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Ntemou E, Rybka L, Lubbers J, Tuncer MS, Vajkoczy P, Rofes A, Picht T, Faust K. Lesion-symptom mapping of language impairments in people with brain tumours: The influence of linguistic stimuli. J Neuropsychol 2023; 17:400-416. [PMID: 36651346 DOI: 10.1111/jnp.12305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/18/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
People with tumours in specific brain sites might face difficulties in tasks with different linguistic material. Previous lesion-symptom mapping studies (VLSM) demonstrated that people with tumours in posterior temporal regions have more severe linguistic impairments. However, to the best of our knowledge, preoperative performance and lesion location on tasks with different linguistic stimuli have not been examined. In the present study, we performed VLSM on 52 people with left gliomas to examine whether tumour distribution differs depending on the tasks of the Aachen Aphasia Test. The VLSM analysis revealed that single-word production (e.g. object naming) was associated with the inferior parietal lobe and that compound and sentence production were additionally associated with posterior temporal gyri. Word repetition was affected in people with tumours in inferior parietal areas, whereas sentence repetition was the only task to be associated with frontal regions. Subcortically, word and sentence production were found to be affected in people with tumours reaching the arcuate fasciculus, and compound production was primarily associated with tumours affecting the inferior longitudinal and inferior fronto-occipital fasciculus. Our work shows that tasks with linguistic stimuli other than single-word naming (e.g. compound and sentence production) relate to additional cortical and subcortical brain areas. At a clinical level, we show that tasks that target the same processes (e.g. repetition) can have different neural correlates depending on the linguistic stimuli used. Also, we highlight the importance of left temporoparietal areas.
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Affiliation(s)
- Effrosyni Ntemou
- International Doctorate for Approaches to Language and Brain (IDEALAB), University of Groningen, Groningen, The Netherlands
- International Doctorate for Approaches to Language and Brain (IDEALAB), University of Potsdam, Potsdam, Germany
- International Doctorate for Approaches to Language and Brain (IDEALAB), Newcastle University, Newcastle upon Tyne, UK
- International Doctorate for Approaches to Language and Brain (IDEALAB), Macquarie University, Sydney, New South Wales, Australia
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lena Rybka
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jocelyn Lubbers
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mehmet Salih Tuncer
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adrià Rofes
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Kabir SS, Jahangiri FR, Rinesmith C, Vilches CS, Chakarvarty S. Intraoperative Testing During the Mapping of the Language Cortex. Cureus 2023; 15:e36718. [PMID: 37123781 PMCID: PMC10139678 DOI: 10.7759/cureus.36718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/28/2023] Open
Abstract
Intracranial lesions, particularly in the language-eloquent areas of the brain, can affect one's speaking ability. Despite advances in surgery, the excision of these lesions can be challenging. Intraoperative neurophysiological monitoring (IONM) during awake craniotomies can help identify language-eloquent areas and minimize postoperative impairments. Preoperative language testing is performed to establish a baseline before intraoperative language testing. This involves subjecting patients to predetermined tasks in the operating room to evaluate their phonological, semantic, and syntactic capabilities. The current state and future directions of intraoperative language testing procedures are discussed in this paper. The most common intraoperative tasks are counting and picture naming. However, some experts recommend utilizing more nuanced tasks that involve regions affected by infrequently occurring tumor patterns. Low-frequency bipolar Penfield stimulation is optimal for language mapping. Exception cases are discussed where awake craniotomies are not feasible. When dealing with multilingual patients, the patient's age of learning and skill level can be accounted for in terms of making informed task choices and mapping techniques to avoid any damage to language areas.
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Papatzalas C, Fountas K, Kapsalaki E, Papathanasiou I. The Use of Standardized Intraoperative Language Tests in Awake Craniotomies: A Scoping Review. Neuropsychol Rev 2021; 32:20-50. [PMID: 33786797 DOI: 10.1007/s11065-021-09492-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/22/2021] [Indexed: 12/12/2022]
Abstract
Assessment of speech and language functions is an essential part of awake craniotomies. Although standardized and validated tests have several advantages compared to homemade (or mixed) batteries, in the literature it is unclear how such tests are used or whether they are used at all. In this study, we performed a scoping review in order to locate standardized and validated intraoperative language tests. Our inquiry included two databases (PubMED and MEDLINE), gray literature, and snowball referencing. We discovered 87 studies reporting use of mixed batteries, which consist of homemade tasks and tests borrowed from other settings. The tests we found to meet the validation and standardization criteria we set were ultimately three (n = 3) and each one has its own advantages and disadvantages. We argue that tests with high sensitivity and specificity not only can lead to better outcomes postoperatively, but they can also help us to gain a better understanding of the neuroanatomy of language.
