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Ghinda CD, Duffau H. Network Plasticity and Intraoperative Mapping for Personalized Multimodal Management of Diffuse Low-Grade Gliomas. Front Surg 2017; 4:3. [PMID: 28197403 PMCID: PMC5281570 DOI: 10.3389/fsurg.2017.00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/16/2017] [Indexed: 01/07/2023] Open
Abstract
Gliomas are the most frequent primary brain tumors and include a variety of different histological tumor types and malignancy grades. Recent achievements in terms of molecular and imaging fields have created an unprecedented opportunity to perform a comprehensive interdisciplinary assessment of the glioma pathophysiology, with direct implications in terms of the medical and surgical treatment strategies available for patients. The current paradigm shift considers glioma management in a comprehensive perspective that takes into account the intricate connectivity of the cerebral networks. This allowed significant improvement in the outcome of patients with lesions previously considered inoperable. The current review summarizes the current theoretical framework integrating the adult human brain plasticity and functional reorganization within a dynamic individualized treatment strategy for patients affected by diffuse low-grade gliomas. The concept of neuro-oncology as a brain network surgery has major implications in terms of the clinical management and ensuing outcomes, as indexed by the increased survival and quality of life of patients managed using such an approach.
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Affiliation(s)
- Cristina Diana Ghinda
- Department of Neurosurgery, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Neuroscience Division, University of Ottawa, Ottawa, ON, Canada
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France; Brain Plasticity, Stem Cells and Glial Tumors Team, National Institute for Health and Medical Research (INSERM), Montpellier, France
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Vassal M, Charroud C, Deverdun J, Le Bars E, Molino F, Bonnetblanc F, Boyer A, Dutta A, Herbet G, Moritz-Gasser S, Bonafé A, Duffau H, de Champfleur NM. Recovery of functional connectivity of the sensorimotor network after surgery for diffuse low-grade gliomas involving the supplementary motor area. J Neurosurg 2016; 126:1181-1190. [PMID: 27315027 DOI: 10.3171/2016.4.jns152484] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The supplementary motor area (SMA) syndrome is a well-studied lesional model of brain plasticity involving the sensorimotor network. Patients with diffuse low-grade gliomas in the SMA may exhibit this syndrome after resective surgery. They experience a temporary loss of motor function, which completely resolves within 3 months. The authors used functional MRI (fMRI) resting state analysis of the sensorimotor network to investigate large-scale brain plasticity between the immediate postoperative period and 3 months' follow-up. METHODS Resting state fMRI was performed preoperatively, during the immediate postoperative period, and 3 months postoperatively in 6 patients with diffuse low-grade gliomas who underwent partial surgical excision of the SMA. Correlation analysis within the sensorimotor network was carried out on those 3 time points to study modifications of its functional connectivity. RESULTS The results showed a large-scale reorganization of the sensorimotor network. Interhemispheric connectivity was decreased in the postoperative period, and increased again during the recovery process. Connectivity between the lesion side motor area and the contralateral SMA rose to higher values than in the preoperative period. Intrahemispheric connectivity was decreased during the immediate postoperative period and had returned to preoperative values at 3 months after surgery. CONCLUSIONS These results confirm the findings reported in the existing literature on the plasticity of the SMA, showing large-scale modifications of the sensorimotor network, at both inter- and intrahemispheric levels. They suggest that interhemispheric connectivity might be a correlate of SMA syndrome recovery.
