[Presurgical functional MR imaging in the mapping of language function].

Area of Science:

• Neuroimaging
• Neurosurgery
• Cognitive Neuroscience

Context:

• Presurgical planning for brain tumors requires accurate mapping of critical functional areas, particularly language.
• Intraoperative electrocortical stimulation (ES) is the gold standard for language function mapping but is invasive.
• Functional magnetic resonance imaging (fMRI) offers a non-invasive alternative for presurgical assessment.

Purpose:

• To evaluate the utility of presurgical functional magnetic resonance imaging (fMRI) as a potential replacement for intraoperative electrocortical stimulation (ES) in mapping language function.
• To compare the information provided by fMRI with the established efficacy of ES.

Summary:

• Presurgical fMRI provides valuable preoperative information, including identification of the language-dominant hemisphere and estimation of tumor proximity to functional language areas.
• Despite its benefits, fMRI currently faces technical and conceptual challenges that prevent it from being a reliable alternative to ES.
• Preliminary clinical experience and literature review indicate fMRI's limitations in replacing the direct mapping capabilities of ES.

Impact:

• This research highlights the current limitations of fMRI in neurosurgical language mapping, guiding future technological development.
• It underscores the continued importance of intraoperative electrocortical stimulation for precise functional localization during surgery.
• The findings inform neurosurgeons and neurologists about the complementary roles and current limitations of non-invasive imaging techniques in presurgical planning.