PMC6615260_01
(A) Language fMRI prior to first surgery. A semantic fluency task fMRI shows activated Broca's Area homolog in the right hemisphere and Wernicke's Area in the left hemisphere. The figure shows voxels activated at a correlation coefficient of 0.54 (p = 3.8 x 10-8) or higher. (B) Language fMRI prior to second surgery. A verbal fluency task shows activated Broca's Area homolog in the right hemisphere and Wernicke's Area in the left hemisphere. Activation was also seen anterior and posterior to the expected Broca's Area in the left hemisphere. Intraoperative cortical stimulation elicited no speech disturbance in the anterior margin and motor-related disturbances in the posterior margin. The figure shows voxels activated at a correlation coefficient of 0.55 (p = 1.7 x 10-7) or higher. (C) Post-operative MRI scan shows a gross total resection including the expected anatomical region of Broca's Area.
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F1
In the semantic fluency task, activation was observed in the anatomical Wernicke's Area (WA) in the left hemisphere and in Broca's Area (BA) homolog in the right hemisphere (Figure 1A). A second pre-operative fMRI was performed, using the same fMRI language tasks in addition to a verb generation task. fMRI showed strong activation of the anatomical homolog of BA in the right hemisphere in addition to activation of WA in the left hemisphere (Figure 1B). Assessment of the resection by intraoperative MRI was performed, which demonstrated a gross-total resection (Figure 1C).
Axial views of the brain with active fMRI areas and links obtained by statistical inference. (Left) Brain network topology inferred from a semantic fMRI task for a typical healthy control subject. The primary language areas, BA and WA, are identified in the left hemisphere and are functionally connected. (Right) the network consistently found across all the fMRI scans for the patient with left insular glioma. The homolog of the BA on the right hemisphere becomes statistically active and connects with several other active brain areas, implicating a functional reorganization of the brain areas involved in a language task. As opposed to the typical healthy brain, this patient's right BA does not connect directly with the left WA. Functional communication between these two areas is conveyed through a common area to which they are both linked, the pre-SMA. Gray lines represent functional connectivity, line thickness is proportional to the strength of connectivity, whereas their arrangement is made to facilitate visualization. In both panels, colors indicate different brain regions as reported in the legend.
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F2
For comparison, we constructed a brain network for a typical healthy subject, who performed the same fMRI tasks as the patient (Figure 2, left panel), where the active brain areas in the fMRI scan were placed on their anatomical location, and the links represented functional connectivity. Frontal Gyrus (MFG). Figure 2, right panel, shows the functional network for the patient with the left insular glioma.