Fractionated resection on low grade gliomas involving Broca＇s area and insights to brain plasticity

作     者：WU Chen-xing PU Song LIN Yi WANG Yong-zhi JIANG Tao XIE Jian WEI Miao YI Xiao-li WANG Xiao-yi 

作者机构：Department of Neurosurgery Beijing Tiantan Hospital Affiliated to Capital Medical University Beijing 100050 China Department of Neuroimage Beijing Tiantan Hospital Affiliated to Capital Medical University Beijing 100050 China Department of Neurosurgery First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang 150001 China Department of Neurosurgery First Affiliated Hospital of Chinese Medical University Shenyang Liaoning 110001 China State Key Laboratory of Cognitive Neuroscience and Learning Beijing 100875 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2008年第121卷第20期

页      面：2026-2030页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：National Key Project of Science and Technology Supporting Programs of China [2007BAI05B08] Major State Basic Research Development Program of China [2007CB12503] 

主　　题：low-grade gliomas Broca's area fractionated resection brain plasticity 

摘      要：Background Resent 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.