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Long term reshaping of language,
sensory, and motor maps after glioma resection: a new parameter to
integrate in the surgical strategy
H Duffau,
D Denvil and L Capelle
Department of Neurosurgery, Hôpital
de la Salpêtriére, 47 Bd de l'hôpital, 75651 Paris, Cedex 13,
France [H.D., L.C.]. Department of Neurology, Hôpital de la Salpêtriére
[D.D.]. Correspondence to: Dr H Duffau, Service de Neurochirurgie, Hôpital
de la Salpêtriére, 47 Bd de l'hôpital, 75651 Paris, Cedex 13,
France; hugues.duffau{at}psl.ap-hop-paris.fr .
Received 11 April 2001. In final revised form 23 November 2001.
Accepted 5 December 2001.
Objectives. To describe
cortical reorganisation and the effects of glioma
infiltration on local brain function in three patients who
underwent two operations 12–24 months apart.
Methods. Three patients
who had no neurological deficit underwent two operations
for low grade glioma, located in functionally important
brain regions.
During each operation, local brain function was
characterised by electrical mapping and awake craniotomy.
Results. Language or
sensorimotor areas had been invaded by the tumour at the
time of the first operation, leading to incomplete glioma
removal in all cases.
Because of a tumour recurrence, the patients were
reoperated on between 12 and 24 months later.
Functional reorganisation of the language, sensory, and motor maps
was detected by electrical stimulation of the brain, and this
allowed total glioma removal without neurological sequelae.
Conclusions. These
findings show that surgical resection of a glioma can lead
to functional reorganisation in the peritumorous and
infiltrated brain.
It may be that this reorganisation is directly or
indirectly caused by the surgical procedure.
If this hypothesis is confirmed by other studies, the use
of such brain plasticity potential could be used when
planning surgical options in some patients with low grade
glioma.
Such a strategy could extend the limits of tumour resection
in gliomas involving eloquent brain areas without causing
permanent morbidity.
Keywords: brain plasticity; direct
electrical stimulations; language; motor; sensory; functional mapping;
low
grade gliomas
© 2002 Journal of Neurology
Neurosurgery and Psychiatry
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