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Awake craniotomy with English and British sign language map** in a patient with a left temporal glioblastoma reveals discordant speech-sign language maps

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Abstract

The aim of this case study was to describe differences in English and British Sign Language (BSL) communication caused by a left temporal tumour resulting in discordant presentation of symptoms, intraoperative stimulation map** during awake craniotomy and post-operative language abilities. We report the first case of a hearing child of deaf adults, who acquired BSL with English as a second language. The patient presented with English word finding difficulty, phonemic paraphasias, and reading and writing challenges, with BSL preserved. Intraoperatively, object naming and semantic fluency tasks were performed in English and BSL, revealing differential language maps for each modality. Post-operative assessment confirmed mild dysphasia for English with BSL preserved. These findings suggest that in hearing people who acquire a signed language as a first language, topographical organisation may differ to that of a second, spoken, language.

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Abbreviations

BSL:

British Sign Language

BSL-CST:

British Sign Language Cognitive Screening Test

CAT:

Comprehensive Aphasia Test

CODA:

Child of Deaf Adult

DES:

Direct Electrical Stimulation

DTI:

Diffusion Tensor Imaging

DuLIP:

Dutch Linguistic Intraoperative Protocol

Hz:

Hertz

ILF:

Inferior Longitudinal Fasciculus

mA:

MilliAmps

MAC:

Monitored Anaesthesia Care

MRI:

Magnetic Resonance Imaging

SLT:

Speech and Language Therapist

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Funding

TRW, HM and SM are supported by doctoral studentships funded by the University of the West of England and HM is supported by a Somerset, Wiltshire, Avon, and Gloucestershire Cancer Alliance grant.

Author information

Authors and Affiliations

  1. Southmead Hospital, North Bristol NHS Trust, Bristol, UK

    Neil U. Barua, T. R. Williamson, Hajira Mumtaz, Sonia Mariotti, Madeleine Farrow & Raenette David

  2. Brain, Language, and Behaviour Laboratory, Bristol Centre for Linguistics, University of the West of England, Bristol, UK

    Neil U. Barua, T. R. Williamson, Lydia Wiernik, Hajira Mumtaz, Sonia Mariotti & Anna E. Piasecki

  3. School of Philosophy, Psychology, and Language Sciences, University of Edinburgh, Edinburgh, UK

    Lydia Wiernik

Authors
  1. Neil U. Barua
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  2. T. R. Williamson
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  3. Lydia Wiernik
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  4. Hajira Mumtaz
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  5. Sonia Mariotti
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  6. Madeleine Farrow
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  7. Raenette David
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  8. Anna E. Piasecki
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Contributions

All authors made substantial contributions to the conception of the work, acquisition, analysis and interpretation of data, drafted the work and revised it critically for intellectual content. All authors approved the version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Neil U. Barua.

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The subject of this case report gave written consent for publication.

Conflicts of interest/competing interests

NB has received honoraria from Brainlab, the manufacturer of the software described in this report.

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Comments

The present case report describes an awake craniotomy in an adult patient with a left glioblastoma, who had a four-week history of difficulties with verbal and written English, whilst the British Sign Language (BSL) was not significantly affected. The patient grew up as a hearing child with deaf adults, aquired the BSL from the beginning and learned English as a second language. At three days before operation, an English language assessment revealed mild deficits in recognition memory respectively sentence comprehension and on BSL testing only minor signs of dysfunction were detected. Intraoperational direct electrostimulation (DES) of the left pars opercularis did not result in any difficulties with object naming nor semantic errors during the English assessment. In contrast stimulation of the same locus during the BSL testing, evoked a dysfunction in a semantic fluency task due to a recall error. An English and BSL assessment, five days postoperatively, according to the same test protocol, showed a mild decline in semantic and phonological fluency in English but no impairment was seen during the BSL testing. The mentioned discrepancy between the the BSL and the English language regarding the test performance during the DES map** and after surgery, suggests that they may have different topographical organisations in hearing persons having aquired sign language as first language. This could possibly due to that the hearing person learns the sign language respectively the spoken language in different ways. This case report adds to the filling of a knowledge gap, since earlier studies have rarely described intraoperative map** of sign language and spoken language in tumor patients who during childhood had normal hearing, lived with deaf adults and aquired sign language as first language and spoken language as second language.

Åsa Bergendal

Stockholm Sweden

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Barua, N.U., Williamson, T.R., Wiernik, L. et al. Awake craniotomy with English and British sign language map** in a patient with a left temporal glioblastoma reveals discordant speech-sign language maps. Acta Neurochir 166, 260 (2024). https://doi.org/10.1007/s00701-024-06130-x

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