From the Department of Neurosurgery (F.A.), Pasteur 2 Hospital, Nice University Medical Center, Université Côte d'Azur; Department of Neurosurgery (H.D., G.H.), Gui de Chauliac Hospital, and Institute for Neurosciences of Montpellier (H.D., G.H.), INSERM 1051, Team "Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors," Saint Eloi Hospital, Montpellier University Medical Center; and University of Montpellier (H.D., G.H.), France.
Neurology. 2018 Nov 13;91(20):e1902-e1908. doi: 10.1212/WNL.0000000000006517. Epub 2018 Oct 10.
To assess the homotopic structural plasticity in case of unilateral damage of the insula.
To detect changes in gray matter volumes of the contralesional insula from structural MRIs, we used voxel-based morphometry (VBM) in a sample of 84 patients with a diffuse low-grade glioma invading the left insula (insL group; n = 47) or the right insula (insR group; n = 37).
The region of interest-based VBM analysis highlighted a large cluster of voxels with gray matter volume increase in the contralesional insula in both patient groups (k = 2,214 voxels for insL and k = 879 voxels for insR, < 0.05, family-wise error corrected) compared with 24 age-matched healthy controls. Gray matter volume was increased for the entire insula ( = 3.63, = 0.0016 for insL; = 3.54, = 0.0024 for insR, Bonferroni corrected), whereas no significant changes were found in 2 control regions for both patient groups. Furthermore, an increase of 24.6% and 31.6% in the gray matter volume was observed in the insula-related VBM cluster for insL and insR patients, respectively, compared with healthy controls ( = 7.39, = 2.59 × 10 and = 7.51, = 3.61 × 10).
The reported results demonstrate that slow-growing but massive lesion infiltration of the insula induces marked increase of gray matter volume in the contralateral one. Our findings give support for a homotopic reorganization that might be a physiologic basis for the high level of functional compensation observed in patients with glioma.
评估单侧岛叶损伤后的同型结构可塑性。
为了从结构 MRI 中检测到对侧岛叶灰质体积的变化，我们使用了基于体素的形态计量学（VBM），对 84 名弥漫性低级别胶质瘤侵犯左侧岛叶（insL 组；n=47）或右侧岛叶（insR 组；n=37）的患者进行了样本研究。
基于感兴趣区域的 VBM 分析在两个患者组中都突出了对侧岛叶灰质体积增加的大块体素（insL 组 k=2214 个体素，insR 组 k=879 个体素，<0.05，家族错误率校正）与 24 名年龄匹配的健康对照组相比。灰质体积在整个岛叶增加（insL 为 =3.63， =0.0016；insR 为 =3.54， =0.0024，Bonferroni 校正），而在两个患者组的两个对照区均未发现显著变化。此外，与健康对照组相比，insL 和 insR 患者的岛叶相关 VBM 簇中的灰质体积分别增加了 24.6%和 31.6%（ =7.39， =2.59×10 和 =7.51， =3.61×10）。
报告的结果表明，缓慢生长但大量的岛叶病变浸润会导致对侧岛叶灰质体积明显增加。我们的发现为同型组织重组提供了支持，这可能是胶质瘤患者观察到的高水平功能代偿的生理基础。
