P.064 Preoperative mapping using fMRI and DTI: a multimodal approach to assessing language dominance

• Published in: Canadian journal of neurological sciences 2018-06, Vol.45 (s2), p.S33-S33
• Main Authors: Gould, L, Kelly, M, Ekstrand, C, Ellchuk, T, Borowsky, R
• Format: Article
• Language: English
• Subjects: Language; NEUROIMAGING; POSTER PRESENTATIONS
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2018.166

Background: Language mapping is a key goal in neurosurgical planning. With the discontinuation of the Wada test in Canada, neurosurgeons often rely on fMRI and intraoperative techniques for determining language lateralization. Recent studies have also evaluated the utility of diffusion tensor imaging (DTI) for preoperative language lateralization, but further research is needed to confirm its efficacy. We report a patient with a left frontal AVM. fMRI and DTI was used to localize language and motor functioning. Methods: The tasks included word reading, picture naming, pseudohomophones (e.g., dawg) and semantic questions. All fMRI analyses were performed using BrainVoyager. Tensors were tracked from 30-direction diffusion MR images using DSI-Studio. Results: The fMRI results revealed consistent Broca’s and Wernicke’s areas, confirming left hemisphere dominance. There was also a region of activation in the precentral gyrus near the surgical resection. The results were loaded onto the neuronavigation system to help determine safe surgical margins. The DTI results revealed that the left arcuate and uncinate -fasciculus had three times more tracts than the right hemisphere, further supporting left hemisphere dominance. Conclusions: This case highlights the value of a combined, multimodal approach for preoperative language localization, which will further enhance surgical safety by helping preserve regions for essential brain functions.