• Leonardo J M de Macêdo Filho, Gilnard C M Aguiar, Fátima C Pessoa, Gabryella S Diógenes, Felipe S Borges, Andrei F Joaquim, and de Albuquerque Lucas Alverne Freitas LAF Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Ceará, Brazil; Department of Neurology, University of Campi.
• Health Science Center, University of Fortaleza, Fortaleza, Ceará, Brazil. Electronic address: leonardomacedofilho@edu.unifor.br.
• World Neurosurg. 2020 Sep 1; 141: 367-372.

BackgroundEpidermoid tumors, or epidermoid cysts (ECs), are benign, slow-growing, congenital, and rare lesions that represent approximately 0.2%-1.8% of all intracranial tumors. Intraparenchymal ECs are very rare lesions that may account for 1.5% of all intracranial epidermoid tumors; frontal lobe involvement is found in 39.2% of intraparenchymal ECs. We present a case using awake craniotomy to achieve maximal safe gross total resection of a rare intraparenchymal EC close to Broca area in a bilingual patient.Case DescriptionA 45-year-old man presented with a generalized seizure episode. He was initially treated with levetiracetam, which led to renal failure. Imaging findings demonstrated an intraparenchymal left frontal EC with peripheral coarse calcifications at Broca area. As the patient was bilingual and had a normal neurologic examination, we performed a left frontal awake craniotomy under local anesthesia so as to map both languages, using the motor task and a test for language monitoring, alternating a naming task in Portuguese and English and a semantic task in Portuguese. A gross total resection was achieved with no neurologic deficits. Histopathologic examination confirmed the diagnosis of an epidermoid cyst. After 1 year, the patient is still seizure-free.ConclusionsAwake surgery proved to be a useful tool for complete resection of the capsule even in a very eloquent language area. In multilingual patients with benign intra-axial lesions, intraoperative mapping should be performed for all the languages in which the patient is fluent to avoid postoperative neurologic deficits.Copyright © 2020 Elsevier Inc. All rights reserved.

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