Language Paradigm Reliability in fMRI: Implications for Pre-surgical Mapping

doi:10.21608/ejhm.2025.451115

Language Paradigm Reliability in fMRI: Implications for Pre-surgical Mapping

Document Type : Original Article

10.21608/ejhm.2025.451115

Abstract

Background: Human language function is highly complex, and surgery in eloquent cortical regions carries a high probability of functional deficits following surgery. Functional magnetic resonance imaging (fMRI) has emerged as a non-invasive approach compared to direct cortical stimulation (DCS) for pre-operative language mapping. However, variability in cortical organization and tumor-related distortion challenge its reliability.

Objectives: This prospective cohort study aimed to assess the clinical reliability of fMRI language paradigms in mapping eloquent cortical regions in patients with brain tumors and to examine the association between the language activation distance (LAD)—defined as the distance from the tumor border to functionally active language areas—and its influence on surgical decision-making.

Patients and methods: Twenty-five patients with different brain tumor pathologies underwent pre-operative fMRI using standardized language paradigms. Activation maps were analyzed to identify eloquent language areas, and determine the Language Activation Distance (LAD) between tumor margins and functionally active regions. Surgical decisions and postoperative outcomes were correlated with fMRI findings.

Results: Functional magnetic resonance imaging (fMRI) successfully identified language-related cortical regions in the majority of patients. Language lateralization patterns varied across tumor locations and grades. A shorter LAD was associated with modifications in surgical planning, including extent of resection and the decision for awake craniotomy. fMRI findings demonstrated good concordance with intraoperative mapping where available.

Conclusions: fMRI-based language mapping is a reliable, non-invasive tool for guiding preoperative planning in patients with brain tumors. By providing critical information on hemispheric dominance and proximity of tumors to eloquent cortex, fMRI can guide surgical strategies, optimize tumor resection, and minimize postoperative functional deficits.

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