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Affiliation(s)
- Christos Papatzalas
- Department of Medicine, University of Thessaly, Larisa, Greece.
- Department of Neurosurgery, University Hospital of Larisa, Larisa, Greece.
| | - Kostas Fountas
- Department of Medicine, University of Thessaly, Larisa, Greece
- Department of Neurosurgery, University Hospital of Larisa, Larisa, Greece
| | - Eftychia Kapsalaki
- Department of Medicine, University of Thessaly, Larisa, Greece
- Department of Radiology, University Hospital of Larisa, Larisa, Greece
| | - Ilias Papathanasiou
- Department of Speech & Language Therapy, University of Patras, Patras, Greece
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Verst SM, de Castro I, Scappini-Junior W, de Melo MN, de Oliveira JR, de Almeida SS, Alvarez NRC, Sucena ACB, Barros MR, Marrone CD, Maldaun MVC. Methodology for creating and validating object naming and semantic tests used by Verst-Maldaun Language Assessment during awake craniotomies. Clin Neurol Neurosurg 2021; 202:106485. [PMID: 33476885 DOI: 10.1016/j.clineuro.2021.106485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/29/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022]
Abstract
Verst-Maldaun Language Assessment (VMLA) is a new intraoperative neuropsychological test (NT) within our local culture, e.g., native Portuguese speaking Brazilians. It aims to fill the specific need of an objective and dynamic approach for assessing the language network during awake craniotomies. The test includes object naming (ON) and semantic functions. This paper describes the process of validation, allowing for other centers to create their own language assessment. The validation process included 248 volunteers and the results were associated with age, gender and educational level (EL). The factor with the greatest impact was EL, followed by age. Intraoperative image learning by repetition is unlikely, since it is composed of 388 items and 70 combinations. The test will be available for free use under http://www.vemotests.com/ (beginning in February 2021).
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Affiliation(s)
- Silvia Mazzali Verst
- Brain Spine Neurophysiologia, Intraoperative Neurophysiology at Hospital Sirio Libanês, São Paulo, Brazil; Rua Barão de Teffé, 1000 sala 55, Jundiai, SP 13208-761, Brazil.
| | - Isac de Castro
- Neuromuscular Diseases Sector, Department of Neurology, Universidade Federal de São Paulo, SP, Brazil.
| | - Wilson Scappini-Junior
- Brain Spine Neurofisiologia, Rua Barão de Teffé, 1000 sala 55, Jundiai, SP 13208-761, Brazil.
| | - Mônica Nascimento de Melo
- Brain Spine Neurofisiologia, Rua dos Salgueiros, QD 09 lote 03, Jardins Valência Goiânia, GO 74885-860, Brazil.
| | - Jean Ramos de Oliveira
- Brain Spine Neurofisiologia, Rua Elzira Sammarco Palma, 405/242, Ribeirão Preto, SP 14021-684, Brazil.
| | - Soraya Soares de Almeida
- Brain Spine Neurofisiologia, Rua Antônio Muniz, 182, Pontalzinho, Itabuna, BA 45603-023, Brazil.
| | | | | | - Maria Rufina Barros
- Vitória Apart Hospital, Rodovia Mário Covas, 591 Sala 113-B, Bairro Boa Vista 1, Vitória, ES, 29161-001, Brazil.
| | - Carlo Domenico Marrone
- Clinica Marrone, Av. Túlio de Rose, 400 apto 501 Torre E Porto, Alegre, RS 91340-110, Brazil.
| | - Marcos Vinicius Calfat Maldaun
- Neuro-Oncology postgraduate course at Sirio Libanês Hospital, São Paulo, Rua Barata Ribeiro, 414, cj 63, São Paulo, SP, 01308-000, Brazil.
