[Functional recuperation after resection of gliomas infiltrating primary somatosensory fields. Study of perioperative electric stimulation].
BACKGROUND
With the aim to achieve the most complete resection in cases of parietal low-grade glioma involving the primary somatosensory area (S I), the authors describe a series with resection of S I using an intraoperative brain mapping. The immediate and delayed postoperative functional results are analyzed.


METHODS
Six patients were operated on for a low-grade glioma involving S I, revealed by seizures with a normal clinical examination. All patients underwent awake surgery under local anesthesia, to allow realization of an intraoperative sensorimotor brain mapping using direct electrical stimulations.


RESULTS
The primary motor area (M I) and S I were detected in all procedures. A part of infiltrated S I was removed in spite of a sensitive response of this area during stimulations (sensory face in 2 cases, upper limb area in 5 cases, and lower limb area in 2 cases). All patients presented an immediate postoperative sensory deficit, with recovery in the 6 cases within 3 months. Five resections were total and one subtotal.


CONCLUSIONS
In our experience, the primary somatosensory area could be resected in case of tumoral infiltration, without inducing a permanent neurological deficit. This may be due to brain plasticity mechanisms, with recruitment of loco-regional and controlateral eloquent regions, and also the learning of new compensatory strategies. Such a phenomenon can lead to perform more extensive resections in cases of infiltrative gliomas in the somatosensory region.
Duffau
H
H
Service de Neurochirurgie 1, Hôpital de la Salpêtrière, 47, boulevard de l'Hôpital, 75651 Paris. hugues.duffau@psl.ap-hop-paris.fr
Capelle
L
L
D000328:Adult; D000772:Anesthesia, Local; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery*; D004292:Dominance, Cerebral / Q000502:physiology; D004558:Electric Stimulation; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe / Q000503:physiopathology / Q000601:surgery*; D010468:Perceptual Disorders / Q000175:diagnosis / Q000503:physiopathology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D013003:Somatosensory Cortex / Q000503:physiopathology / Q000601:surgery*
Récupération fonctionnelle après résection de gliomes infiltrant l'aire somato-sensorielle primaire (S I). Etude par stimulations électriques per-opératoires.