Potential differences between monolingual and bilingual patients in approach and outcome after awake brain surgery

Karim ReFaey, Shashwat Tripathi, Adip G. Bhargav, Sanjeet S. Grewal, Erik H. Middlebrooks, David S. Sabsevitz, Mark Jentoft, Peter Brunner, Adela Wu, William O. Tatum, Anthony Ritaccio, Kaisorn L. Chaichana, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticlepeer-review


Introduction: 20.8% of the United States population and 67% of the European population speak two or more languages. Intraoperative different languages, mapping, and localization are crucial. This investigation aims to address three questions between BL and ML patients: (1) Are there differences in complications (i.e. seizures) and DECS techniques during intra-operative brain mapping? (2) Is EOR different? and (3) Are there differences in the recovery pattern post-surgery? Methods: Data from 56 patients that underwent left-sided awake craniotomy for tumors infiltrating possible dominant hemisphere language areas from September 2016 to June 2019 were identified and analyzed in this study; 14 BL and 42 ML control patients. Patient demographics, education level, and the age of language acquisition were documented and evaluated. fMRI was performed on all participants. Results: 0 (0%) BL and 3 (7%) ML experienced intraoperative seizures (P = 0.73). BL patients received a higher direct DECS current in comparison to the ML patients (average = 4.7, 3.8, respectively, P = 0.03). The extent of resection was higher in ML patients in comparison to the BL patients (80.9 vs. 64.8, respectively, P = 0.04). The post-operative KPS scores were higher in BL patients in comparison to ML patients (84.3, 77.4, respectively, P = 0.03). BL showed lower drop in post-operative KPS in comparison to ML patients (− 4.3, − 8.7, respectively, P = 0.03). Conclusion: We show that BL patients have a lower incidence of intra-operative seizures, lower EOR, higher post-operative KPS and tolerate higher DECS current, in comparison to ML patients.

Original languageEnglish (US)
Pages (from-to)587-598
Number of pages12
JournalJournal of neuro-oncology
Issue number3
StatePublished - Jul 1 2020


  • Bilingual patients
  • Direct cortical stimulation
  • Electrocorticography
  • Extent of resection
  • Intraoperative speech mapping
  • Language cortex

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research


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