Clinical Report: BOATIM—A Standardized British-English Naming Test for Awake Brain Surgery

Overview

The British Object and Action Naming Assessment for Intraoperative Mapping (BOATIM) provides linguistically and culturally tailored stimuli for language mapping during awake craniotomy. Developed specifically for British-English speakers, BOATIM addresses limitations of translated or homemade tasks by controlling psycholinguistic variables and standardizing stimuli for reliable intraoperative use.

Background

In awake craniotomy, direct electrical stimulation (DES) is used to identify language-eloquent brain regions to maximize tumor resection while preserving neurological function. Picture-naming tasks are widely used intraoperatively to assess language domains under the 4-second DES time constraint. Existing naming assessments often rely on translations or culturally inappropriate stimuli, which can bias results and reduce reliability. There is a critical need for standardized, culturally relevant tools tailored to British-English speakers to improve language mapping accuracy and patient outcomes.

Data Highlights

BOATIM development involved selecting target words from the British National Corpus to ensure cultural and linguistic appropriateness. Psycholinguistic variables such as word frequency, familiarity, and age-of-acquisition were controlled. Images were sourced or created to maintain homogeneity and were piloted in two steps: initial small-group testing to exclude poor representations, followed by larger-group testing to select items named correctly within 4000 ms by at least 80% of participants. This rigorous standardization process ensures robust and reliable stimuli for clinical use.

Key Findings

• BOATIM is the first standardized intraoperative naming test specifically developed for British-English speakers.
• Stimuli were derived from a representative spoken corpus rather than translations, ensuring cultural and linguistic relevance.
• Psycholinguistic variables were carefully controlled to minimize bias and improve naming accuracy and latency consistency.
• Two-step piloting ensured that only items reliably named within the DES time constraint were included.
• BOATIM includes separate object and action naming tasks, enabling assessment of lexical-semantic and syntactic language domains.
• Existing English-language intraoperative tests are limited and often translated from other languages, highlighting the clinical need for BOATIM.

Clinical Implications

BOATIM offers neurosurgeons and neuropsychologists a reliable, culturally appropriate tool for intraoperative language mapping in British-English speakers. Its standardized stimuli improve the accuracy of identifying language-eloquent cortex, potentially enhancing tumor resection outcomes while minimizing language deficits. Additionally, BOATIM can be used pre- and post-operatively to monitor language function and guide rehabilitation.

Conclusion

BOATIM fills a critical gap by providing a rigorously developed, standardized naming assessment tailored to British-English speakers for awake brain surgery. Its implementation may improve intraoperative language mapping reliability and patient care.

References

1. British National Corpus (BNC) -- Source for target word selection
2. Direct Electrical Stimulation in Awake Craniotomy -- Importance for language mapping
3. Previous English-language intraoperative tests (VAN-POP, MULTIMAP) -- Limitations due to translation
4. Psycholinguistic variables impact on naming accuracy -- Relevant studies cited
5. Survey of UK language mapping practices -- Prevalence of homemade tasks