Neurolinguists Assist in Awake Surgery on 11-Year-Old Patient with Epilepsy
Researchers at the HSE Centre for Language and Brain took part in a rare awake neurosurgical procedure performed on an 11-year-old patient with drug-resistant epilepsy. Working alongside surgeons at the Voyno-Yasenetsky Centre of Specialised Medical Care for Children in Solntsevo, they monitored the resection of a portion of the left temporal lobe, where the epileptic focus had been identified.
The need for surgical intervention was confirmed by the results of intracranial EEG monitoring and analysis. Because the planned resection area was located near brain regions involved in language processing, neurolinguists from the HSE Centre for Language and Brain joined the surgical team. Their role was to assess the patient's language functions and help surgeons preserve functionally important areas of the brain.
Before the operation, the researchers conducted a comprehensive preoperative assessment to determine the lateralisation and localisation of language functions. The assessment employed advanced neuroimaging techniques, including tractography with reconstruction of language tracts, preoperative functional MRI (fMRI) of language processing, and both passive and active mapping of language functions using stereo-EEG.
The findings from the assessment were presented at a clinical case conference. Based on the results, the team decided to perform an awake craniotomy with intraoperative language mapping, enabling real-time monitoring of language functions during the resection and minimising the risk of damage.
Staff members of the HSE Centre for Language and Brain regularly participate in intraoperative language mapping; however, this was the first case in their practice involving a patient of such a young age.
Olga Dragoy
'Awake surgeries in children as young as 11 are extremely rare in clinical practice worldwide. At this age, interventions are typically performed under general anaesthesia to minimise discomfort and reduce the risk of seizures. However, in this case, maximum precision was required to preserve language functions,' said Olga Dragoy, Director of the HSE Centre for Language and Brain.
Before the intervention, the boy’s cognitive functions, including language and memory, were assessed. Based on the results, the specialists developed individualised protocols and intraoperative testing tasks. The Linguistic Intraoperative Support (LIS) software was used to select appropriate tests, facilitating task selection according to the planned resection zone at both the cortical and white matter levels. During the operation, both cortical and subcortical structures were stimulated to identify and preserve language-related areas of the brain.
Tatiana Ananyeva
'The awake surgery allowed us to monitor language function in real time and safely resect the epileptic focus without affecting critical areas. Without intraoperative mapping, the risk to the patient’s language abilities would have been significantly higher,' said Tatiana Ananyeva, a neurologist at the Voyno-Yasenetsky Centre of Specialised Medical Care for Children in Solntsevo.
This surgery was the first joint project between the HSE Centre for Language and Brain and the Voyno-Yasenetsky Centre in Solntsevo. According to the researchers, this form of collaboration combines neurolinguistic expertise with the clinical experience of neurosurgeons and is expected to enable more precise performance of complex paediatric interventions in the future.
From June 1 to 3, HSE University will host the 13th Summer Neurolinguistics School 'Clinical Linguistics in Neurosurgery,' organised by the Centre for Language and Brain.
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