Surgery for gliomas of Broca’s area

Zhurnal Voprosy Neirokhirurgii Imeni N.N. Burdenko. 2025. Vol. 6. P. 38–45.

Dimertsev A. V., Batmanova Y. V., Zhikhar T. V., Pedyash N. V., Alekseev I. M., Dragoy O., Teplykh B. A., Zuev A. A.

Background. There are some unresolved issues in surgery for gliomas of Broca’s area (optimal intraoperative testing, cortical mapping, and stimulation parameters).

Objective. To clarify the peculiarities of neurosurgical technique and speech testing in surgery for gliomas of Broca’s area.

Material and methods. A single-center cohort retrospective study was devoted to surgical treatment of patients with Broca’s area gliomas in 2014—2023. Speech function was evaluated preoperatively, 7 days and 6 months after surgery. The Russian intraoperative naming test was used to assess speech production and understanding. Speech disorders were categorized as normal (2.1 to 3 points), moderate (1.1 to 2 points), and severe (0 to 1 point). Final analysis included 47 patients.

Results. Total resection was performed in 27 (58%) patients, near-total — 7 (15%), subtotal — 4 (8%), partial — in 9 (19%) cases. Mean resection rate was 92%. At baseline, there were 9 (19%) patients with aphasia (severe — 2 (4%), moderate — 7 (15%) patients). In 7 days after surgery, 31 (66%) ones had speech disorders (severe — 12 (24%), moderate — 19 (40%) cases). In 6 months after surgery, aphasia persisted in 10 (21%) patients (severe — 3 (6%), moderate — 7 (15%) cases).

Conclusion. Broca’s area gliomas do not require craniotomy larger than tumor projection size and «positive» mapping of all visible cortical areas, except for those regions where encephalotomy is planned («negative» mapping). When assessing the risks of persistent speech disorders, one should take into account such factors as tumor malignancy grade, baseline speech disorders, the need for mapping of motor areas, spread of tumor from Broca’s area to parietal lobe and subcortical nuclei. For more accurate determination of cortical speech zones in Broca’s area, testing should include naming of actions.

Keywords: опухоль мозга, краниотомия в сознании, brain tumor, awake craniotomy, glioma, intraoperative brain mapping, интраоперационное картирование, глиома

Publication based on the results of: Neural foundations of language and its impairments: From basic research to clinical practice (2025)