Functional compensation of the left dominant insula for language

The left dominant insula was recently described as an essential area of spe ech, inducing definitive language disturbances when injured. We describe a patient with mild dysphasia, harboring a left insular glioma. A functional MRI found activations within the left inferior and middle frontal gyri, sup erior temporal gyrus, basal ganglia, but not in the insula. Surgery was per formed using intraoperative electrical mapping in the awake patient. identi fying the same language sites as showed by fMRI. A complete glioma resectio n was then performed. Despite an entire dominant insula removal, the patien t presented no postoperative deficit, and even recovered from the preoperat ive dysphasia. This case illustrates the brain ability to maintain normal l anguage without the left insula. The mechanisms of compensation are discuss ed. NeuroReport 12:2159-2163 (C) 2001 Lippincott Williams & Wilkins.