Preoperative activation and intraoperative stimulation of language-related areas in patients with glioma

Neurosurgery. 1997 Dec;41(6):1253-60; discussion 1260-2. doi: 10.1097/00006123-199712000-00004.

Abstract

Objective: Evaluation of the accuracy of preoperative localization of language-related cortex by magnetic resonance imaging-guided positron emission tomography.

Methods: Patients with gliomas in the left dominant hemisphere were examined preoperatively with magnetic resonance imaging-guided positron emission tomography and intraoperatively by electrical stimulation of cortex.

Results: A verb generation task yielded more intense and better lateralized local increases of cerebral blood flow in the positron emission tomographic examination than did a naming task. Significant correspondence of preoperative and intraoperative findings was observed for the verb generation task. Cortical sites with aphasic disturbance during electrical stimulation had a significantly higher cerebral blood flow increase during preoperative activation than did sites without intraoperative language impairment. Areas with cerebral blood flow increases above an optimum threshold had 73% sensitivity and 81% specificity to predict aphasic disturbance during intraoperative stimulation.

Conclusion: The data suggest that with further technical improvements, imaging of language function may become a preoperative diagnostic tool for patients with tumors close to language-related brain structures.

MeSH terms

  • Adult
  • Brain / physiopathology*
  • Brain Mapping
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / physiopathology*
  • Brain Neoplasms / surgery*
  • Cerebrovascular Circulation / physiology
  • Electric Stimulation
  • Female
  • Glioma / diagnosis
  • Glioma / physiopathology*
  • Glioma / surgery*
  • Humans
  • Intraoperative Period
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Tomography, Emission-Computed
  • Verbal Behavior / physiology*