Awake Craniotomy for Subcortical Brain Metastasis Beneath the Speech Center: A Technical Case Report

Abstract

Background: To preserve language function, intraoperative functional brain mapping (IFBM) in and near the speech center is essential. Case Report: We present a case of a 73-year-old right-handed woman with colon cancer. She presented with mild speech disturbance. Magnetic resonance imaging revealed a ringed enhancing lesion in the frontal operculum. The preservation of language function was critical; therefore, she underwent awake craniotomy using IFBM. Thus, the speech site was elicited by cortical electrical stimulation at the surface, near the location of the tumor. We made a safe corticotomy on the surface of the lesion and performed the resection of brain metastasis (BM) via a safety corridor. We achieved gross total resection of the BM while preserving the language function. After surgery, she recovered from speech disturbance. She returned to her normal life with improved language function. Conclusion: IFBM is a useful tool to undertake a safe approach via the speech center, avoiding permanent language deficits.