Reorganization of Language Areas in Patient with a Frontal Lobe Low Grade Glioma – fMRI Case Study

Abstract

SummaryBackgroundFunctional magnetic resonance (fMRI) studies results in case of an adult patient with low grade glioma (LGG) in dominant hemisphere suggest brain plasticity process with acquisition of language functions by the non-dominant hemisphere speech regions.Case ReportA 36-years old right-handed woman was admitted to the Department of Neurosurgery for surgical treatment of brain tumor. An MRI examination revealed a pathological mass in the left frontal lobe, in close topographical relationship to the Broca’s area. A left fronto-parietal craniotomy was performed, with an intraoperative awake language mapping procedure. A total resection of the pathological mass was achieved. The tumor was examined histologically as LGG. In the follow-up MRI exam 32 months after the operation a tumor recurrence was suggested. The fMRI exams performed preoperative and 3, 32 and 41 months after the operation showed changes in language regions activation patterns, with a progressive right-sided activation of Broca’s and Wernicke’s areas. Pre- and postoperative cognitive evaluation by a neuropsychologist did not detect any language impairment. We present a running process of reorganization of language areas in a patient after brain tumor resection, from strong left-sided to symmetrical lateralization.Conclusions1. FMRI results in comparison with the psychological status of the patient proved contribution of functional reorganization to the preservation of language performance. 2. A slow growing LGG as well as the recurrence of the tumor near the left Broca’s area might be the factors leading to reorganization of language-related areas by recruiting the right hemisphe.

Functional Mapping before and after Low-Grade Glioma Surgery: A New Way to Decipher Various Spatiotemporal Patterns of Individual Neuroplastic Potential in Brain Tumor Patients

“…Conversely, inter-hemispheric activations in the homologous language areas were evidenced, with an activation of the right “Broca’s area” in five frontal LGG patients without language disorders, and with an activation of the right “Wernicke’s area” in five temporal gliomas, both before and after surgery [ 113 ]. In a patient with resection for a left LGG near the “Broca’s area”, without language impairment, fMRI achieved before surgery and 3, 32, and 41 months after resection demonstrated a progressive right-sided activation of Broca’s and Wernicke’s areas [ 114 ]. Sarubbo et al [ 115 ] identified a more complex pattern of redistribution on language fMRI performed following resection of a left LGG within the “Wernicke’s area”, with both intra- and inter-hemispheric compensatory reorganization.…”

Neuroplasticity: Insights from Patients Harboring Gliomas

“…For example, fMRI data can be obtained pre- and postoperatively in glioma patients after surgical resection in order to study changes in functional anatomy [ 47 ]. To date, the results of the fMRI studies have been inconsistent; some reports demonstrate significant changes in motor and language plasticity while others claim no changes are found [ 5 , 18 , 65 – 67 ]. While the correlation of fMRI with DES is not always consistent, perhaps due to fMRI indicating all regions involved in a given function as opposed to only the critical regions, fMRI does provide an important noninvasive technique to assist in decision-making for surgery or to study the activation patterns of the brain in patients who cannot be examined via DES.…”

What do we know about pre- and postoperative plasticity in patients with glioma? A review of neuroimaging and intraoperative mapping studies

“…The authors observed larger language laterality changes between consecutive surgeries in patients who had stronger lateralization to the dominant hemisphere at first surgery, hence limited preoperative involvement of the contralateral hemisphere. Similarly, the patient described in Kośla et al (2015) did not experience a relevant language involvement of the right hemisphere either before surgery or at follow-up, but this compensatory recruitment was observed only many months later, at tumor recurrence. The authors commented that, despite being an LGG, the lesion was small at first surgery and for this reason it did not entail recruitment of the contralesional hemisphere; this compensatory recruitment appeared instead fundamental later, at the tumor regrowth.…”

“…In spite of these differences, a general tenet relates the extent of postoperative remodeling to that occurred before surgery. Accordingly, patients with smaller tumors (i.e., of recent onset) displayed a higher degree of postoperative plasticity than larger tumors, given that substantial remodeling for the latter could have already taken place before surgery (e.g., Southwell et al, 2016 ; see also Kośla et al, 2015 ). The impact of surgery in promoting further brain reorganization can be more restrained in the case of larger tumors, which already entailed consistent remodeling.…”