Case Report: High-grade glioma resection in the Broca area without functional loss

Abstract

Context: The Broca’s (BA) and Wernicke’s Area (WA) are fundamental for the language function. Surgical interventions in proximal areas can cause functional deficits. The left brain (LB) contains BA and WA in 92.5-97% of the right-handed individuals and 2/3 of the left-handed. The mapping of these functional areas is done with functional magnetic resonance (fMRI), which identifies which cerebral hemisphere is responsible for to the language function. In slow-growing tumor lesions, there might be plasticity in these areas, which allows tumor resection with functional recovery. In high-grade tumors, growth is fast and there is usually no significant plasticity. This article aims to demonstrate that even in high-grade tumors, brain plasticity in language areas can occur. Case report: T.R.P., male, 20 years old, right-handed, with type-2 neurofibromatosis. Evaluated due to the epileptic seizure with a lesion suggestive of high-grade glioma (IV-WHO) affecting the lower frontal gyrus in magnetic resonance imaging. Results: Undergoing surgical resection with awake craniotomy for functional language mapping. Functional studies have shown that the anatomical area corresponding to BA had no function and was surgically removed. T.R.P. evolved without functional deficits and fMRI showed complete resection of the Broca’s area and the anatomo-pathological exam confirmed that the tumor was a high-grade Glioma (IV-WHO). Conclusions: Even in the presence of a fast-growing lesion, the possibility of brain plasticity in the language areas should be considered. When plasticity is found, complete resection of the tumor is possible using invasive brain mapping, which has a direct impact on prognosis and survival.