Awake surgery and music: Two illustrative cases of frontal resection in pianists

Functional anatomy underlyng music perception and production has been quite abundantly described in literature, together with some examples of musical tasks adopted during awake surgery. We have used a keyboard-playing test for per-operative monitoring of two patients affected by a glial lesion. Our two cases differ in age, lateralization and hemispheric localization of the lesion. One of them, who presented a left middle frontal gyrus lesion, showed a decrease in his ability to play piano, together with other neurological abnormalities, from which he completely recovered within a year. The other patient, whose lesion was instead right and prefrontal, didn't show any music-related anomalies. Our patients' outcomes are consistent with previous literature concerning lateralization and localization of music-related functions in musicians. In our left-sided case, the emerging of a slowdown in piano playing, without other relevant language, sensitive or motor abnormalities, confirmed by mistakes in picture naming (DO80 N-1) performed simultaneously with a motor task, led us to interrupt our resection, allowing the patient to fully recover within a year, suggesting, with the limitations that we will further discuss, a certain sensibility of the action of playing for early detection of cognitive abnormalities, usually determined with a task-switching test strategy.