Intraoperative functional remapping unveils evolving patterns of cortical plasticity

Brain, Journal Year: 2023, Volume and Issue: 146(7), P. 3088 - 3100

Published: April 8, 2023

The efficiency with which the brain reorganizes following injury not only depends on extent and severity of lesion, but also its temporal features. It is established that diffuse low-grade gliomas (DLGG), tumours a slow-growth rate, induce compensatory modulation anatomo-functional architecture, making this kind an ideal lesion model to study dynamics neuroplasticity. Direct electrostimulation (DES) mapping well-tried procedure used during awake resection surgeries identify spare cortical epicentres are critical for range functions. Because DLGG chronic disease, it inevitably relapses years after initial surgery, thus requires second surgery reduce tumour volume again. In context, contrasting mappings obtained two sequential neurosurgeries offers unique opportunity both characterize dynamic (i.e. re-evolving) patterns re-arrangements. Here, we capitalized unprecedented series 101 patients who benefited from DES-guided usually spaced several apart, resulting in large DES dataset 2082 sites. All sites (either non-functional or associated language, speech, motor, somatosensory semantic processing) were recorded Montreal Neurological Institute (MNI) space. Next, multi-step approach generate probabilistic neuroplasticity maps reflected rearrangements one another, at population individual level. Voxel-wise revealed regions relatively high potential evolving reorganizations level, including supplementary motor area (SMA, Pmax = 0.63), dorsolateral prefrontal cortex (dlPFC, 0.61), anterior ventral premotor (vPMC, 0.43) middle superior gyrus (STG 0.36). Parcel-wise confirmed dlPFC (Fisher's exact test, PFDR-corrected 6.6 × 10-5), (PFDR-corrected 0.0039) precentral 0.0058). A clustering analyses topological migration clusters, especially within left STG (language sites); vPMC (speech arrest/dysarthria sites) right SMA (negative response sites). At these changes (bilateral), (threshold free cluster enhancement, 5000 permutations, family-wise error-corrected). Taken as whole, our results provide insight into DLGG-induced continuing cerebral cortex, considerable implications re-operations.

Language: Английский

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Long-term autonomy, professional activities, cognition, and overall survival after awake functional-based surgery in patients with IDH-mutant grade 2 gliomas: a retrospective cohort study

The Lancet Regional Health - Europe, Journal Year: 2024, Volume and Issue: 46, P. 101078 - 101078

Published: Sept. 20, 2024

Language: Английский

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Multivariate mapping of low-resilient neurocognitive systems within and around low-grade gliomas

Brain, Journal Year: 2024, Volume and Issue: 147(8), P. 2718 - 2731

Published: April 22, 2024

Accumulating evidence suggests that the brain exhibits a remarkable capacity for functional compensation in response to neurological damage, resilience potential is deeply rooted malleable features of its underlying anatomofunctional architecture. This propensity particularly exemplified by diffuse low-grade glioma, subtype primary tumour. However, plasticity not boundless, and surgical resections directed at structures with limited neuroplasticity can lead incapacitating impairments. Yet, maximizing glioma offers substantial oncological benefits, especially when resection extends beyond tumour margins (i.e. supra-tumour or supratotal resection). In this context, objective study was identify which cerebral were associated less favourable cognitive outcomes after surgery, while accounting intra-tumour resections. To achieve objective, we leveraged unique cohort 400 patients who underwent surgery awake mapping. Patients benefitted from neuropsychological assessment consisting 18 subtests administered before 3 months surgery. We analysed changes performance applied topography-focused disconnection-focused multivariate lesion-symptom mapping using support vector regressions, an attempt capture resected cortico-subcortical amenable full compensation. The observed magnitude, suggesting overall recovery (13 tasks recovered fully despite mean extent 92.4%). Nevertheless, analyses revealed lack picture naming linked damage left inferior temporal gyrus longitudinal fasciculus. Likewise, semantic fluency abilities, association established precuneus/posterior cingulate. For phonological dorsomedial frontal cortex aslant tract implicated. Moreover, difficulties spatial exploration injury right prefrontal connectivity. An exploratory analysis suggested pronounced following specific patterns, such as uncinate fasciculus (picture naming), corticostriatal anterior corpus callosum (phonological fluency), hippocampus parahippocampus (episodic memory) frontal-mesial areas (visuospatial exploration). Collectively, these patterns results shed new light on both low-resilient neural systems prediction Furthermore, they indicate only occasionally well tolerated viewpoint. doing so, have deep implications planning rehabilitation strategies.

