Functional recovery after surgical resection of low grade gliomas in eloquent brain: hypothesis of brain compensation
Functional recovery after surgical resection of low grade gliomas in eloquent brain: hypothesis of brain compensation
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DOI：
10.1136/jnnp.74.7.901
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发表时间：
2003-07-01
影响因子：
11
通讯作者：
Van Effenterre, R
中科院分区：
文献类型：
--
作者：
Duffau, H;Capelle, L;Van Effenterre, R
目的：描述脑功能区低级别胶质瘤(LGG)手术切除后的功能恢复情况，并探讨其代偿机制。方法：对77例无功能障碍的右手脑胶质瘤患者，术前行MRI解剖检查，术中行脑电刺激和皮质下标测。结果：肿瘤累及31个辅助运动区、28个隔离区、8个主要体感区、4个主运动区、4个Broca区和2个左侧颞叶语言区。所有患者术后立即出现缺陷。除4例(确诊率：5%)外，其余均在3个月内恢复。92%的肿瘤在术后MRI上被完全或广泛切除。结论：这些发现提示瘤周脑内可能存在时空功能重组，且这一过程是动态的。补充具有长期周围功能重塑的代偿区将解释为什么：手术前，尽管肿瘤在有能力的区域生长，但没有临床缺陷；手术后立即出现缺陷，这可能是由于受侵区切除参与(但不是必要的)功能；以及为什么在手术三个月后，几乎完全恢复。这种大脑的可塑性，可以降低手术并发症的长期风险，可以用来扩大口才区域的手术范围。
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.