A Super-selective Wada Test Successfully Detected an Artery That Supplied Broca’s Area in a Case of Left Frontal Lobe Glioblastoma: Technical Case Report

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  • YAMASHITA Shota
    Department of Neurosurgery, Graduate School of Medicine, Tohoku University
  • SAITO Ryuta
    Department of Neurosurgery, Graduate School of Medicine, Tohoku University Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine
  • OSAWA Shin-ichiro
    Department of Neurosurgery, Graduate School of Medicine, Tohoku University
  • NIIZUMA Kuniyasu
    Department of Neurosurgery, Graduate School of Medicine, Tohoku University Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University
  • UKISHIRO Kazushi
    Department of Epileptology, Graduate School of Medicine, Tohoku University
  • KANAMORI Masayuki
    Department of Neurosurgery, Graduate School of Medicine, Tohoku University
  • KAKINUMA Kazuo
    Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University
  • SUZUKI Kyoko
    Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University
  • TOMINAGA Teiji
    Department of Neurosurgery, Graduate School of Medicine, Tohoku University

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<p>In cases of malignant gliomas located at language eloquent area, it is often difficult to preoperatively detect those area with functional MRI. Awake surgery is often used to spare the language eloquent area during surgery for such tumors; it is not available for a patient whose intracranial pressure is elevated due to the malignant tumor. The Wada test involves infusing anesthetic agents into the internal carotid artery to determine language dominancy before surgery for epilepsy or brain tumor. The super-selective Wada test is a technique to detect more detailed functional localization by infusing anesthetics into far distal middle cerebral artery branches. We present a 37-year-old man suffering from a left frontal lobe glioblastoma, in whom detection of an artery supplying Broca’s area was attempted by a super-selective Wada test. The super-selective Wada test successfully detected the branch of middle cerebral artery supplying Broca’s area. Total resection of the contrast-enhancing area was achieved without damaging the artery supplying Broca’s area without any neurological sequelae. This is the first report describing the usefulness of the super-selective Wada test in glioblastoma treatment. Our findings suggest that the super-selective Wada test is a powerful and useful means to distinguish the artery that supplies the language area from the tumor feeding artery in cases of tumors in the language eloquent area.</p>

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