The emerging contribution of speech and language therapists in awake craniotomy: a national survey of their roles, practices and perceptions

Background:Awake craniotomy with electrical stimulation has become the gold standard for tumour resection ineloquent areas of the brain. Patients’ speech during the procedure can inform the intervention and evidence forlanguage experts to support the procedure is building. Within the UK a burgeoning speech and language therapistawake craniotomy network has emerged to support this practice. Further evidence is needed to underpin thespecific 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- andpostoperative 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 invitedto complete an online questionnaire. Participants were recruited via several networks supported by a social mediacampaign. Data were analysed using a mixed methodology approach including descriptive statistics, summativeand conventional content analysis.Outcomes & Results:A total of 24 speech and language therapists completed the survey, an unknown proportionof the available population. All four UK countries were represented. The majority were highly specialist clinicians58% (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 experiencewith awake craniotomy was 3 years. Median estimated contact time per case was 10.3 h. Current intraoperativepractice 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, oncedetected, are immediately communicated to surgeons. There was evidence of variable and diverse language mappingpractices and barriers to the translation of information at multidisciplinary team level. Barriers to participationin awake craniotomy included lack of: standardized validated language mapping methods, funding, standardizedtraining methods and guidance to direct practice.Conclusions & Implications:The evidence suggests areas of consistent practice patterns in preoperative preparationand intraoperative assessment. However, considerable variability exists within language testing and mappingthat would benefit from validation. These speech and language therapists support improved outcomes of awakecraniotomy by real-time intraoperative speech, language, oromotor and cognitive assessment, rapid detectionof clinical deterioration and immediate communication to surgeons. Further research exploring intraoperativelanguage testing, consistent use of language mapping terminology, and selection of test methods is recommended.