title: Evidence for potentials and limitations of brain plasticity using an atlas of functional resectability of WHO grade II gliomas: towards a "minimal common brain".
abstract: Despite recent advances in non-invasive brain mapping imaging, the resectability of a given area in a patient harboring a WHO grade II glioma cannot be predicted preoperatively with high reliability, due to mechanisms of functional reorganization. Therefore, intraoperative mapping by direct electrical stimulation remains the gold standard for detection and preservation of eloquent areas during glioma surgery, because it enables to perform on-line anatomo-functional correlations. To study potentials and limitations of brain plasticity, we gathered 58 postoperative MRI of patients operated on for a WHO grade II glioma under direct electrical cortico-subcortical stimulation. Postoperative images were registered on the MNI template to construct an atlas of functional resectability for which each voxel represents the probability to observe residual non-resectable tumor, that is, non-compensable area. The resulting atlas offers a rigorous framework to identify areas with high plastic potential (i.e. with probabilities of residual tumor close to 0), with low compensatory capabilities (i.e. probabilities of residual tumor close to 1) and with intermediate level of resectability (probability around 0.5). The resulting atlas highlights the utmost importance of preserving a core of connectivity through the main associative pathways, namely, it supports the existence of a "minimal common brain" among patients.
authors.affiliation: Department of Neurosurgery, Udine, Italy.
authors.forename: Tamara
authors.initials: T
authors.lastname: Ius
authors.forename: Elsa
authors.initials: E
authors.lastname: Angelini
authors.forename: Michel
authors.initials: M
authors.lastname: Thiebaut de Schotten
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mandonnet
authors.forename: Hugues
authors.initials: H
authors.lastname: Duffau
mesh_terms: D000328:Adult; D001271:Atlases as Topic; D001369:Axons / Q000502:physiology; D001921:Brain / Q000473:pathology* / Q000502:physiology*; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery; D002540:Cerebral Cortex / Q000473:pathology / Q000502:physiology; D004558:Electric Stimulation; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D005910:Glioma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D015233:Models, Statistical; D009434:Neural Pathways / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology*; D019635:Neurosurgical Procedures; D017711:Nonlinear Dynamics; D012189:Retrospective Studies; D055815:Young Adult