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Affiliation(s)
- Matthieu Vassal
- Departments of 1 Neurosurgery and.,Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Céline Charroud
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and
| | - Jérémy Deverdun
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and.,Institut de Génomique Fonctionnelle, UMR 5203-INSERM U661.,Laboratoire Charles Coulomb, CNRS UMR 5221, and
| | - Emmanuelle Le Bars
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Laboratoire Charles Coulomb, CNRS UMR 5221, and
| | - François Molino
- Institut de Génomique Fonctionnelle, UMR 5203-INSERM U661.,Laboratoire Charles Coulomb, CNRS UMR 5221, and
| | - Francois Bonnetblanc
- Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier, CNRS UMR5506, Université de Montpellier, Montpellier, France
| | - Anthony Boyer
- Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier, CNRS UMR5506, Université de Montpellier, Montpellier, France
| | - Anirban Dutta
- Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier, CNRS UMR5506, Université de Montpellier, Montpellier, France
| | - Guillaume Herbet
- Departments of 1 Neurosurgery and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Sylvie Moritz-Gasser
- Departments of 1 Neurosurgery and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Alain Bonafé
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Hugues Duffau
- Departments of 1 Neurosurgery and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Nicolas Menjot de Champfleur
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and.,Laboratoire Charles Coulomb, CNRS UMR 5221, and
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Hayashi Y, Nakada M, Kinoshita M, Hamada JI. Functional Reorganization in the Patient with Progressing Glioma of the Pure Primary Motor Cortex: A Case Report with Special Reference to the Topographic Central Sulcus Defined by Somatosensory-Evoked Potential. World Neurosurg 2014; 82:536.e1-4. [DOI: 10.1016/j.wneu.2013.01.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 01/15/2013] [Indexed: 12/01/2022]
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Hayashi Y, Nakada M, Kinoshita M, Hamada JI. Surgical strategies for nonenhancing slow-growing gliomas with special reference to functional reorganization: review with own experience. Neurol Med Chir (Tokyo) 2014; 53:438-46. [PMID: 23883554 DOI: 10.2176/nmc.53.438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nonenhancing intrinsic brain tumors have been empirically treated with a strategy that has been adopted for World Health Organization (WHO) grade II gliomas (low-grade gliomas: LGGs), even though small parts of the tumors might have been diagnosed as WHO grade III gliomas after surgery. However, the best surgical strategy for nonenhancing gliomas, including LGGs, is still debatable. LGGs have the following features: slow growth, high possibility of histologically malignant transformation, and no clear border between the tumor and adjacent normal brain. We retrospectively examined 26 consecutive patients with nonenhancing gliomas who were surgically treated at Kanazawa University Hospital between January 2006 and May 2012, with special reference to functional reorganization, extent of resection (EOR), and functional mapping during awake surgery. These categories are closely related with the features of LGG, i.e. functional reorganization due to slow-growing nature, EOR with related malignant transformation, and functional mapping for delineating the unclear tumor border. Finally, we discuss surgical strategies for slow-growing gliomas that are represented by LGGs and nonenhancing gliomas. In conclusion, slow-growing gliomas tend to undergo functional reorganization, and the functional reorganization affects the presurgical evaluation for resectability based on tumor location related to eloquence. In the clinical setting, to definitely identify the reorganized functional regions, awake surgery is recommended. Therefore, awake surgery could increase the extent of the resection of the tumor without deficits, resulting in the delay of malignant transformation and increase in overall survival.
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Affiliation(s)
- Yutaka Hayashi
- Department of Neurosurgery, Kanazawa University, Kanazama, Ishikawa, Japan.
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Ionta S, Ferretti A, Merla A, Tartaro A, Romani GL. Step-by-step: the effects of physical practice on the neural correlates of locomotion imagery revealed by fMRI. Hum Brain Mapp 2010; 31:694-702. [PMID: 19862697 DOI: 10.1002/hbm.20898] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Previous studies have shown that mental imagery is a suitable tool to study the progression of the effect of practice on brain activation. Nevertheless, there is still poor knowledge of changes in brain activation patterns during the very early stages of physical practice. In this study, early and late practice stages of different kinds of locomotion (i.e., balanced and unbalanced) have been investigated using functional magnetic resonance imaging during mental imagery of locomotion and stance. During the task, cardiac activity was also recorded. The cerebral network comprising supplementary motor area, basal ganglia, bilateral thalamus, and right cerebellum showed a stronger activation during the imagery of locomotion with respect to imagery of stance. The heart beat showed a significant increase in frequency during the imagery of locomotion with respect to the imagery of stance. Moreover, early stages of practice determined an increased activation in basal ganglia and thalamus with respect to late stages. In this way, it is proposed the modulation of the brain network involved in the imagery of locomotion as a function of physical practice time.
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Affiliation(s)
- Silvio Ionta
- ITAB-Institute for Advanced Biomedical Technologies, G. D'Annunzio University Foundation, Chieti, Italy.
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Shinoura N, Suzuki Y, Yamada R, Tabei Y, Saito K, Yagi K. Marked and rapid recovery of motor strength in premotor area compared with primary motor area in surgery for brain tumors. Br J Neurosurg 2009; 23:309-14. [DOI: 10.1080/02688690802638166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lundborg G, Waites A, Björkman A, Rosén B, Larsson EM. Functional magnetic resonance imaging shows cortical activation on sensory stimulation of an osseointegrated prosthetic thumb. ACTA ACUST UNITED AC 2007; 40:234-9. [PMID: 16911998 DOI: 10.1080/02844310600787005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Functional magnetic resonance imaging (fMRI) was used to study the cortical integration of an osseointegrated prosthetic thumb that had been attached to the amputee's hand 13 years ago. We found that tactile stimuli applied to the prosthesis activated the primary somatosensory cortex on both sides.
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Affiliation(s)
- Göran Lundborg
- Department of Hand Surgery, Malmö University Hospital, Malmö.
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