Temporal Glioma: Mapping Wernicke’s Area

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- Let's discuss resection of Temporal Lobe Gliomas, using mapping within and close to the Wernicke's area. This is a 35 year old female who presented with intermittent episodes of speech difficulties suspected to be seizures. MRI evaluation demonstrated a relatively non enhancing left temporal lobe located within the Middle Temporal Gyrus, relatively close to the Wernicke's area. She subsequently underwent an Awake Left Temporal Craniotomy. You can see the incision and left temporal craniotomy for exposure of the face area, as well as the superior, middle and inferior temporal gyri. First, Cortical Stimulation was used to map their face area. After the face was mapped. We also mapped the Wernicke's area using naming parameters discussed as swearing the atlas. Here, you can see the face area, the Wernicke's area, Language receptive area of the cortex over the tumor was hyper stimulated to assure no function is present in the area. Vein of Labbe is apparent, this vein has to be protected. Small corticotomy was created parallel to the route of the vein of labbe, to remove the inferior border of the tumor and additional Corticotomy was also conducted just below the vein. So I worked on both sides of the vein to remove the gelatinous tumor until normal appearing yellow glistening white matter was encountered. You can see again, the proximity of function to our resection cavity. We preserved as much of the cortex as possible while undermining it to remove their residual tumor. Here, Resection cavity appears relatively clean. Post-operative MRI demonstrated adequate removal of the tumor. The patient had some minor receptive speech difficulty after surgery, which resolved within a month after her operation. Thank you.

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