Abstract
Background
Neuroplasticity is well established in low grade glioma patients. Our case report demonstrates that it can occur even in more aggressive brain lesions.
Methods
A 56-year-old lady presented with a recurrent speech deficit seventeen months after her initial craniotomy for a language eloquent glioblastoma (GBM). Pre-operative navigated trans-cranial magnetic stimulation (n-TMS) for language mapping, tractography and intra-operative language mapping were performed.
Results
During her second admission, preoperative n-TMS revealed positive responses anterior and posterior to the tumour recurrence. Tractography showed superior displacement of the Arcuate Fasciculus (AF) with fewer perisylvian fibres and more prominent fibres adjacent to the inferior frontal sulcus (IFS). The Fronto-Aslant Tract (FAT) was displaced supero-anteriorly. A second resection was carried out and the patient was discharged with no language deficit for second line treatment with Lomustine. Intraoperatively, speech arrest was found in a new position posterior to the previous surgical cavity and away from tumour recurrence (where speech arrest was previously located).
Conclusions
Language function neuroplasticity in glioblastoma is supported by preoperative cortical and subcortical mapping. This report supports that neuroplasticity can occur even with aggressive lesions and in a shorter period of time compared to low grade gliomas.