Journal of Neurosurgery

Publication date: 2005-01
Volume: 102 Pages: 169 - 73
ISSN: 0022-3085, 1933-0693 PMID: 15658111
DOI: 10.3171/jns.2005.102.1.0169
Publisher: American Association of Neurological Surgeons


Kho, Kuan Hua
Leijten, Frans SS ; Rutten, Geert-Jan ; Vermeulen, Jan ; Van Rijen, Peter ; Ramsey, Nick F


Adult, Amobarbital, Brain, Brain Mapping, Electric Stimulation, Electroencephalography, Epilepsy, Female, Functional Laterality, GABA Modulators, Humans, Language, Magnetic Resonance Imaging, Preoperative Care, Neurology & Neurosurgery, 1103 Clinical Sciences, 1109 Neurosciences


The Wada test is still considered the gold standard for determining the language-dominant hemisphere prior to brain surgery. The authors report on a 34-year-old right-handed woman whose Wada test results indicated that the right hemisphere was dominant for language. In contrast, functional magnetic resonance (fMR) imaging was indicative of bilaterally represented language functions. Activation in the left hemisphere demonstrated on fMR imaging was most pronounced in the Broca area. Importantly, fMR imaging results in this area were confirmed on electrocortical stimulation mapping. These contradictory findings indicated that a right hemispherre dominance for language according to the Wada test should be questioned and verified using electrocortical stimulation. Nonetheless, the question remains whether involvement of these areas in the left frontal hemisphere is critical for language, as these were spared during surgery.