Glioma surgery based on anatomical structure of the white matter

The primary aim of glioma surgery is to achieve a balance between maximum tumor removal and minimal functional morbidity. The advent of awake surgery has greatly increased the number of patients with tumors in or around the eloquent language areas undergoing extensive removal. Preoperative anatomical evaluation modalities, such as diffusion tensor imaging (DTI) tractography or color mapping, are used to visualize the subcortical neuronal network in the white matter. This structural information can help predict further tumor extension and neuronal damage adjacent to the surrounding area of tumor. To achieve successful functional evaluation and maximum tumor removal without surgical complication, we must be well aware of the symptomatic evaluation following electrical stimulation. In the white matter, identifying the short association fibers and the long association fibers involving the association with language function are the key for successful resection. In our report, an overview of the anatomical structures and the clinical symptoms related to the language area encounterd in glioma removal surgery are reported.