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Evaluating language lateralization after recurrent malignant glioma: a longitudinal functional MRI and voxel-based
Teresa Julio-Ramos1, David Toloza-Ramirez2,3, Barbara Cortes-Rivera4
1PhD Program in Health Sciences and Engineering, Universidad de Valparaíso, Valparaíso, Chile.
Neurocase
|June 3, 2026
Summary
This study assessed language lateralization (LL) in a patient with recurrent glioma undergoing multiple surgeries. Functional and structural brain imaging consistently showed left-hemisphere LL, highlighting its stability across repeated tumor resections.
Area of Science:
- Neuroscience
- Neurosurgery
- Radiology
Background:
- Language lateralization (LL) is crucial for preoperative surgical planning in brain tumor patients.
- Functional magnetic resonance imaging (fMRI) and crossed cerebro-cerebellar (CCC) activation are used to determine LL.
- Gray matter volume (GMV) offers insights into structural asymmetries related to LL, but its role in repeated surgeries is less understood.
Purpose of the Study:
- To characterize LL in a patient with recurrent glioma undergoing multiple tumor resections.
- To evaluate the utility of both functional (CCC activation) and structural (GMV) measures for assessing LL over time.
- To investigate potential changes in LL following repeated surgical interventions.
Main Methods:
- A case study of a 33-year-old woman with recurrent glioma who underwent three awake tumor resections.
- Conventional MRI and fMRI were performed before each surgery (2017, 2020, 2023).
- CCC activation served as the functional marker for LL, while GMV analysis assessed structural asymmetries. Linguistic and cognitive functions were evaluated pre- and postoperatively.
Main Results:
- Supratentorial activation patterns exhibited some variability across the three time points.
- CCC activation consistently indicated left-hemisphere LL throughout the study period.
- Structural analysis revealed distinct volumetric patterns in ipsilateral and contralateral language regions.
Conclusions:
- Combined functional (CCC activation) and structural (GMV) analyses provide complementary information for assessing LL.
- LL appears stable in this patient despite recurrent glioma and repeated surgeries.
- These multimodal approaches may enhance LL assessment in patients undergoing multiple surgical procedures.
