New approaches for resection of gliomas
Prof. Hugues Duffau
77 slide(s) – 00:29:46– English –2010-09-27
- better understand the natural history of low-grade gliomas and glioblastomas
- know the oncological role of surgical resection in the treatment of gliomas
- know the functional contribution of surgery performed with cerebral mapping
- better understand the mechanisms of brain plasticity
The goal of tumor surgery is to optimize the extent of resection, while minimizing the risk of permanent deficit. Because tumors often invade “eloquent areas” and due to a major interindividual anatomofunctional variability, the cortical functional organization, the subcortical connectivity and the brain plastic potential should be studied for each patient. Functional neuroimaging (FNI) and tractography show the relationships between the tumor and eloquent regions, but FNI has methodological limitations. Consequently, intraoperative electrostimulation mapping (IES) is increasingly used. IES is performed in awake patient for sensory(-motor), visuo-spatial, language and cognitive mapping. This is an easy, accurate, reliable and safe technique of detection of cortical areas, white matter pathways and deep grey nuclei crucial for the function. IES enables to study the individual cortical functional organization before resection; to understand the pathophysiology of \"eloquent\" areas; to map the subcortical structures throughout the resection; to analyze the mechanisms of on-line plasticity; and to tailor the resection according to individual cortico-subcortical functional boundaries. Moreover, IES can be combined with repeated pre-and post-operative FNI, to validate FNI and to study the functional reorganization over time. Such plastic potential opens the door to multiple surgeries spaced by several months/years to optimize the benefit/risk ratio of surgery, i.e. to increase the extent of resection while preserving or improving the quality of life. IES is a unique tool to improve our knowledge of brain processing and to revisit the classical model of cognitive neurosciences, by switching from a localisationnist to a “hodotopic” view of cerebral organization.