Twenty one cases of glioma involving speech were reviewed and followed. The following tests were assessed at pre- and postoperative period by neurologist: Neuropsychiatric analysis, fMRI and DTI tractography of arcuate fasciculus (AF), superior and inferior longitudinal fasciculus (ILF) and inferior fronto-occiptal fiber tracts.  NIHSS (language and speech items) were used as scale. Awake craniotomy with intraoperative functional mapping and monitoring was performed by neurologist. Demographic data, extent of tumor resection, configuration/FA/ MD/ displacement of fiber tracts and grade of speech dysfunction were recorded pre- and postoperatively. Student T-test and Wilcoxon-signed rank test were used for analysis and correlation.

Tumors involved functional language cortex, insula and subcortical area. All patients were right handed. 168 fiber tracts and 84 functional cortical areas were depicted in tractography and fMRI, pre- and postoperatively. NIHSS was 0 in 66% and 1 or 2 in 33% of patients preoperatively. Significant changes in speech were detected in 43% (9 cases); all suffering from large or insular glioma. AF and ILF were the main tract involved in those patients. Significant differences were detected between pre- vs postoperative and right vs left AF in 7 out of 9 patients (p-value<0.05), regarding shape and FA/MD. Similar findings were not detected at other fibers.