The superior longitudinal fasciculus and speech arrest

Area of Science:

• Neurosurgery
• Neuroimaging
• Neurology

Background:

• Recurrent glioblastoma multiforme (GBM) presents significant surgical challenges.
• Precise mapping of critical white matter tracts is crucial for minimizing neurological deficits during tumor resection.

Observation:

• A 59-year-old woman with left medial frontal GBM showed tumor proximity to the supracallosal portion of the left superior longitudinal fasciculus (SLF) on diffusion tensor imaging (DTI).
• Intraoperative tumor border dissections contacting the dominant SLF resulted in transient speech arrests.
• Postoperative edema led to temporary aphasia and paraphasic errors.

Findings:

• Preoperative DTI accurately predicted intraoperative speech arrest due to SLF involvement.
• Postoperative DTI confirmed the resection cavity's proximity to the supracallosal SLF.
• This case is the first to report speech arrest specifically related to the supracallosal SLF.

Implications:

• DTI is a valuable tool for identifying critical white matter tract involvement in GBM.
• Understanding SLF anatomy is vital for neurosurgeons to prevent speech deficits in frontal lobe tumor resections.
• This finding expands the known functional deficits associated with SLF lesions.