Integrated analysis of language area using MEG, functional MRI and PET. -Clinical application to brain tumor surgery-

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The present study was carried out to establish the functional mapping method of speech area using magnetoencephalogram (MEG), functional MRI (fMRI) and positron emission tomography (PET) and to improve the treatment results of the patients with frontal brain tumors in close vicinity to Broca area by optimum presurgical planning based on the functional mapping. 20 healthy volunteers were served as the control group. Speech areas were examined with fMRI and MEG while performing a verb generation task in a blocked paradigm design. In the fMRI study, the Broca area was identified at the left frontal hemisphere (inferior or middle frontal gyrus) in ninteen of the 20 right handed volunteers. With MEG study, left hemispheric speech dominance was determined in all cases. However, activation area was not always localized to Broca area indicating that MEG can detect speech-related brain areas activated simultaneously and sequentially.Six patients (ages 31-56 years) suffering from the left fronta … More l intracerebral tumors were examined with fMRI, MEG and PET while performing a verb generation task. All patients demonstrated left frontal activation which could be clearly located outside the tumor area and adjacent edema with varying degrees of additional right frontal activation. Based on the presurgical functional mapping, tumor resection was performed using a neuronavigation system. All three patients presenting with motor aphasia preoperatively showed improvement on the symptom after surgery. Two of the 3 patients without preexisting speech disturbance were symptom-free on the postoperative course. Remaining one patient showed transient motor aphasia postoperatively, and the symptom disappeared in about 10 days. Functional mapping was also undertaken postoperatively, and it was demonstrated that speech areas were preserved in all cases. The present study is indicating that preoperative multi-modality functional mapping of speech-related brain areas is useful for presurgical planning in the patients with frontal brain tumors close to language areas. Less