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Functional recovery after surgical
resection of low
grade gliomas in eloquent brain: hypothesis of brain
compensation
H Duffau,
L Capelle, D Denvil, N Sichez, P
Gatignol, M Lopes, M-C Mitchell, J-P
Sichez and R Van Effenterre
Department of Neurosurgery, Hôf.pital
Salpêtriére, Paris, France [H.D., L.C., D.D., M.L., J.-P.S.,
R.V.E.]. Department of Neurology, Hôf.pital Salpêtriére, Paris,
France [N.S., P.G.]. Department of Neuroanesthesiology, Hôf.pital
Salpêtriére, Paris, France [M.-C.M.]. Correspondence to: Dr Duffau,
Service de Neurochirurgie, Hôf.pital de la Salpêtriére, 47–83 Bd
de l’hôf.pital, 75651 Paris, Cedex 13, France; email: hugues.duffau{at}psl.ap-hop-paris.fr
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Objectives.
To describe functional recovery after surgical resection of
low
grade gliomas (LGG) in eloquent brain areas, and discuss the
mechanisms of compensation.
Methods. Seventy-seven
right-handed patients without deficit were operated on for
a LGG invading primary and/or secondary sensorimotor and/or
language areas, as shown anatomically by pre-operative MRI
and intraoperatively by electrical brain stimulation and
cortico-subcortical mapping.
Results. Tumours involved
31 supplementary motor areas, 28 insulas, 8 primary
somatosensory areas, 4 primary motor areas, 4 Broca’s areas,
and 2 left temporal language areas.
All patients had immediate post-operative deficits.
Recovery occurred within 3 months in all except four cases
(definitive morbidity: 5%).
Ninety-two percent of the lesions were either totally or extensively
resected on post-operative MRI.
Conclusions. These
findings suggest that spatio-temporal functional re-organisation
is possible in peritumoural brain, and that the process is
dynamic.
The recruitment of compensatory areas with long term
perilesional functional reshaping would explain why: before
surgery, there is no clinical deficit despite the tumour
growth in eloquent regions; immediately after surgery, the
occurrence of a deficit, which could be due to the resection of
invaded areas participating (but not essential) to the function; and
why three months after surgery, almost complete recovery had
occurred.
This brain plasticity, which decreases the long term risk
of surgical morbidity, may be used to extend the limits of
surgery in eloquent areas.
Keywords: direct electrical
stimulations; functional mapping; low grade glioma; plasticity
© 2003 BMJ Publishing Group
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