Background: Awake surgery to preserve language function in young children is challenging, therefore reliable non-invasive work-up of language functional anatomy is needed to preserve language function at any cost. Furthermore, there are obvious limitations of an awake craniotomy with direct stimulation on a child.
Case report: A 6-year-old boy with a low-grade glioma of the left temporal lobe suffering from epileptic seizures underwent surgery, guided by preoperative transcranial magnetic stimulation (TMS) language mapping and consecutive DTI fiber tracking.
Discussion and conclusion: We report successful surgery of a language eloquent brain tumor in a young child based on TMS mapping and DTI fiber tracking alone. Surgical treatment of left-sided perisylvian tumors in children is discussed.
Keywords: Brain tumor surgery; Diffusion tensor imaging; Navigated transcranial magnetic stimulation (nTMS); Pilocytic astrocytoma.