Language Evaluation and Feasibility of Awake Craniotomy in Deaf Individuals

Overview

Awake craniotomy (AC) enables real-time functional brain mapping to maximize tumor resection while preserving neurological function. This systematic review synthesizes case reports on AC in hearing-impaired patients, focusing on communication strategies, intraoperative feasibility, and neurological outcomes.

Background

Awake craniotomy is a standard approach for resecting brain lesions near eloquent cortex, relying on patient cooperation for language and motor mapping. Hearing impairment poses unique challenges due to reduced auditory perception and reliance on sign language, which involves visuomotor and spatial processing. These factors complicate intraoperative communication and functional assessment, often leading to exclusion of deaf patients from AC despite potential benefits. Understanding communication adaptations and outcomes in this population is critical to expanding equitable access to awake neurosurgery.

Data Highlights

The review included case reports and series of AC performed in patients with documented hearing impairment, encompassing congenital and acquired deafness. Data extraction focused on intraoperative communication methods, mapping paradigms, perioperative feasibility, and neurological outcomes. The literature remains sparse and heterogeneous, with no large-scale studies or consolidated safety data available.

Key Findings

• Effective bidirectional communication is essential for successful AC, but hearing impairment challenges traditional auditory-verbal paradigms.
• Sign language, a visuospatial and motoric language, recruits classical language networks plus additional visuomotor and parietal regions, necessitating tailored mapping approaches.
• Stimulation-induced motor deficits can mimic language errors in signing patients, complicating intraoperative interpretation.
• Use of sign language interpreters and alternative communication technologies facilitates intraoperative interaction and functional assessment.
• Careful preoperative planning and individualized communication strategies enable technically feasible AC in selected deaf patients.
• Existing evidence is limited to case reports and small series, highlighting a need for further research to establish standardized protocols and safety profiles.

Clinical Implications

Clinicians should consider individualized communication strategies, including sign language support and alternative technologies, when planning AC for hearing-impaired patients. Awareness of the neurobiological differences in sign language processing and potential motor confounds is essential for accurate intraoperative mapping. Expanding inclusion criteria may improve access to the benefits of awake mapping in this underserved population.

Conclusion

Awake craniotomy in deaf individuals is feasible with tailored communication approaches and careful intraoperative assessment. However, limited and fragmented evidence underscores the need for further systematic investigation to optimize protocols and ensure equitable care.

References

1. Introduction References 1-28 -- Various sources on awake craniotomy and language mapping