Male, 58 years old, with left frontal tumor and word finding deficits. Evaluate speech and language function for presurgical planning. Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Wernicke's area activity is particularly well visualized on the sentence completion paradigm where it maps to its expected location along the posterior aspect of the left superior temporal gyrus. Wernicke's activity is strongly left dominant.Presumed Broca's area activity, however, appears to be more evenly distributed between the right and left hemispheres. Potential Broca's area activity is best visualized on the word generation paradigm where it maps bilaterally to the inferior frontal gyri, particularly the pars opercularis and to a lesser degree the pars triangularis.The visualized putative Wernicke's area activity is well removed from the patient's large left frontal lobe tumor and the extensive edema which it creates. The visualized putative Broca's area activity sits mainly at the margins of the tumor-induced edema. The anterior medial aspect of this activity does, however, reach to within one gyrus of the inferior lateral margin of the tumor itself (see image 96, series 601, and image 46, series 602).No functional activation is identified frankly within the tumor itself or the edematous surrounding parenchyma. Please note, however, that nonvisualization of functional activity does not ensure that there is no functional capacity in these areas.Somewhat less than the typical amount of secondary language activity is seen in the middle frontal gyri. Language SMA activity is, however visualized in its expected paramedian location along the superior frontal gyri, and this too approaches the margin of tumoral edema.
1.Wernicke's area activity is strongly left dominant, visualized in its expected location along the posterior aspect of the superior left temporal gyrus, and is well removed from the patient's tumor.2.Broca's area activity is somewhat more evenly distributed between the right and left hemispheres, which may reflect compensation due to the clear extension of edema into the expected domain of Broca's area on the left. Cortical activation felt to reflect Broca's area approaches the margins of tumoral edema, primarily within the pars opercularis. The most anterior medial aspect of this activation does approach within one gyrus to the inferior lateral margin of the tumor.