Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping
Figure 1
(a) This left hemisphere dissected with Klingler’s technique is focused on the posterior temporal lobe after removal of the gray matter of the middle and posterior thirds of the superior and inferior temporal sulci (resp., STS and ITS) and of the inferior parietal lobule. The purple arrows show the direction of the indirect posterior portion of the superior longitudinal fascicle (SLF), connecting the inferior parietal lobule (angular and supramarginal gyri) to the Wernicke’s territories (posterior thirds of superior and middle temporal gyri and superior temporal sulcus, BA 22), which are evidenced by the red circle. The red circles at the level of the junction between the posterior and middle thirds of the superior and middle temporal gyri (resp., STG and MTG) represent the eloquent sites identified by means of cortical DES during denomination task. The yellow circle identifies the inferior temporal gyrus (ITG) language areas shown by fMRI and confirmed by means of cortical DES. Finally, the green circle shows the cortical approach to the lesion directly through the posterior third of the STS (BA 22). (b) After removal of the more superficial cortices of the STG and MTG, the courses and terminations of the direct component of the SFL, the arcuate fasciculus (AF), are demonstrated and evidenced by green arrows. Red arrows evidence the more ventral fibers of IFOF, crossing the AF just underneath the Wernicke’s territories. The grey circle shows the position of cavernous angiomas (CA) in respect to the deeper bundles. ANT: anterior; INF: inferior; ITG: inferior temporal gyrus; ITS: inferior temporal sulcus; MTG: middle temporal gyrus; POST: posterior; STG: superior temporal gyrus; STS: superior temporal sulcus; SUP: superior.
