New Insights into Functional Mapping in Cerebral Tumor by Hugues Duffau

By Hugues Duffau

The reason of mind tumour surgical procedure depends upon antagonist ambitions: on one hand, to optimise the standard of resection, nonetheless, to minimise the chance of everlasting postoperative deficit. even if, as a result of physiological interindividual anatomo-functional variability, elevated in situations of cerebral tumours as a result of plastic capability of the mind, a learn of the interactions among the lesion and the host turns out essential - in an effort to comprehend the person dynamic business enterprise of the mind, then with the objective to prevent postsurgical sequelae. during this method, new equipment of practical mind mapping might be beneficial for the neurosurgeon. First, earlier than surgical procedure, non-invasive useful neuroimaging ideas (fMRI, puppy, MEG) and invasive extraoperative electric mapping (subdural grids) might permit to review the cortical business enterprise for every sufferer. moreover, Diffusion Tensor Imaging can assist to appreciate the mind connectivity.Thus, the relationships among the tumour and the eloquent parts might be expected, and those info utilized to the surgical making plans. moment, in the course of surgical procedure, direct intraoperative electric stimulation allows to discover with accuracy and reliability, either the cortical websites and the white pathways crucial for a given functionality, at each one second and every position of the tumour elimination. furthermore, repeated stimulations all alongside the surgical act additionally enable to review the mechanisms of momentary plasticity, brought about by means of the resection itself. This online mapping is used to tailor the resection in keeping with cortico-subcortical practical boundaries.Third, postoperative neurofunctional imaging, mixed to the perfect review of the scientific direction and the target evaluation of the site and quantity of resection, provides the chance to check the mechanisms underlying the practical reimbursement, i.e. the long term plasticity. This strength can be used to accomplish a moment surgical procedure with a greater caliber of resection than the 1st one, due to attainable mind remapping.Such a pre-, intra- and post-surgical longitudinal research of dynamic interactions among mind and lesion, permits to raised understand the targeted styles of sensible redistribution for every sufferer, hence to use this information so as: to higher decide upon the surgical indication in mind tumours; to higher tell the sufferer of the particular threat of temporary postoperative deficit; to raised plan the resection (surgical technique, cortico-subcortical boundaries); to optimise the standard of tumour elimination whereas keeping the sensible components and tracts; and to devise a particular rehabilitation. ultimately, on a primary viewpoint, the organization of equipment of sensible mapping in neurosurgical sufferers permits to higher comprehend the pathophysiology of mind parts, their connectivity, and the mechanisms of plastic power of the glio-neurono-synaptic networks.

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