TUMORS OF HESCHL GYRUS - REPORT OF 2 CASES

OBJECTIVE AND IMPORTANCE: The clinical presentation and treatment of p atients with lesions involving Heschl's gyrus is reported. Intraoperat ive bipolar cortical stimulation mapping of Heschl's gyrus has not bee n previously reported. Only monopolar stimulation of this region (with potential electrical recruitment of large areas of surrounding cortex ) has been undertaken. CLINICAL PRESENTATION: Two patients with intrin sic brain tumors located in Heschl's gyrus, in the hemisphere dominant for speech, presented with interictal or ictal auditory changes. INTE RVENTION: Craniotomies were performed with the patients awake and with intraoperative bipolar cortical stimulation mapping of language corte x and of Heschl's gyrus. CONCLUSION: In contrast to previous studies u sing monopolar cortical stimulation, auditory changes were not elicite d by stimulation. In one of the patients, a persistent interictal ring ing sound stopped abruptly during lesion resection. Neither patient ha d essential temporal lobe language cortex near the lesion. Lesions in Heschl's gyrus can be identified by clinical presentation and magnetic resonance imaging. Based on topographic anatomy, cytoarchitecture, an d functional mapping data, these lesions may be resectable without lan guage or auditory mapping, although further experience will be necessa ry to confirm this observation.