We report herein the case of a 41-year-old man operated on for a small inferior parietal lobule ganglioglioma with a sleep-awake-sleep protocol and language mapping to avoid major speech disorders. Postoperatively, however, writing disturbance was characterized by persistent graphemic errors that lasted for about 8 months. The topic is discussed in light of recent literature, exploring the possible relationship between writing difficulties and disconnections produced by a combination of resecting supramarginal gyrus components and interrupting arcuate fasciculus fibers. Awake mapping of eloquent structures is typically done using direct brain stimulation to maximize the extent of the resection while minimizing permanent neurological deficits. However, most intraoperative language tests focus on language skills such as oral and reading skills. Therefore, the detection of dysgraphia requires a high degree of attention from the surgical team and direct examination intra-and perioperatively. To this end, employing an intraoperative writing test during awake surgery may be considered. Advances in this field may aid in increasing the accuracy during parenchymal dissections, influencing the extent of the resection, improving the patient's functional prognosis and long-term quality of life.
Keywords: Aphasia; Brain mapping; Brain tumor; Dysgraphia; Ganglioglioma; Language; Parietal lobe.
© 2025. The Author(s).