Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping
Figure 3
(a) The intraoperative picture after resection shows the results of the direct electrical cortical mapping. The stimulation threshold was set at 3 mA after eliciting speech arrest at stimulation of ventral premotor cortex (VPMC) during counting task (tag 1). The cortical stimulation during denomination test (Laiacona-Capitani) elicited semantic paraphasias (tag 3) at the level of the posterior thirds of the inferior temporal sulcus (ITS) and middle temporal gyrus (MTG; BA37 and BA21), at the extreme posterior third of the superior temporal sulcus (STS), posteriorly to the lesion, and at the border between middle and posterior thirds of the STS and superior temporal gyrus (STG; BA22) anteriorly to the lesion. Anomias (tag 2) were elicited at the border between middle and posterior thirds of the STG (BA22) at the upper and anterior margin of the lesion. The site of corticectomy was in the free activations zone in the posterior third of the peri-STS area (BA22). In the deepest part of the surgical cavity direct electrical stimulation elicited semantic paraphasias due to deactivation of the inferior fronto-occipital fasciculus (IFOF). (b) This picture shows the 1 cm cavernous angioma (CA) removed. BA: Brodmann area; IFOF: inferior fronto-occipital fasciculus; ITS: inferior temporal sulcus; VPMC: ventral premotor cortex; STG: superior temporal gyrus; STS: superior temporal sulcus.
