Objective:

To report the case of a post-lingual deaf patient undergoing awake craniotomy for glioma resection, testing both sign language and spoken language during intraoperative mapping, highlighting the unique aspects of this case.

Key Findings:

• Both sign language and spoken language were tested intraoperatively for the first time in a single patient, providing a unique perspective on language localization.
• Subcortical mapping revealed phonemic paraphasias, indicating proximity to critical language pathways, which is significant for understanding language processing.
• Postoperative MRI confirmed gross total resection of the tumor.

Interpretation:

The findings suggest that awake mapping can effectively localize language functions in hearing-impaired patients, providing insights into the neural basis of language processing in diverse modalities.

Limitations:

• Only one case study limits generalizability; further research is needed to validate findings.
• The study did not test sign language during cortical mapping due to procedural constraints, which may limit the understanding of its localization.

Conclusion:

Awake craniotomy with intraoperative language mapping is feasible and informative for hearing-impaired patients, enhancing understanding of language localization and suggesting avenues for future research.