Surgical Outcomes in Broca's Area Tumor Resection: Advances, Insights, and Implications

Introduction: Broca's area is crucial for expressive language, leading to non-fluent aphasia when damaged. The severity of outcomes varies with lesion size, age, and the speed of injury development. Advances in medical technology have made surgeries involving Broca's area feasible, using intraoperative mapping to preserve language function during resection.

Methods: We retrospectively reviewed a prospective database. A single surgeon performed all procedures. Patients underwent preoperative language and cognitive assessments, with lesion location confirmed in the dominant hemisphere using fMRI or Wada testing. Intraoperative awake language mapping and direct cortical stimulation (DCS) were used. Patients were prospectively followed.

Results: We included 39 patients (22 male, 17 female). Mean age at surgery was 41.3 years old. Prevalent presenting symptoms were seizures(n=26), speech problems(n=12), headache(n=10). Common tumor histologies were astrocytoma(n=13), oligodendoglioma(n=10), and glioblastoma(n=7). 20 lesions were classified as WHO grades III or IV.
Median PFS and OS were 17 and 36 months, respectively. Surgery was interrupted in 9 patients (due to intraoperative deterioration). Gross total and near total resection were obtained in 20 patients. Immediate post-op deficits were seen in 13 patients(speech related=11). At 3 month follow up, 3 still patients had deficits. WHO grading and tumor histology correlated with PFS(p=0.014;p=0.02) and OS(p=0.004;p=0.001). WHO grade II tumors had the best PFS (median 46 months) and OS(median 55 months). Grade IV tumors had the poorest PFS (median 9 months) and OS (median 15 months). Diffuse glioma had the most favorable prognosis, while glioblastoma and oligoastrocytoma had the worst. Resection extent was associated with PFS (p=0.02) but not with OS (p=0.24).

Conclusion : Resection of tumors in Broca's area is feasible with relative safety, and most immediate post-operative deficits are transient. Like tumors in other brain locations, aggressive histology and WHO grades correlate with shorter PFS and OS. Intraoperative mapping and DCS plays a vital role in preserving language function