Language: Английский

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Feasibility, Safety, and Impact of Awake Resection for Recurrent Insular Diffuse Gliomas in Adults

Neurosurgery, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 29, 2025

BACKGROUND AND OBJECTIVES: The risk-to-benefit ratio of transopercular awake resection for recurrent insular diffuse gliomas is poorly studied. We assessed feasibility, safety, and efficacy surgical in patients with previous treatments (resection and/or radiotherapy chemotherapy combination). METHODS: Observational, retrospective, single-institution cohort analysis (2010-2023) 123 consecutive adult operated on an glioma (2021 World Health Organization classification) under conditions. Comparison between as first-line treatment (n = 87) after 36). RESULTS: Function-based a (1) did not increase intraoperative adverse events compared resection; (2) was associated higher rate insufficient cooperation combined oncological (33.3%), monotherapeutic modality (7.4%), surgery (8.1%, P .046); (3) resulted rates similar to those at (median 91.9%, vs 90.1%); (4) surgery-related complications or duration hospital stay; (5) worsen the 6-month Karnofsky Performance Status score, seizure control, sick leave; (6) influence leave from work, but longer high-grade (38.0% 7.7%, < .001). CONCLUSION: seems feasible safe recurrence previously treated glioma, outcomes than first-time surgery.

Language: Английский

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Where are higher-order cognitive functions? The paradox of non-locality in awake cognitive mapping using a complex dynamic system framework

Frontiers in Psychology, Journal Year: 2025, Volume and Issue: 16

Published: March 3, 2025

This study addresses the challenge in identifying and preserving higher-order cognitive functions within a complex dynamic systems framework during neurosurgery. Traditionally, neurosurgical practice has prioritized avoiding language motor deficits, while functions-such as social cognition executive processes-remain underexplored. These arise from large-scale networks operating an optimal balance between synchronization metastability rather than isolated localized cortical regions. complexity highlights paradox of non-locality awake mapping: no single area "contains" function, but certain "critical points" can transiently disrupt network dynamics when stimulated intraoperatively. Direct electrical stimulation provides unique real-time insights by inducing brief dyssynchronizations that elicit observable behavioral changes, allowing neurosurgeons neuropsychologists to pinpoint crucial subcortical "connectome-stop minimize damage. Preserving deep white-matter tracts is essential, given their limited neuroplasticity profound, often irreversible impact tract lesions on cognition. To address these challenges, we propose three-step mapping approach: (1) localizing critical points via DES-driven impairment, (2) constant monitoring multiple domains tumor resection progresses, (3) halting at connectome-stop prevent deficits. An illustrative case involving right parietal glioma demonstrates how this methodology integrates computational neuroscience, theory, clinical achieve functional preservation maintain patient's quality life.

