Evaluating language lateralization after recurrent malignant glioma: a longitudinal functional MRI and voxel-based morphometry case study.

Language lateralization (LL) is a key aspect for preoperative surgical planning in patients with brain tumors. Crossed cerebro-cerebellar (CCC) activation, derived from functional magnetic resonance imaging (fMRI), guides LL determination. Structural features, such as gray matter volume (GMV), may provide complementary information on structural asymmetries associated with LL. However, the literature suggests that LL may change after surgery, and less is known about its variation over repeated surgeries. This case study aims to characterize LL in a patient with a recurrent glioma using both functional and structural measures. The case is a 33-year-old woman who underwent three intraoperative awake speech mapping tumor resections. Conventional MRI and fMRI were acquired before each surgery: 2017 (T1), 2020 (T2), and 2023 (T3). CCC activation was used as a functional marker of LL, and GMV was used to examine structural asymmetries. Linguistic and cognitive functions were examined pre-and postoperatively. Although supratentorial activation patterns showed some variability, CCC activation consistently indicated left-hemisphere LL. Structural analyses revealed differential volumetric patterns between the ipsilateral and contralateral language regions. Combining functional and structural measures, such as CCC activation and GMV analysis, may provide complementary information for assessing LL in patients undergoing repeated surgeries.