Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping
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 functiona...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2013/835029 |
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| author | Silvio Sarubbo Gianpaolo Basso Franco Chioffi Edward Cesnik Beatrice Paradiso Enrico Grandi Enrico Fainardi Valeria Tugnoli Marco Farneti Enrico Granieri |
| author_facet | Silvio Sarubbo Gianpaolo Basso Franco Chioffi Edward Cesnik Beatrice Paradiso Enrico Grandi Enrico Fainardi Valeria Tugnoli Marco Farneti Enrico Granieri |
| author_sort | Silvio Sarubbo |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-7b6ee5ee4aae407daf86dbef2e5aebcb |
| institution | OA Journals |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
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| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-7b6ee5ee4aae407daf86dbef2e5aebcb2025-08-20T02:07:03ZengWileyCase Reports in Neurological Medicine2090-66682090-66762013-01-01201310.1155/2013/835029835029Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake MappingSilvio Sarubbo0Gianpaolo Basso1Franco Chioffi2Edward Cesnik3Beatrice Paradiso4Enrico Grandi5Enrico Fainardi6Valeria Tugnoli7Marco Farneti8Enrico Granieri9Department of Neurosciences, Division of Neurosurgery, “S. Chiara” Hospital, 9 Largo Medaglie d’Oro, 38122 Trento, ItalyDepartment of Cognitive Sciences and Education (DiSCoF), University of Trento, 101 Via delle Regole, 38123 Trento, ItalyDepartment of Neurosciences, Division of Neurosurgery, “S. Chiara” Hospital, 9 Largo Medaglie d’Oro, 38122 Trento, ItalyDepartment of Cognitive Sciences and Education (DiSCoF), University of Trento, 101 Via delle Regole, 38123 Trento, ItalyDepartment of Diagnostic and Experimental Medicine, Section of Human Anatomical, Histological and Cytological Pathology, “S. Anna” University Hospital, 8 Via Aldo Moro, 44124 Ferrara, ItalyDepartment of Diagnostic and Experimental Medicine, Section of Human Anatomical, Histological and Cytological Pathology, “S. Anna” University Hospital, 8 Via Aldo Moro, 44124 Ferrara, ItalyDepartment of Neurosciences and Rehabilitation, Division of Neuroradiology, “S. Anna” University Hospital, 8 Via Aldo Moro, 44124 Ferrara, ItalyDepartment of Neurosciences and Rehabilitation, Neurophysiology Unit, “S. Anna” University Hospital, 8 Via Aldo Moro, 44124 Ferrara, ItalyDepartment of Neurosciences and Rehabilitation, Division of Neurosurgery, “S. Anna” University Hospital, 8 Via Aldo Moro, 44124 Ferrara, ItalyDepartment of Cognitive Sciences and Education (DiSCoF), University of Trento, 101 Via delle Regole, 38123 Trento, ItalyIntroduction. 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.http://dx.doi.org/10.1155/2013/835029 |
| spellingShingle | Silvio Sarubbo Gianpaolo Basso Franco Chioffi Edward Cesnik Beatrice Paradiso Enrico Grandi Enrico Fainardi Valeria Tugnoli Marco Farneti Enrico Granieri Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping Case Reports in Neurological Medicine |
| title | Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping |
| title_full | Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping |
| title_fullStr | Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping |
| title_full_unstemmed | Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping |
| title_short | Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping |
| title_sort | technical anatomical and functional study after removal of a symptomatic cavernous angioma located in deep wernicke s territories with cortico subcortical awake mapping |
| url | http://dx.doi.org/10.1155/2013/835029 |
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