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
‡Department of Neurology and Fundamental Neurosciences, Geneva University Hospitals, Geneva, Switzerland
§Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
‖Department of Neurology, Geneva University Hospitals, Geneva, Switzerland
¶Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
Correspondence: Karl Schaller, MD, Department of Neurosurgery, University Hospital, 4, Rue Gabrielle-Perret-Gentil, CH-1211 Geneve 14, Switzerland. E-mail: Karl.Schaller@hcuge.ch
* These authors contributed equally to the article.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.neurosurgery-online.com)
Received May 21, 2012
Accepted November 27, 2012