Language area localization with three-dimensional functional magnetic resonance imaging matches intrasulcal electrostimulation in Broca's area

In this study, intraoperative electrocortical stimulation mapping (ioESM), the current gold standard for the localization of critical language areas, is compared with functional magnetic resonance imaging (fMRI) in a 14-year- old girl with medically intractable epilepsy caused by a tumor in the regio n of Broca's area. prior to the operation, four different fMRI tasks that t arget inferior frontal language areas were applied. Prior to the resection, ioESM as well as fMRI detected no language areas at the exposed cortical a rea. After removal of the tumor, a unique opportunity presented itself, whe re ioESM could be performed in the depth of a now exposed and intact gyrus. One specific locus that was indicated to be a critical language area by mu ltiple-task fMRI was targeted. IoESM selectively confirmed the location of this language area to within an estimated 3 mm. We propose that the combine d use of different fMRI tasks increases the sensitivity and specificity for the detection of essential language areas.