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Neurosurgery:
doi: 10.1227/NEU.0b013e318282cdad
Research-Human-Clinical Studies

Noninvasive Language Mapping in Patients With Epilepsy or Brain Tumors

Genetti, Melanie PhD*,‡; Grouiller, Frederic PhD*,‡,§; Vulliemoz, Serge MD, PhD; Spinelli, Laurent PhD; Seeck, Margitta MD; Michel, Christoph Martin PhD; Schaller, Karl MD

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Abstract

BACKGROUND: Functional magnetic resonance imaging (fMRI) has become part of routine brain mapping in patients with epilepsy or tumor undergoing resective surgery. However, robust localization of crucial functional areas is required.

OBJECTIVE: To establish a simple, short fMRI task that reliably localizes crucial language areas in individual patients who undergo respective surgery.

METHODS: fMRI was measured during an 8-minute auditory semantic decision task in 28 healthy controls and 35 consecutive patients who had focal epilepsy or a brain tumor. Nineteen underwent resective surgery. Group and individual analyses were performed. Results in patients were compared with postsurgical language outcome and electrocortical stimulation when available.

RESULTS: fMRI activations concordant with the anterior and posterior language areas were found in 96% and 89% of the controls, respectively. The anterior and posterior language areas were both activated in 93% of the patients. These results were concordant with electrocortical stimulation results in 5 patients. Transient postsurgical language deficits were found in 2 patients in whom surgery was performed in the vicinity of the fMRI activations or who had postsurgical complications implicating areas of fMRI activations.

CONCLUSION: The proposed fast fMRI language protocol reliably localized the most relevant language areas in individual subjects. It appears to be a valuable complementary tool for surgical planning of epileptogenic foci and of brain tumors.

ABBREVIATIONS: ECS, electrocortical stimulation

FLI, frontal lateralization index

fMRI, functional magnetic resonance imaging

FWE, family-wise error

LI, lateralization index

MNI, Montreal Neurological Institute

SD, standard deviation

SEM, standard error of the mean

TPLI, temporoparietal lateralization index

Copyright © by the Congress of Neurological Surgeons

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