Duffau H
Department of Neurosurgery, Gui-de-Chauliac Hospital, Montpellier University Medical Center, 80, avenue Augustin-Fliche, 34295 Montpellier, France; U1051 Laboratory, Team "Brain Plasticity, Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, National Institute for Health and Medical Research (Inserm), Montpellier University Medical Center, 34091 Montpellier, France.
Neurochirurgie. 2017 Jun;63(3):259-265. doi: 10.1016/j.neuchi.2016.12.001. Epub 2017 May 15.
The historical approach in neurooncology is used to mainly investigate the tumor, with very few considerations regarding the brain itself. Nonetheless, to select the best personalized therapeutic management for each patient with a diffuse glioma, i.e. to optimize the "onco-functional balance", the brain reaction induced by glioma growth and migration should be studied. Indeed, due to strong interactions between the glioma and the brain, cerebral adaptive phenomena often occur in order to maintain neurological and cognitive functions, as well as to compensate glioma spreading. Here, the goal is to detail mechanisms underlying neuroplasticity and its implications for surgical neurooncology.
Data issues from cerebral mapping and functional outcomes in patients who underwent awake surgery for gliomas were discussed.
Massive resections of the brain, including so-called "eloquent areas", are possible without generating permanent neurological deficits in adult patients harbouring a diffuse glioma.
From a fundamental point of view, these findings open the door to a hodotopical anatomo-functional organization of the brain, i.e. organized in dynamic and interactive parallel large-scale distributed networks, able to compensate for each other. Furthermore, cognitive neurosciences represent valuable help to neuro-oncology, by leading to the elaboration of new treatment strategies, such as multistage surgical approach, made possible thanks to cerebral remapping over years. In other words, understanding neuroplasticity in a connectomal account of brain processing permitted a dramatic improvement of both quality of life as well as overall survival in glioma patients, and resulted in the proposal of an "individualized functional neurooncology".
神经肿瘤学的传统方法主要用于研究肿瘤，而对大脑本身的考虑甚少。然而，为了为每位弥漫性胶质瘤患者选择最佳的个性化治疗方案，即优化“肿瘤-功能平衡”，应研究胶质瘤生长和迁移所引发的大脑反应。事实上，由于胶质瘤与大脑之间存在强烈的相互作用，大脑常出现适应性现象，以维持神经和认知功能，并补偿胶质瘤的扩散。在此，目标是详细阐述神经可塑性的潜在机制及其对外科神经肿瘤学的影响。
讨论了接受胶质瘤清醒手术患者的脑图谱数据问题和功能结果。
对于患有弥漫性胶质瘤的成年患者，即使对包括所谓“明确功能区”在内的大脑进行大规模切除，也不会产生永久性神经功能缺损。
从基础层面来看，这些发现为大脑的局部解剖功能组织打开了一扇门，即大脑由动态且相互作用的平行大规模分布式网络组成，这些网络能够相互补偿。此外，认知神经科学通过促使制定新的治疗策略，如多阶段手术方法，为神经肿瘤学提供了宝贵帮助，而这种方法因多年来的脑图谱绘制成为可能。换句话说，从大脑处理的连接组学角度理解神经可塑性，显著改善了胶质瘤患者的生活质量和总生存率，并促成了“个性化功能神经肿瘤学”的提出。
