Spontaneous Speech

In this chapter the authors critically discuss the relevance of analyzing spontaneous speech in the peri-operative awake surgery phase of glioma patients. First a brief review of the neural basis is provided in order to shed light on the dissociation between spontaneous speech and other isolated language/speech functions, in the literature known as the “SMA syndrome” or “dynamic aphasia.” Subsequently, methods to assess (semi-)spontaneous speech intraoperatively are discussed, as well as their potential added value for long-term postoperative language outcome. Until now, adequate and sensitive assessment of spontaneous speech in clinical settings still remains a challenge as it is still not yet fully understood in what exact way glioma patients show impairments and suffer from it in the perioperative phase due to large individual variability. However three different approaches appeared to be essential in glioma treatment to elucidate the quality of daily language use: (1) actual transcription of spontaneous speech, (2) administration of semi-spontaneous speech tasks (e.g., sentence completion in broad context), and (3) self-reported language complaints. By only monitoring language functions in isolation, “subtle” yet devastating impairments could be missed, increasing the risk for long-term postoperative impairments with negative effects on daily life.