Gamma Oscillation Regularity-Guided Intraoperative Language-Area Visualization and Functional Monitoring of Language-Related Cortical Recruitment Under General Anesthesia in Glioma Surgery.

Abstract

For tumors located in eloquent brain regions, mapping these areas is typically performed to guide surgical resection. We have achieved safe and reliable epilepsy surgery by visualizing epileptic lesions using gamma oscillation regularity (GOR) analysis. In this report, we present a unique case of glioblastoma resection near the language area, where safe and proactive tumor removal was successfully performed using intraoperative language-area visualization and functional monitoring of language-related cortical recruitment under general anesthesia based on GOR analysis. A man in his 50s was admitted to the hospital following a generalized seizure. Magnetic resonance imaging revealed a ring-enhancing gadolinium-contrasted lesion with a maximum diameter of 70 mm, extending from the left frontal lobe to the temporal lobe, suggestive of glioblastoma. The patient exhibited mild anomia and apraxia of speech but retained comprehension. While awaiting surgery, speech difficulties progressed significantly. Therefore, tumor resection was performed under general anesthesia using intraoperative GOR analysis. During the surgery, the language area was visualized, which allowed for aggressive tumor resection under language-area visualization and functional monitoring of language-related cortical recruitment under general anesthesia. Postoperatively, symptoms did not worsen, and motor aphasia improved. Glioblastoma surgery using intraoperative GOR analysis is highly beneficial and represents a promising approach for intraoperative language-area visualization and functional monitoring of language-related cortical recruitment under general anesthesia.