2020 Volume 29 Issue 4 Pages 298-305
In epilepsy surgery, lesionectomy is challenging, since epileptogenic zone is often located in functionally dominant areas, as in the case of focal cortical dysplasia (FCD). Brain mapping is necessary in such a case to achieve precise resection of the epileptogenic area while preserving brain function. In this report, we presented a case where epileptic focus was identified in the classical Broca's area, that is, the opercular part of the inferior frontal gyrus, and resected under awake craniotomy. Although this area demonstrated positive findings during intraoperative mapping with language tasks, it could be successfully resected with minor deterioration of speech function-phonological paraphasia. This symptom may not be caused by cortical but subcortical damages, and disappeared within two weeks postoperatively. In addition, no apparent seizure was documented postoperatively. The Broca's area is usually refrained from resection if language mapping demonstrates positive findings. There are two major considerations for successful results in this case. Firstly, for preserving language function, a connection of subcortical fibers is important and the cortex itself can be removed without permanent neurological deficits. Secondly, the cortex with the epileptic focus may have already reorganized during relatively long period of disease, and may not be functionally dominant at the time of surgery. This case is interesting for reconsidering the neural plasticity and functional preservation in the classical Broca's area. Here, we report this case along with a review of the relevent literature.