Language: Английский

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The capability to successfully study and to be graduated in students who underwent awake surgical resection for a low-grade glioma

Journal of Neuro-Oncology, Journal Year: 2025, Volume and Issue: unknown

Published: April 17, 2025

Language: Английский

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The urgent need to redefine quality of life in patients with low-grade glioma

ESMO rare cancers., Journal Year: 2025, Volume and Issue: unknown, P. 100003 - 100003

Published: Feb. 1, 2025

Language: Английский

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Beyond Avoiding Hemiplegia after Glioma Surgery: The Need to Map Complex Movement in Awake Patient to Preserve Conation

Cancers, Journal Year: 2023, Volume and Issue: 15(5), P. 1528 - 1528

Published: Feb. 28, 2023

Improving the onco-functional balance has always been a challenge in glioma surgery, especially regarding motor function. Given importance of conation (i.e., willingness which leads to action) patient’s quality life, we propose here review evolution its intraoperative assessment through reminder increasing knowledge neural foundations—based upon meta-networking organization at three levels. Historical preservation primary cortex and pyramidal pathway (first level), was mostly dedicated avoid hemiplegia, nonetheless shown limits prevent occurrence long-term deficits complex movement. Then, movement control network (second level) permitted such more subtle (but possibly disabling) thanks mapping with direct electrostimulations awake conditions. Finally, integrating multitasking evaluation during surgery (third enabled preserve volition highest finest level according patients’ specific demands (e.g., play instrument or perform sports). Understanding these levels underlying cortico-subcortical basis is therefore critical an individualized surgical strategy centered on choice: this implies increasingly use cognitive monitoring regardless involved hemisphere. Moreover, also pleads for finer systematic before, after as well stronger integration fundamental neurosciences into clinical practice.

Language: Английский

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Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies

Cancers, Journal Year: 2023, Volume and Issue: 15(14), P. 3698 - 3698

Published: July 20, 2023

The ability of neural circuits to compensate for damage the central nervous system is called postlesional plasticity. In diffuse low-grade gliomas (LGGs), a crosstalk between brain and tumor activates modulations plasticity, as well proliferation migration, by means paracrine electrical intercommunications. Such adaptative mechanisms have major impact on benefits risks oncological treatments but are still disregarded current neuro-oncological guidelines. this review, authors first aimed highlight clinical, radiological, markers that robustly reflect plasticity potentials limitations in LGG patients, including location degree critical white matter tract infiltration, velocity expansion, reactional changes neuropsychological performances over time. Second, interactions potential/limitations cerebral efficacy/tolerance treatment options (i.e., surgery, chemotherapy, radiotherapy) reviewed. Finally, longitudinal multimodal approach accounting evolutive profiles proposed. an integrates personalized predictive models with step-by-step therapeutic decision making supports onco-functional balanced strategies patients LGG, ultimate aim optimizing overall survival quality life.

Language: Английский

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Repeated Awake Surgical Resection(s) for Recurrent Diffuse Low-Grade Gliomas: Why, When, and How to Reoperate?

Frontiers in Oncology, Journal Year: 2022, Volume and Issue: 12

Published: July 5, 2022

Early maximal surgical resection is the first treatment in diffuse low-grade glioma (DLGG), because reduction of tumor volume delays malignant transformation and extends survival. Awake surgery with intraoperative mapping behavioral monitoring enables to preserve quality life (QoL). However, infiltrative nature DLGG, relapse unavoidable, even after (supra)total resection. Therefore, besides chemotherapy radiotherapy, question reoperation(s) increasingly raised, especially patients DLGG usually enjoy a normal long-lasting projects. Here, purpose review literature emerging field iterative surgeries DLGG. First, long-term follow-up results showed that who underwent multiple had an increased survival (above 17 years) preservation QoL. Second, criteria guiding decision reoperate defining optimal timing are discussed, mainly based on dynamic intercommunication between (including its kinetics pattern regrowth) reactional cerebral reorganization—i.e., mechanisms underpinning reconfiguration within across neural networks enable functional compensation. Third, how adapt medico-surgical strategy this individual spatiotemporal brain interplay detailed, by considering perpetual changes connectome. These data support early reoperation recurrent before onset symptoms transformation. Repeat awake resection(s) should be integrated global management including (neo)adjuvant medical treatments, enhance oncological outcomes. The prediction potential limitation neuroplasticity at each step disease must improved anticipate personalized multistage therapeutic attitudes.

Language: Английский

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