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good approach for the language function and its multiple DES, the overall resection rate and the rate of involvement
association areas, which could be more complex and even of the language functional area in the resection were
specific for different languages/cultures. Language function significantly increased. [23]
is the most complex and superior level function, with
multiple localizations and spread connective areas. The Event thought DES is a relative novel technology, is also an
exact language-related cortical area is not mathematical important research method for higher cognitive functions,
and is individual related, especially in patients with intra- such as music, calculation, memory, complex speech
cranial lesions. Patients with intra-cranial tumors can have processes, hemispheric ignorance, perception, visual
very atypical language areas related to their brain mapping pathways and more. [25-29]
conformation and compliance to the tumor. The key for
[22]
brain surgery of the dominant hemisphere is the central core Neuronavigation and intra-operative magnetic
and language function, which has become possible. [22,23] resonance imaging
Magnetic resonance has changed the course of anatomical
Brain mapping usually needs large craniotomies and longer
time of surgical/anesthetic exposure, but provides multiple marks in neurosurgery; since its beginning in the early 80’s,
functional areas. [23,24] Li et al. analyzed 91 cases of brain the pursuit of high field technologies for better images has
[9]
functional area glioma surgery under direct electrical become a challenge.
stimulation (DES) and noticed that the most commonly
observed areas of counting interruption were distributed on In the neuronavigation era, planning surgery has become not
the posterior part of the left anterior central gyrus (47.7%), only a decision on craniotomies and different approaches,
the operculum of the left inferior frontal gyrus (24.4%), the but also a way to prevent and predict the final surgery
triangular part of the left inferior frontal gyrus (12.8%), and with minimal injuries. This way, fMRI, positron emission
even the posterior part of the superior frontal gyri (4.7%). tomography (PET), and diffusion tensor imaging (DTI) are
After surgery, 46% had no post-operative dysfunction, important technologies. [1]
42.9% a brief language dysfunction, 29.7% limb movement
15
disorder, and 1 case had a permanent disability; this shows PET utilizes H O as a blood tracer to measure flow
2
18
that DES is a non-invasive accurate method. Another or ( F)-fluorodeoxglucose uptake to measure cerebral
[22]
positive point of DES is the mapping of the sub-cortical metabolism. [30]
areas because it does not have influences on brain shift or
other positioning errors. [22] fMRI measures blood oxygen level dependency changes
due to alterations in the ratio of the oxyhaemoglobin
Even though fMRI is satisfying for motor/sensitivity areas, and deoxyhaemoglobin in the most metabolically active
its sensitivity is only of 59-100% and specificity of 0-97% regions [Figure 2].
[30]
for language areas. [22]
Another image technology is the DTI, which visualizes the
De Witt Hamer et al. reviewed and made a meta-analysis fiber tracts with the thermally driven motion, or diffusion of
of surgical situations of 8,091 glioma cases and found water and molecules through fibers. [31,32]
that the rate of long-term severe neurological dysfunction
sub-sequent to DES was 3.4%, while the long-term severe DTI and fMRI allow neurosurgeons to have functional/
disability rate of patients that underwent surgery without eloquent areas and sub-cortical fibers related to the lesions
DES was 8.2%. In addition, for the patients undergoing in their pre-operative planning; therefore, functional

Figure 2: Functional magnetic resonance imaging and glioma: Red spots of the functional areas for the speech test near/between the tumor

Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ March 11, 2016 ¦ 73