Language Mapping of Hindi and English in a Bilingual Patient During Resection of a Right Frontal Glioma

Background Recent advancements in understanding the molecular basis of gliomas and new concepts of neuronal plasticity have shown the importance of maximal resection in gliomas to improve progression-free overall survival. Awake craniotomies with intraoperative cortical and subcortical mapping have helped to achieve this aim while allowing us to preserve executive function including language. Language mapping becomes a daunting task in individuals who are bilingual because of the complexity of varied cortical representation of different languages. Case Description We present a case of a bilingual patient who underwent re-resection of right frontal astrocytoma using principles of awake surgery and language mapping. Our patient was fluent in English and Hindi. She underwent a complete neurophysiologic cognitive assessment in both languages preoperatively. She was tested for speech arrest, nominal aphasia, and semantic paraphasia intraoperatively for both English and Hindi. She underwent a gross total resection with postoperative preservation of both English and Hindi. Intraoperative language mapping revealed that while certain cortical areas overlapped between 2 languages, other aspects were represented by distinct areas. Postoperative assessment at 2 months revealed most major aspects of language remained preserved or had improved relative to the preoperative baseline. Conclusions Advancements in anesthesia and neuromonitoring have further allowed for long awake periods, permitting complex language tasks to be tested intraoperatively. The results obtained from this case study have allowed us to further plan for awake surgeries for patients with bilingualism. With understanding bilingual representation of languages, we hope to achieve maximal resection with minimal postoperative deficits.