The degree of spatial overlap between functional language areas for each language remains debated. Intra-operative speech mapping in conjunction with functional radiographic studies have observed that language co-localization is more common with early bilingualism. However, in bilingual individuals, additional cortical regions may exist and must be identified ( Figure 1). Prior studies demonstrated that speech and language areas in monolingual individuals are localized to certain cortical regions during direct cortical brain mapping. In both bilingual and monolingual individuals diagnosed with brain lesions (epileptogenic foci or tumors) located in the dominant hemisphere, careful direct cortical brain mapping must be conducted to identify the eloquent areas in order to maximize resection with preservation of function. In recent years, there has been increasing interest in understanding the functional and behavioral sciences in bilingual individuals in order to uncover fundamental concepts in language processing and cognition. The mechanistic underpinnings of bilingual language representation and contributory linguistic features remains poorly understood and controversial. Late bilinguals are hypothesized to have decreased neuroplasticity and require enhanced recruitment of neural circuits, thereby producing more diffuse cortical language representation. In early bilinguals (acquisition before the age of 6–9 years), the first language (L1) and the second language (L2) showed cortical regions overlap, while late bilinguals (acquisition after the age of 6–9 years) L1 and L2 have spatially separate cortical regions. In contrast, recent fMRI studies demonstrate that AoA may also independently influence second-language cortical representation. For example, several studies suggest that language proficiency is an important determinant of spatial language localization, where proficiency in the second language is hypothesized to be inferior to the first language and leads to specific localization patterns. ![]() These linguistic features of bilingualism have been shown to impact structural organization, cortical representation of language, and neuroplasticity. Related to second language proficiency, an important feature referred to as the age of acquisition (AoA) has been defined as the age at which monolinguals acquire their second language. This number continues to rise with the increase in global connectivity. The postoperative imaging showed gross total resection with expected postoperative changes.Īpproximately 20.8% of the population in the United States and 67% of the European population speak two or more languages. The pathology was consistent with Oligodendroglioma, IDH-mutant, and 1p19q co-deleted (WHO grade II). The patient tolerated the surgery well with no issues or complications and was discharged on a postoperative day 3 after an unremarkable hospital course. Tumor resection proceeded in tandem with neuropsychological testing. A prolonged and after-discharge and focal electrographic seizure was detected and was aborted using cold water irrigation. Ojemann stimulator and the circular grid was used for cortical brain mapping at the same time, neuropsychological testing in both English and Spanish was conducted. The dura was opened in a curvilinear fashion. Two burr holes were placed and connected using a footplate, and the bone flap was removed. The patient was taken to the operating room for a left-sided awake craniotomy in a supine position a curvilinear skin incision was done, and the musculocutaneous flap was elevated after removal of the previous titanium plates and miniscrews. These findings were consistent with the evidence of disease progression vs. His most recent scan in February 2020 revealed left frontal expected post-surgical changes, with an increase in the surrounding T2/FLAIR hyperintensity signals with slight fullness of the parenchyma at the superior and inferior aspects. The recommendations were for him to continue to monitor the lesion with a serial of MRI scans, which remained stable. ![]() The pathology was consistent with WHO grade II Oligodendroglioma, IDH-mutant, and 1p19q co-deleted. 1655949_Video1: Video 1: This 32-year-old right-handed, Hispanic male presented with a history of seizures and was diagnosed with a left frontal lobe lesion, for which he underwent a near-total resection back in 2013.
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