# Awake Surgery for a Patient With Glioblastoma and Severe Aphasia: Case Report

## TL;DR

A patient with severe aphasia and glioblastoma underwent awake surgery using singing as a communication tool, successfully preserving language function.

## Contribution

Demonstrates that singing can be used as an alternative during awake surgery for aphasic patients to preserve language function.

## Key findings

- 90% of the tumor was resected while preserving language function.
- The patient showed improvement in language function post-surgery.
- Singing was effective in detecting language dysfunction during surgery.

## Abstract

Patients with severe aphasia rarely become candidates for awake surgery because the intraoperative tasks of awake surgery for patients with aphasia have not been established.

A 50-year-old, right-handed woman presented with recurrent glioblastoma invading her left superior temporal gyrus and inferior parietal lobule. She had severe aphasia, as she could barely verbalize her own name. However, we noticed that she could sing nursery rhymes with simple melodies and applied her singing ability as an axis of awake surgery. During awake surgery, she continuously sang simple songs to detect language dysfunction. As a result, 90% of the tumor was resected, preserving her language function and allowing for improvement. She was discharged 9 days after surgery without further neurological deterioration.

Awake surgery is usually not indicated in patients with severe aphasia. However, for patients with aphasia who retain the ability to sing, intraoperative singing could be a possible alternative to maximize tumor resection while minimizing neurological dysfunction.