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O'Neill M, Henderson M, Duffy OM, Kernohan WG. The emerging contribution of speech and language therapists in awake craniotomy: a national survey of their roles, practices and perceptions. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:149-162. [PMID: 31778003 DOI: 10.1111/1460-6984.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Awake craniotomy with electrical stimulation has become the gold standard for tumour resection in eloquent areas of the brain. Patients' speech during the procedure can inform the intervention and evidence for language experts to support the procedure is building. Within the UK a burgeoning speech and language therapist awake craniotomy network has emerged to support this practice. Further evidence is needed to underpin the specific contribution of speech and language therapists working within the awake craniotomy service. AIMS To investigate and analyse the current practices of speech and language therapists: their role, pre-, intra- and postoperative assessment, and management practice patterns and skill set within awake craniotomy. METHODS & PROCEDURES Speech and language therapists in the UK, who work in awake craniotomy, were invited to complete an online questionnaire. Participants were recruited via several networks supported by a social media campaign. Data were analysed using a mixed methodology approach including descriptive statistics, summative and conventional content analysis. OUTCOMES & RESULTS A total of 24 speech and language therapists completed the survey, an unknown proportion of the available population. All four UK countries were represented. The majority were highly specialist clinicians 58% (n = 14) with the remainder clinical leads 25% (n = 6) or specialist clinicians 17% (n = 14). Only 29% (n = 7) had funding for awake craniotomy or had awake craniotomy in their job description. Median experience with awake craniotomy was 3 years. Median estimated contact time per case was 10.3 h. Current intraoperative practice is characterized by a sustained period of real-time, dynamic, informal assessment of speech, language, oromotor and cognitive functions. Respondents described a range of intraoperative clinical deficits that, once detected, are immediately communicated to surgeons. There was evidence of variable and diverse language mapping practices and barriers to the translation of information at multidisciplinary team level. Barriers to participation in awake craniotomy included lack of: standardized validated language mapping methods, funding, standardized training methods and guidance to direct practice. CONCLUSIONS & IMPLICATIONS The evidence suggests areas of consistent practice patterns in preoperative preparation and intraoperative assessment. However, considerable variability exists within language testing and mapping that would benefit from validation. These speech and language therapists support improved outcomes of awake craniotomy by real-time intraoperative speech, language, oromotor and cognitive assessment, rapid detection of clinical deterioration and immediate communication to surgeons. Further research exploring intraoperative language testing, consistent use of language mapping terminology, and selection of test methods is recommended.
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Affiliation(s)
- Michelle O'Neill
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Newtownabbey, UK
| | | | - Orla M Duffy
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Newtownabbey, UK
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Newtownabbey, UK
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Ruis C. Monitoring cognition during awake brain surgery in adults: A systematic review. J Clin Exp Neuropsychol 2018; 40:1081-1104. [DOI: 10.1080/13803395.2018.1469602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Carla Ruis
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Utrecht University, Utrecht, The Netherlands
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Kulikov A, Bilotta F, Borsellino B, Sel'kov D, Kobyakov G, Lubnin A. Xenon anesthesia for awake craniotomy: safety and efficacy. Minerva Anestesiol 2018; 85:148-155. [PMID: 30035455 DOI: 10.23736/s0375-9393.18.12406-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The asleep-awake-asleep (AAA) craniotomy is a technique that offers the opportunity of having a patient fully cooperative during the awake phase, and minimizes the possible discomfort, due to the asleep phase. The aim of this prospective observational study was to test the use of xenon in the first asleep phase of an AAA craniotomy, in patients undergoing craniotomy for brain tumor resection. METHODS The data have been collected from 40 awake craniotomy procedures, performed in patients with cerebral tumor, treated with the AAA technique. Patients were treated with xenon during the asleep phase, and quality of mapping, complications and qualitative judgment of the experience given by the patients were recorded. RESULTS The mapping was carried out as planned in 37 out of 40 cases. The doses of xenon administered during the first asleep phase of the anesthesia was 13±2 L. Time for awakening after xenon was switched off was 5±1 minute. A combination of xenon and regional anesthesia (with no need for additional systemic anesthetics) was adequate to accomplish craniotomy in 27/40 patients (67.5%). On the day after the operation, 37 patients recalled the testing procedure for mapping during the awake period, none had recollection of local anesthetic injections for regional anesthesia or sound associated with the neurosurgical drill. Five patients (12.5%) reported mild pain during tumor removal (VAS Score less than three). CONCLUSIONS In this case series, xenon anesthesia was successfully used for the sedative phase of an awake craniotomy accomplished with an AAA approach.
