Fractionated resection on low grade gliomas involving Broca's area and insights to brain plasticity.
BACKGROUND
Recent advances on functional mapping have enabled us to conduct surgery on gliomas within the eloquent area. The objective of the article is to discuss the feasibility of a planned fractionated strategy of resection on low-grade gliomas (LGGs) involving Broca's area. We report the first surgical series of planned fractionated resections on LGGs within Broca's area, focusing on language functional reshaping.


METHODS
Four patients were treated with fractionated operations for LGGs involving Broca's area. All cases underwent conventional magnetic resonance (MR) scanning, language functional MR and diffusion tensor imaging (DTI) before operation. The resections were then performed on patients under awake anesthesia using intraoperative electrical stimulation (IES) for functional mapping. Pre- and post-operative neuro-psychological examinations were evaluated.


RESULTS
Total resections were achieved in all cases as confirmed by the postoperative control MR. After transient language worsening, all patients recovered to normal 3-6 months later. Language functional MR scannings have shown language functional cortical and subcortical pathway reorganization (in the perilesion or contra-lateral hemisphere) after the operation. All patients returned to a normal socioprofessional life.


CONCLUSIONS
By utilizing the dynamic interaction between brain plasticity and fractionated resections, we can totally remove the tumor involving Broca's structure without inducing permanent postoperative deficits and even improve the quality of life.
Wu
Chen-xing
CX
Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China.
Pu
Song
S
Lin
Yi
Y
Wang
Yong-zhi
YZ
Jiang
Tao
T
Xie
Jian
J
Wei
Miao
M
Yi
Xiao-li
XL
Wang
Xiao-yi
XY
D000328:Adult; D001932:Brain Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe; D005910:Glioma / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009473:Neuronal Plasticity; D009483:Neuropsychological Tests