title: Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke's Territories with Cortico-Subcortical Awake Mapping.
abstract: Introduction. The subcortical region underneath Wernicke's area (WA) is a critical crossing of the eloquent language pathways involved in all semantic, phonological, syntactic, and working memory elaboration. We report the resection of a CA located underneath the dominant WA discussing the functional and anatomical evidence provided by fMRI, dissections with Klingler's technique, and intraoperative mapping during awake surgery. Case Report. A 64-year-old right-handed female affected by daily complex focal seizures underwent f-MRI, showing language activations in the middle and inferior temporal gyri and an unusual free entry zone in the "classical" WA. The cortical intraoperative mapping partially confirmed the f-MRI results, and we approached the lesion directly through WA. Subcortical DES allowed the identification of the eloquent language pathways and the radical resection of the perilesional gliotic rim. The patient did not report deficits and she is seizures and drug free after 1-year surgery. Discussion. Cortical DES demonstrated the variability of the eloquent areas within the cortex of the dominant temporal lobe. The subcortical DES confirmed the crucial role in language elaboration and the anatomical course of the bundles underneath WA. Conclusions. Awake surgery with DES represents a reliable and dynamic technique also for safer and functional-customized resection of CAs.
authors.affiliation: Department of Neurosciences, Division of Neurosurgery, "S. Chiara" Hospital, 9 Largo Medaglie d'Oro, 38122 Trento, Italy ; Department of Medical and Surgical Sciences of Communication and Behavior, Clinics of Neurology, "S. Anna" University Hospital, 8 Via Aldo Moro, 44124 Ferrara, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Sarubbo
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Basso
authors.forename: Franco
authors.initials: F
authors.lastname: Chioffi
authors.forename: Edward
authors.initials: E
authors.lastname: Cesnik
authors.forename: Beatrice
authors.initials: B
authors.lastname: Paradiso
authors.forename: Enrico
authors.initials: E
authors.lastname: Grandi
authors.forename: Enrico
authors.initials: E
authors.lastname: Fainardi
authors.forename: Valeria
authors.initials: V
authors.lastname: Tugnoli
authors.forename: Marco
authors.initials: M
authors.lastname: Farneti
authors.forename: Enrico
authors.initials: E
authors.lastname: Granieri