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


CONCLUSIONS
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.
Herholz
K
K
Max-Planck-Institut, Köln, Germany.
Reulen
H J
HJ
von Stockhausen
H M
HM
Thiel
A
A
Ilmberger
J
J
Kessler
J
J
Eisner
W
W
Yousry
T A
TA
Heiss
W D
WD
D000328:Adult; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D004558:Electric Stimulation; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014055:Tomography, Emission-Computed; D014705:Verbal Behavior / Q000502:physiology*