defect) OR (writing OR spelling OR ‘written language’ OR ‘written spelling’ OR orthograph* OR graphem* OR graphomotor OR allographic* OR phoneme-grapheme) NEAR/3 (abilit* OR function* OR assessment* OR batter*) AND (‘glioma’/exp. OR ‘glioblastoma’/exp. OR ‘high grade glioma’ OR ‘low grade glioma’ OR ‘astrocytoma’/exp. OR ‘brain tumor’/exp. OR ‘brain tumour’/exp. OR ‘meningioma’/exp) AND (‘awake surgery’ OR ‘awake craniotomy’ OR craniotom* OR ‘electrostimulation’/exp. OR intraoperat* OR peroperat* OR preoperat* OR postoperat* OR ‘peroperative care’/exp. OR ‘patient monitoring’/exp. OR ‘brain mapping’/exp. OR ‘brain surgery’/exp) NOT (‘child’/exp. OR ‘adolescence’/exp. OR ‘childhood’/exp. OR ‘newborn’/exp. NOT (‘adult’/exp. OR ‘adulthood’/exp. OR ‘aged’/exp)) AND [article]/lim AND [english]/lim.
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van Ierschot, F., Bastiaanse, R. & Miceli, G. Evaluating Spelling in Glioma Patients Undergoing Awake Surgery: a Systematic Review. Neuropsychol Rev 28, 470–495 (2018). https://doi.org/10.1007/s11065-018-9391-7
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DOI: https://doi.org/10.1007/s11065-018-9391-7