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Plastic relocation of motor cortex in a patient with LGG (low grade glioma) confirmed by NBS (navigated brain stimulation)

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Abstract

We report on a patient with LGG, in whom NBS mapping confirmed relocation of the primary motor cortex (M1) concurrent with multistage surgery. Comparing the NBS results at 18 months with the initial results revealed that the M1 representation had shifted from the precentral to the postcentral gyrus. The patient underwent a third surgical intervention. Intraoperative direct cortical stimulation (DCS) confirmed the shift of the M1. Plastic changes in M1 localization permitted complete tumour removal without neurological sequela. To our knowledge, this is the first report on a LGG patient where induced brain plasticity has been confirmed by NBS mapping.

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Acknowledgments

This work was supported by a grant from the Berliner Krebsgesellschaft.

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Authors and Affiliations

  1. Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Satoshi Takahashi, Daniel Jussen, Peter Vajkoczy & Thomas Picht

  2. Department of Neurosurgery, Keio University, School of Medicine, Shinanomachi 35 Sinjuku-ku, 160-8582, Tokyo, Japan

    Satoshi Takahashi

Authors
  1. Satoshi Takahashi
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  2. Daniel Jussen
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  3. Peter Vajkoczy
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  4. Thomas Picht
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Corresponding author

Correspondence to Satoshi Takahashi.

Additional information

Comment

The authors present an interesting case of brain plasticity in a patient who underwent repeated surgeries for a low grade glioma (LGG) located in the motor area. Brain plasticity in patients affected by neurological diseases has been already largely described. The phenomenon is of striking importance because it can provide new insights in neurophysiological mechanisms and also could entail some remarkable and tangible advantages for patients in the clinical setting. In fact, brain plasticity is a main issue in neuro-rehabilitation and now an emerging concept in neurosurgery. With regard to the specific field of neuro-oncology, a distinction has been made between preoperative, intra-operative, and postoperative brain plasticity. Finally, a multi-stage surgery based on brain plasticity has been suggested to achieve maximal safe removal of brain tumors. The appealing and original data reported by the Authors on NBS represent a noteworthy advance in this setting.

Domenico d’Avella

Alessandro DellaPuppa

Padova, Italy

The authors report the case of a 20-year-old male who underwent three surgeries for a glioma involving the left precentral gyrus. The patient benefited from navigated brain transcranial stimulation (NBS) before the first and the third operation. NBS showed a relocation of the primary motor cortex, which shifted from the precentral to the postcentral gyrus. This functional reorganization was confirmed using intraoperative direct cortical stimulation. It allowed total resection without neurological deficit.

This is a very exciting paper. It demonstrates the existence of mechanisms of brain plasticity, thanks to the use of NBS combined with intrasurgical direct stimulation. This original study enables a better understanding of the pathophysiology underlying cerebral remapping, that is, the recruitment of the retrocentral gyrus to compensate the invasion of the precentral gyrus by the glioma. In addition, such knowledge led the authors to re-operate the patient, with an improvement of the extent of resection within the precentral gyrus while preserving brain functions. This observation supports the fact that cerebral plastic potential have been underestimated by neurosurgeons during many decades, and that it should be used to increase surgical indications within areas for a long time considered as inoperable [1]. Combination of different mapping techniques (non-invasive NBS in addition to functional neuroimaging) serially performed over time in the same patient, and correlated to intraoperative stimulation could optimize the chances to investigate patterns of reorganization at the individual level, and thus to open the door to more aggressive surgical strategies based on multistage approach [2].

Hugues Duffau, Montpellier, France

1. Duffau H (2008) Brain plasticity and tumors. Adv Tech Stand Neurosurg 3:3–33

2. Duffau H (2012) The challenge to remove diffuse low-grade gliomas while preserving brain functions. Acta Neurochir (Wien) 154:569–574

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Takahashi, S., Jussen, D., Vajkoczy, P. et al. Plastic relocation of motor cortex in a patient with LGG (low grade glioma) confirmed by NBS (navigated brain stimulation). Acta Neurochir 154, 2003–2008 (2012). https://doi.org/10.1007/s00701-012-1492-0

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  • DOI: https://doi.org/10.1007/s00701-012-1492-0

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