Resection of glioma in an fMRI-defined "split" Broca's area.
Gross total resection of gliomas can be limited by the involvement of tumor in eloquent areas. Moreover, lesions can impart cortical reorganization and make the precise determination of hemispheric dominance and localization of language function even more difficult. Preoperative mapping with functional magnetic resonance imaging (fMRI), intraoperative imaging modalities, and intraoperative direct cortical stimulation enable surgeons to map the functional topography of the brain in relation to the tumor and perform a safe maximal resection. In this report, we present a patient with left frontal glioma of complex morphology, wherein the tumor was enveloped by Broca's area on fMRI. Intraoperative mapping and intraoperative magnetic resonance imaging (iMRI) allowed gross total resection of the tumor with preservation of language function and illustrate the utility of multiple contemporary modalities in the surgical management of low-grade gliomas located in eloquent cortices.
a Department of Neurosurgery , Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
Joon-Hyung
JH
Kim
Nduka M
NM
Amankulor
Kyung K
KK
Peck
Nicole
N
Brennan
Philip H
PH
Gutin
Andrei I
AI
Holodny
D001931:Brain Mapping; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D065711:Broca Area / Q000473:pathology*; D004558:Electric Stimulation; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative
Awake craniotomy; Broca’s area; Functional magnetic resonance imaging; Intraoperative electrocorticography