title: Cortical and subcortical mapping of language areas: correlation of functional MRI and tractography in a 3T scanner with intraoperative cortical and subcortical stimulation in patients with brain tumors located in eloquent areas.
abstract: OBJECTIVE
  To describe the detection of cortical areas and subcortical pathways involved in language observed in MRI activation studies and tractography in a 3T MRI scanner and to correlate the findings of these functional studies with direct intraoperative cortical and subcortical stimulation.
  
  
  METHODS
  We present a series of 14 patients with focal brain tumors adjacent to eloquent brain areas. All patients underwent neuropsychological evaluation before and after surgery. All patients underwent MRI examination including structural sequences, perfusion imaging, spectroscopy, functional imaging to determine activation of motor and language areas, and 3D tractography. All patients underwent cortical mapping through cortical and subcortical stimulation during the operation to resect the tumor. Postoperative follow-up studies were done 24 hours after surgery.
  
  
  RESULTS
  The correlation of motor function and of the corticospinal tract determined by functional MRI and tractography with intraoperative mapping of cortical and subcortical motor areas was complete. The eloquent brain areas of language expression and reception were strongly correlated with intraoperative cortical mapping in all but two cases (a high grade infiltrating glioma and a low grade glioma located in the frontal lobe). 3D tractography identified the arcuate fasciculus, the lateral part of the superior longitudinal fasciculus, the subcallosal fasciculus, the inferior fronto-occipital fasciculus, and the optic radiations, which made it possible to mark the limits of the resection. The correlation with the subcortical mapping of the anatomic arrangement of the fasciculi with respect to the lesions was complete.
  
  
  CONCLUSIONS
  The best treatment for brain tumors is maximum resection without associated deficits, so high quality functional studies are necessary for preoperative planning.
authors.affiliation: Departamento de Diagnóstico por la Imagen, Hospital Universitario Quirón, Madrid, España. Electronic address: cataldo@telefonica.net.
authors.forename: M
authors.initials: M
authors.lastname: Jiménez de la Peña
authors.forename: S
authors.initials: S
authors.lastname: Gil Robles
authors.forename: M
authors.initials: M
authors.lastname: Recio Rodríguez
authors.forename: C
authors.initials: C
authors.lastname: Ruiz Ocaña
authors.forename: V
authors.initials: V
authors.lastname: Martínez de Vega
mesh_terms: D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000503:physiopathology*; D056324:Diffusion Tensor Imaging; D004558:Electric Stimulation; D006801:Humans; D007430:Intraoperative Care; D007802:Language; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies