Spell surgery
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Spelling and Surgery: Insights from Recent Research
Spelling Assessment in Glioma Patients Undergoing Awake Surgery
Importance of Spelling in Awake Surgery
Awake surgery aims to preserve critical language functions to ensure patients can return to their daily lives and maintain their quality of life. Despite the increasing importance of spelling in everyday communication, it has not been a primary focus in awake surgery practices. Recent research has begun to address this gap by evaluating how spelling is assessed in glioma patients undergoing awake surgery1.
Incidence and Types of Spelling Errors
A systematic review of studies on glioma patients undergoing awake surgery revealed that post-operative dysgraphia, a condition affecting writing abilities, occurred in 26.9% of patients who had intact handwriting before surgery. This condition persisted in 45.0% of these patients at follow-up. The types of spelling errors varied depending on the tumor's location, with a network of frontal, parietal, and temporal regions being implicated in both central and peripheral spelling processes1.
Intra-Operative Interference and Neurofunctional Theories
Intra-operative stimulation during awake surgery interfered with handwriting in 37.7% of patients. The findings align with neurofunctional theories derived from stroke studies, suggesting that specific brain regions are crucial for spelling. This knowledge can guide pre-, intra-, and post-operative practices to better preserve spelling abilities in glioma patients1.
Respiratory Function During Spells in Tetralogy of Fallot Surgery
Impact of Spells on Lung Volume and Ventilation
In children with Tetralogy of Fallot (ToF), spells can significantly impact respiratory function. A study observed changes in end-expiratory lung volume and ventilation inhomogeneities during spells in three children undergoing surgical repair for ToF. The results showed a significant decrease in lung volume and an increase in ventilation inhomogeneities during spells, which only slowly improved even after treatment2.
Management and Parental Awareness
A retrospective audit of ToF infants who experienced hypercyanotic 'Tet' spells highlighted the importance of early diagnosis and parental education. The study found that most ToF patients were diagnosed early, often antenatally, and that associated abnormalities could predict the risk of early spells. Parental education on initial management, such as the knee-chest position, played a crucial role in preventing complications and ensuring timely surgical intervention3.
Conclusion
Recent research underscores the importance of addressing spelling in glioma patients undergoing awake surgery and highlights the significant impact of spells on respiratory function in children with Tetralogy of Fallot. These findings emphasize the need for comprehensive pre-, intra-, and post-operative assessments and interventions to preserve critical functions and improve patient outcomes. Enhanced parental education and awareness are also vital in managing conditions like ToF to prevent long-term complications.
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