J Korean Neurosurg Soc.  1974 Oct;3(2):7-12.

Microneurosurgery in Dominant Cerebral Hemisphere

• Lee CW
• Chung HJ

Abstract

With the aid of surgical microscope, operations could successfully be attempted directly to the motor and sensory speech areas of dominant cerebral hemisphere. Case 1 who is a right hander showed to have a small post-traumatic intracerebral hematoma located deeply beneath the Wernicke's area of left temporoparietal region resulted from the stab wound caused by fall on a long nail. After the removal of depressed bone fragments and hematomas from epidural and subdural spaces, no actual evidence of intracerebral hematoma which was hidden deeply into the white matter could be found by simple naked eyes. A minute nail tract could, however, easily be detectable by using a magnified surgical microscope under the excellent illumination. A small cortical incision, 1.5cm in length, was enough to evacuate the blood clot formed hematoma. The surgery was performed under local anesthesia and the patient was recovered uneventfully from aphasia, stupor and hemiparesis post-operatively. Case 2 who is a right handed man presented with a left frontal lobe tumor, cystic astrocytoma, located adjacent to the Broca's area. Microsurgical technique was introduced during the removal of tumor. A cortical incision, 2.5cm in length, was made in middle frontal gyrus anterior to the speech area for the preservation of those important neural elements. No blood transfusions were required in both cases and vital signs were kept within normal limits throughout the surgery. Post-operative recuperation revealed to be excellent. To cope with the risk of damage to the speech centers in dominant cerebral hemisphere, microsurgical technique supported by adequate magnification and excellent illumination should preferably be adopted in cases who has been suffering from speech disorders.

MeSH Terms

Anesthesia, Local
Aphasia
Astrocytoma
Blood Transfusion
Cerebrum*
Frontal Lobe
Hand
Hematoma
Humans
Lighting
Paresis
Speech Disorders
Stupor
Subdural Space
Vital Signs
Wounds, Stab