Speech-Language Pathology Interventions in Pediatric Awake Brain Surgery: A Moroccan and Global Perspective.

Abstract

Introduction Awake brain surgery (ABS) is a groundbreaking technique that not only enhances tumor resection but also preserves vital neurocognitive functions, particularly through advanced brain mapping. Despite its success in adults, ABS in pediatric patients remains significantly underexplored, especially concerning the role of speech-language pathology (SLP) in these procedures. This study addresses this gap by providing a thorough examination of SLP interventions in pediatric ABS across various university hospitals, including those in Morocco and internationally. Methods We utilized a web-based survey, translated into French, English, and Spanish, to capture the clinical practices of 10 pediatric ABS teams globally, including one team at Rabat University Hospital in Morocco. The survey included questionnaires tailored for neurosurgeons, speech therapists, and other professionals involved in ABS. Additionally, a detailed review of medical records for three pediatric patients who underwent ABS in Morocco between 2017 and 2022 was conducted. Data were analyzed using SPSS (IBM Corp., Armonk, NY, USA) for quantitative results and qualitative content analysis for case study evaluations. Results The study found a global consensus on the essential role of SLP in pediatric ABS, with 62.5% of neurosurgeons stressing the need for specialized SLP training. A significant correlation was observed between postoperative speech therapy and reduced neurolinguistic disorders (Pearson correlation=0.340, p=0.007). Challenges in assessing written language components were identified due to a lack of suitable tools, highlighting the need for improved resources. Additionally, most speech assessments during brain mapping were conducted in the patient's mother tongue (60.7%), and assessments were most commonly performed during all three stages of surgery (25%). Conclusion This study emphasizes the importance of speech therapy in pediatric ABS, highlighting the need for specialized tools and training. Findings suggest a positive impact of postoperative speech therapy on neurolinguistic outcomes, but further research with larger cohorts and long-term follow-up is needed to confirm these benefits.