Jane Hocker, M.A., CCC-SLP recently helped a team at Atlanticare led by neurosurgeon Dr. David Stidd to perform its first procedure known as an awake craniotomy.
During such a procedure, the patient is heavily sedated then awakened from the sedation enough to be responsive. It is performed when a tumor is close to an area of the brain that controls critical functions, such as speech, vision or movement.
In the case of this patient, Jane said the tumor was located near the Broca’s area of the brain which is central to speech and language. Her role was to talk to the patient to test the patient’s language skills while the neurosurgeon mapped the area.
Preparing for the Surgery
“Prior to the surgery I met with Dr. Stidd to understand his expectations of what was needed from Speech therapy,” said Jane. “I was very nervous but exhilarated to participate. This was a new experience for me and there are no formal protocols established in the literature for exactly how the speech therapist conducts her part. The morning of the surgery I met with two neurophysiologists who offered their previous experiences working with SLPs in other facilities for this surgery and the anesthesiology team. The environment felt very calm and controlled, and I felt well supported by all disciplines.”
Meeting the Patient
Jane was familiar with the patient’s deficits before the procedure.
“Before the surgery, I did a full speech and language assessment and determined that the patient had a mild to moderate aphasia.”
“As Dr. Stidd stood with his surgery team at the head of the patient, I sat face to face with the patient. There was surgical screen separating me from the surgery team. There were two neurophysiologists monitoring brain waves on the computer as Dr. Stidd stimulated areas of the brain and as I encouraged the patient to talk. I indicated to the neurophysiologist and Dr. Stidd when the patient was unable to speak.”
The Mapping Process
“During the mapping process, I talked to the patient. I asked the patient to count to ten, say the alphabet, list the days of the week. As long as the patient is talking, the neurosurgeon knows he is not near potentially critical tissue. When the patient has a ‘speech arrest’ – a pause when the patient is trying to speak but cannot- the neurosurgeon marks that and stays away.”
The mapping process took about 45 minutes, but the surgery was almost 8 hours. Afterward, the neurosurgeon removed the tumor while the patient was still talking.
On the very next day, Jane again performed a full language assessment and found that the patient had already improved. He was discharged home that day.
“Dr. Stidd indicated in the following days that over all the procedure was a good success and there is hope to do more in the future.”