• Philippe Metellus, Salah Boussen, Maxime Guye, and Agnes Trebuchon.
• Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France; Département de Neurochirurgie, Hôpital de la Timone, Marseille, France; Faculté de Médecine, Aix-Marseille Université, Marseille, France. Electronic address: philippe.metellus@outlook.fr.
• World Neurosurg. 2017 Feb 1; 98: 883.e1-883.e5.

BackgroundResection of tumors located within the insula of the dominant hemisphere represents a technical challenge because of the complex anatomy, including the surrounding vasculature, and the relationship to functional (motor and language) structures. We report here the case of a successful resection of a left insular glioma in a native deaf signer during an awake craniotomy.Case DescriptionThe patient, a congenitally deaf right-handed patient who is a native user of sign language, presented with a seizure 1 week before he was referred to our department. Magnetic resonance imaging revealed a left heterogeneous insular tumor enhanced after intravenous gadolinium infusion. Because of its deep and dominant hemisphere location, an awake craniotomy was decided. The patient was evaluated intraoperatively using object naming, text reading, and sign repetition tasks. An isolated inferior frontal gyrus site evoked repeated object naming errors. A transopercular parietal approach was performed and allowed the successful removal of the tumor under direct electric stimulation and electrocorticography. To our knowledge, this is the first report of successful removal of a left insular tumor without any functional sequelae in a native deaf signer using intraoperative direct cerebral stimulation during an awake craniotomy.ConclusionsThe methodology used also provides the first evidence of the actual anatomo-functional organization of language in deaf signers.Copyright © 2016 Elsevier Inc. All rights reserved.

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