Complete recovery after surgical resection of left Wernicke's area in awake patient: a brain stimulation and functional MRI study

Abstract We report the first observation of a complete functional recovery following surgical resection of the left Wernicke’s area involved by a WHO grade II glioma in a 38-year-old right-handed woman. Intraoperative electrostimulation language mapping performed during awake procedure revealed a compensatory cortico- subcortical circuit around Wernicke’s area, including the left insula (eliciting articulatory disturbances when stimulated), the left superior longitudinal fascicle (inducing phonemic paraphasia during stimulation) and the left inferior occipito-frontal fascicle (eliciting semantic paraphasia when stimulated). Following a specific functional rehabilitation, especially concerning verbal working memory, the patient returned to a normal social and professional life two months after surgery, with a normal language examination despite resection of the left Wernicke’s area. Interestingly, postoperative language functional MR demonstrated a wide bilateral network partly common between phonological and semantic processing, underlying the functional recovery. Therefore, combination of intraoperative mapping with functional neuroimaging may provide original insights into the neural basis of compensation of Wernicke’s area, opening the door to surgery in this structure classically considered inoperable.