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Affiliation(s)
- Alexander Kulikov
- Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia -
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University, Rome, Italy
| | - Beatrice Borsellino
- Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University, Rome, Italy
| | - Denis Sel'kov
- Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Grigory Kobyakov
- Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Andrey Lubnin
- Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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Survey on current cognitive practices within the European Low-Grade Glioma Network: towards a European assessment protocol. Acta Neurochir (Wien) 2017; 159:1167-1178. [PMID: 28474122 DOI: 10.1007/s00701-017-3192-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The European Low-Grade Glioma network indicated a need to better understand common practices regarding the managing of diffuse low-grade gliomas. This area has experienced great advances in recent years. METHOD A general survey on the managing of diffuse low-grade gliomas was answered by 21 centres in 11 European countries. Here we focused on specific questions regarding perioperative and intraoperative cognitive assessments. RESULTS More centres referred to the same speech and language therapist and/or neuropsychologist across all assessments; a core of assessment tools was routinely used across centres; fluency tasks were commonly used in the perioperative stages, and object naming during surgery; tasks that tapped on attention, executive functions, visuospatial awareness, calculation and emotions were sparsely administered; preoperative assessments were performed 1 month or 1 week before surgery; timing for postoperative assessments varied; finally, more centres recommended early rehabilitation, whenever needed. CONCLUSIONS There is an emerging trend towards following similar practices for the management of low-grade gliomas in Europe. Our results are descriptive and formalise current discussions in our group. Also, they contribute towards the development of a European assessment protocol.
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Wager M, Rigoard P, Bouyer C, Baudiffier V, Stal V, Bataille B, Gil R, Du Boisgueheneuc F. Operating environment for awake brain surgery – Choice of tests. Neurochirurgie 2017; 63:150-157. [DOI: 10.1016/j.neuchi.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/25/2016] [Accepted: 10/17/2016] [Indexed: 10/19/2022]
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Stevanovic A, Rossaint R, Veldeman M, Bilotta F, Coburn M. Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0156448. [PMID: 27228013 PMCID: PMC4882028 DOI: 10.1371/journal.pone.0156448] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/13/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Awake craniotomy (AC) renders an expanded role in functional neurosurgery. Yet, evidence for optimal anaesthesia management remains limited. We aimed to summarise the latest clinical evidence of AC anaesthesia management and explore the relationship of AC failures on the used anaesthesia techniques. METHODS Two authors performed independently a systematic search of English articles in PubMed and EMBASE database 1/2007-12/2015. Search included randomised controlled trials (RCTs), observational trials, and case reports (n>4 cases), which reported anaesthetic approach for AC and at least one of our pre-specified outcomes: intraoperative seizures, hypoxia, arterial hypertension, nausea and vomiting, neurological dysfunction, conversion into general anaesthesia and failure of AC. Random effects meta-analysis was used to estimate event rates for four outcomes. Relationship with anaesthesia technique was explored using logistic meta-regression, calculating the odds ratios (OR) and 95% confidence intervals [95%CI]. RESULTS We have included forty-seven studies. Eighteen reported asleep-awake-asleep technique (SAS), twenty-seven monitored anaesthesia care (MAC), one reported both and one used the awake-awake-awake technique (AAA). Proportions of AC failures, intraoperative seizures, new neurological dysfunction and conversion into general anaesthesia (GA) were 2% [95%CI:1-3], 8% [95%CI:6-11], 17% [95%CI:12-23] and 2% [95%CI:2-3], respectively. Meta-regression of SAS and MAC technique did not reveal any relevant differences between outcomes explained by the technique, except for conversion into GA. Estimated OR comparing SAS to MAC for AC failures was 0.98 [95%CI:0.36-2.69], 1.01 [95%CI:0.52-1.88] for seizures, 1.66 [95%CI:1.35-3.70] for new neurological dysfunction and 2.17 [95%CI:1.22-3.85] for conversion into GA. The latter result has to be interpreted cautiously. It is based on one retrospective high-risk of bias study and significance was abolished in a sensitivity analysis of only prospectively conducted studies. CONCLUSION SAS and MAC techniques were feasible and safe, whereas data for AAA technique are limited. Large RCTs are required to prove superiority of one anaesthetic regime for AC.
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Affiliation(s)
- Ana Stevanovic
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Veldeman
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, University of Rome “La Sapienza”, Rome, Italy
| | - Mark Coburn
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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Trimble G, McStravick C, Farling P, Megaw K, McKinstry S, Smyth G, Law G, Courtney H, Quigley G, Flannery T. Awake craniotomy for glioma resection: Technical aspects and initial results in a single institution. Br J Neurosurg 2015; 29:836-42. [DOI: 10.3109/02688697.2015.1054354] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bilotta F, Stazi E, Titi L, Lalli D, Rosa G, Delfini R, Santoro A. Reply to De Witte et al - Language therapists for language testing in awake craniotomy. Br J Neurosurg 2015. [PMID: 26204457 DOI: 10.3109/02688697.2015.1071338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Federico Bilotta
- a Department of Anaesthesiology , Critical Care and Pain Medicine, "Sapienza" University of Rome , Rome , Italy
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