Two-staged resection of a left frontal XXXX involving the operculum and insula using intraoperative neurophysiological monitoring--case report.

@entity1 @entity41 @entity5 @entity75 @entity11 @entity51 @entity816 @entity302
A 29-year-old right-handed male with a 12-year education presented with a 2-month history of generalized @entity302 activity. Neuroradiological imaging demonstrated a large lesion in the left frontal lobe involving the insulooperculum and in the temporal tip. Neurological and neuropsychological examination revealed no abnormality. Two-staged total resection of a left frontal large @entity816 involving the insulooperculum was achieved, with preservation of the speech and motor functions. The prefrontal area was resected en bloc under general anesthesia. To avoid vascular damage including the lenticulostriate arteries, the sylvian and the interhemispheric fissures were thoroughly opened. The @entity5 was apparently located in the anatomical Broca's area. Eighteen days later, the @entity41 was totally resected with no language deficit after identifying the motor-speech cortex, which was displaced from the usual location, by direct cortical stimulation under local anesthesia. The medially extended insular @entity5 was then resected stepwise with frequent neurological monitoring with the @entity1 awake. Surgery for @entity75 in the dominant hemisphere carries a high risk of speech and @entity51 . This staged operation enables maximum @entity5 resection of dominant-side large frontal @entity11 involving the insuloopercular region, with preservation of both motor and speech functions.
