title: Localization of primary language areas by arcuate fascicle fiber tracking.
abstract: BACKGROUND
  To reduce the risk of disabling postoperative functional deficit in patients with lesions in the dominant hemisphere, information about the localization of eloquent language areas is mandatory.
  
  
  OBJECTIVE
  To demonstrate the feasibility of arcuate fascicle (AF) tractography for proper localization of eloquent language areas in the superior temporal (STG) and inferior frontal gyrus (IFG).
  
  
  METHODS
  Between January and June 2010, we performed surgery in 13 patients with highly eloquent lesions with close spatial relationship to the primary language areas. All of them received preoperative diffusion tensor imaging for AF tractography. The STG and IFG were delineated at the ends of the AF. Five patients underwent functional magnetic resonance imaging of the primary language areas. The results were compared with tractography.
  
  
  RESULTS
  Tractography of the AF without prior knowledge of the localization of the STG and IFG was feasible in all cases. In the cases with functional magnetic resonance imaging, the activation maps matched the tractography results. In all but 1 patient, preservation of the primary language areas was possible, proven by the good neurological outcome. One patient suffered from a language dysfunction caused by a lesion in the medial and inferior temporal gyrus along the surgical pathway.
  
  
  CONCLUSIONS
  Tractography of the AF is a useful tool for identification of parts of the main primary language areas. Using tractography as a localization procedure to determine the primary language areas aids in the delineation of the STG and IFG and thus may help reduce the risk of postoperative permanent neurological deficit.
authors.affiliation: Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland. Lennart@Stieglitze.de
authors.forename: Lennart
authors.initials: L
authors.lastname: Henning Stieglitz
authors.forename: Kathleen
authors.initials: K
authors.lastname: Seidel
authors.forename: Roland
authors.initials: R
authors.lastname: Wiest
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000175:diagnosis / Q000503:physiopathology; D056324:Diffusion Tensor Imaging; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000378:metabolism / Q000502:physiology*; D007839:Functional Laterality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000378:metabolism / Q000502:physiology*; D009415:Nerve Net / Q000098:blood supply / Q000378:metabolism / Q000502:physiology; D010100:Oxygen / Q000097:blood; D013702:Temporal Lobe / Q000098:blood supply / Q000378:metabolism / Q000502:physiology*; D055815:Young Adult
chemical_list: D010100:Oxygen