CASE REPORT article
Front. Neurosci.
Sec. Brain Imaging Methods
Volume 19 - 2025 | doi: 10.3389/fnins.2025.1587594
Personalized Model of Care for Surgical Resection of Complex Brain Tumor with Atypical Language Dominance: A Case Report
Provisionally accepted
Natalie Sherry1,2*
Neslihan Nisa Gecici1,3
Amelia Stepniak4Daniel Miller5
Ahmed Habib1,3Ajay Niranjan1,2
Jessica Barrios-Martinez1
Frank Yeh1Jeffrey Balzer1,2Pascal Zinn1,3*- 1University of Pittsburgh, Pittsburgh, United States
- 2University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- 3Center for Hillman Cancer, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- 4Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- 5Kenneth P. Dietrich School of Arts & Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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The gold standard for preserving language and cognitive function during complex brain tumor resection is direct electrical stimulation (DES) during awake craniotomy. DES is predominantly utilized for left hemisphere (LH) tumors, where language dominance is most common. However, atypical language dominance and functional reorganization due to tumor growth are increasingly recognized and can complicate preoperative planning. We present the novel case of a 58-year-old monolingual, Englishspeaking, strongly right-handed male with recurrent right temporal glioblastoma who exhibited right hemisphere (RH) language dominance based on multimodal preoperative evaluation. The patient had no known perinatal or neurodevelopmental history, and had a prior resection of the tumor under general anesthesia with no post-operative aphasia. An awake craniotomy with intraoperative mapping (IOM) was performed which confirmed language representation in the right frontal and temporal lobes. This was further substantiated by neuropsychological testing (NPT) revealing a decline in semantic language postoperatively. This case challenges the prevailing practice of limiting awake procedures to LH tumors and supports a personalized, multimodal approach to mapping eloquent cortex irrespective of tumor laterality to optimize surgical outcomes.
Keywords: brain tumor, Language, atypical, Neuropsychology, Neurosurgery, case report
Received: 06 Mar 2025; Accepted: 24 Jun 2025.
Copyright: © 2025 Sherry, Gecici, Stepniak, Miller, Habib, Niranjan, Barrios-Martinez, Yeh, Balzer and Zinn. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Natalie Sherry, University of Pittsburgh, Pittsburgh, United States
Pascal Zinn, University of Pittsburgh, Pittsburgh, United States
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