Awake craniotomy for a cavernous angioma in the Broca’s area

View More View Less
  • 1 Departments of Neurosurgery and
  • | 2 Anesthesiology, Hospital Geral de Fortaleza, Ceará, Brazil
Free access

Cavernous angiomas constitute 5%–10% of cerebrovascular malformations and may cause seizure and neurological deficits from bleeding. The authors present a case of a 44-year-old man with a 3.5-year history of epilepsy without complete seizure control despite anticonvulsants. Brain MRI showed a 2.8 cm cavernous angioma at the left pars opercularis, also known as the Broca’s area. The patient underwent an awake craniotomy for intraoperative cortical–subcortical language and sensory-motor mapping for a complete resection of the cavernous angioma and the hemosiderin rim. The procedure was uneventful, and the patient evolved seizure free and with no deficits.

The video can be found here: https://youtu.be/QajbLIsr_vg.

Cavernous angiomas constitute 5%–10% of cerebrovascular malformations and may cause seizure and neurological deficits from bleeding. The authors present a case of a 44-year-old man with a 3.5-year history of epilepsy without complete seizure control despite anticonvulsants. Brain MRI showed a 2.8 cm cavernous angioma at the left pars opercularis, also known as the Broca’s area. The patient underwent an awake craniotomy for intraoperative cortical–subcortical language and sensory-motor mapping for a complete resection of the cavernous angioma and the hemosiderin rim. The procedure was uneventful, and the patient evolved seizure free and with no deficits.

The video can be found here: https://youtu.be/QajbLIsr_vg.

Contributor Notes

CORRESPONDENCE Lucas Alverne Freitas de Albuquerque: Hospital Geral de Fortaleza, Ceará, Brazil. lucasalverne@yahoo.com.br.

INCLUDE WHEN CITING Published online October 1, 2018; DOI: http://thejns.org/doi/abs/10.3171/2018.10.FocusVid.18240.

  • 1

    Boetto J, Bertram L, Moulinié G, Herbet G, Moritz-Gasser S, Duffau H: Low rate of intraoperative seizures during awake craniotomy in a prospective cohort with 374 supratentorial brain lesions: electrocorticography is not mandatory. World Neurosurg 84:18381844, 2015

    • Search Google Scholar
    • Export Citation
  • 2

    Deras P, Moulinié G, Maldonado IL, Moritz-Gasser S, Duffau H, Bertram L: Intermittent general anesthesia with controlled ventilation for asleep-awake-asleep brain surgery: a prospective series of 140 gliomas in eloquent areas. Neurosurgery 71:764771, 2012

    • Search Google Scholar
    • Export Citation
  • 3

    Duffau H: The error of Broca: from the traditional localizationist concept to a connectomal anatomy of human brain. J Chem Neuroanat 89:7381, 2018

    • Search Google Scholar
    • Export Citation
  • 4

    Matsuda R, Coello AF, De Benedictis A, Martinoni M, Duffau H: Awake mapping for resection of cavernous angioma and surrounding gliosis in the left dominant hemisphere: surgical technique and functional results. J Neurosurg 117:10761081, 2012

    • Search Google Scholar
    • Export Citation
  • 5

    Osborn I, Sebeo J: ‘‘Scalp block’’ during craniotomy: a classic technique revisited. J Neurosurg Anesthesiol 22:187194, 2010

  • 6

    Ribas GC, Yasuda A, Ribas EC, Nishikuni K, Rodrigues AJ Jr: Surgical anatomy of microneurosurgical sulcal key points. Neurosurgery 59 (4 Suppl 2):ONS177ONS211, 2006

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1258 243 22
PDF Downloads 462 92 16
EPUB Downloads 0 0 0