Clinical case: Left Temporal Tumor

• Twenty three year-old epileptic patient.
• Small left temporal tumor detected at MRI.
• Increased uptake of methionine (PET scan).
• Surgical treatment preferred but tumor close to language (Wernicke's area) and auditory cortex (Heschl's gyrus)
• Language and auditory fMRI requested in order to minimize post-operative deficit.

• phonemic verbal fluency task: think of words that begin with a specific letter vs. rest (WORD)
• semantic word generation task based on short sentence processing (visual stimuli): short sentences vs. punctuation marks (READ)
• semantic word generation task based on short sentence processing (auditory stimuli): short sentences vs. reverse audio samples (AUDT)

fMRI analysis

Automatic SPM analysis with our AutoSPM software identified:

activation of the left inferior & middle temporal gyrus (Wernicke area), just posterior to the tumor (READ in green & AUDT in red). Bilateral activation of auditory cortex in the inferior, transverse and middle temporal gyri. Activations surround tumor in the left hemisphere (AUDT in red). activation of the left inferior frontal gyrus, corresponding to Broca's area Activation of the left dorso-lateral prefrontal cortex: not specific to language, but linked with attention and working memory. Always activated in language tests and lateralized in the dominant language hemisphere. Bilateral activation of SMA (planning of articulatory movements)

Surgery and outcome

• Tumor was resected, taking into account fMRI results
• Total resection of the tumor, which turned out to be a low-grade astrocytoma at histologic analysis
• Overlay of fMRI on post-operative FLAIR image shows activations around the resection site. The images can be visualized below in the preliminary version of Imagilys's multi-modality viewer for neurosurgical planning.
• No post-operative deficit, normal language and auditory functions
• After 3 years: no tumoral recurrence. Seizures completely eliminated, excepted very rare partial seizures with auditory hallucinations.

fMRI experiment: Dr. Cecile Grandin, Dr. Laurent Hermoye. Neurosurgery: Pr. Chistian Raftopoulos. Saint-Luc University Hospital, Brussels, Belgium.

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