Department of Diagnostic Imaging, Hospital Universitario Quirónsalud, Madrid, Spain; Universidad Europea de Madrid. Faculty of Biomedical and Health Sciences, Spain.
Department of Neurosurgery, Hospital Universitario Quirónsalud, Madrid, Spain; Universidad Europea de Madrid. Faculty of Biomedical and Health Sciences, Spain.
Clin Neurol Neurosurg. 2024 Nov;246:108586. doi: 10.1016/j.clineuro.2024.108586. Epub 2024 Oct 5.
Brain plasticity after multistep surgery in low-grade glioma is highly variable; the neurosurgical approach must be individualised and functional imaging can be used for this purpose. In supplementary motor area complex (SMAC) tumors, the early and adequate functional recovery of patients raises the possibility of a latent bihemispheric or "mirror" cortico-subcortical network, which would develop depending on the needs of each patient.
Functional and DTI-MR data from 4 right-handed patients with left frontal low grade gliomas near the SMAC, who were operated at least in two occasions were collected. The time of the reintervention was variable (18 months- 8 years), related to the tumor growth. All patients were evaluated by a neuropsychologist and imaged before each surgery, in a 3 T MR, with a 24 multichanel head coil Motor and expressive language task-fMRI and DTI sequences were obtained to evidence the main cortico-subcortical components of the SMAC. Data were processed with Brainwave (GE Medical Systems) and with an Iplan Fiber Tracking tool (MEDTRONIC), respectively RESULTS: None of our patients presented permanent neurological deficits after the first or second functional surgery. Three patients with partial or complete resection of the left middle and / or inferior frontal gyrus, and the left frontal aslant tract evidenced new right hemispherical cortical activity. This right shift were not observed in the patient without left middle gyrus resection, indeed with partial absent of the left frontal aslant tract.
SMAC is a latent cortico-subcortical bihemispheric network that allows it to reorganize itself in response to specific neurological deficits. We highlight the importance in the cortical reorganization of the left middle frontal gyrus in the SMAC, closely connected with the essential language areas of this region, but also we focused in the potential cortioco-subcortical changes to compensate the functionality of the FAT.
低级别胶质瘤多步骤手术后大脑的可塑性变化很大；神经外科手术方法必须个体化，功能成像可用于此目的。在补充运动区复合体（SMAC）肿瘤中，患者的早期和充分的功能恢复提出了存在潜在的双侧或“镜像”皮质-皮质下网络的可能性，该网络将根据每个患者的需要而发展。
收集了 4 例位于 SMAC 附近左额部低级别胶质瘤的右利手患者的功能和 DTI-MR 数据，这些患者至少进行了两次手术。再次干预的时间（18 个月至 8 年）与肿瘤的生长有关。所有患者在每次手术前均由神经心理学家进行评估，并在 3TMR 上进行 24 通道头部线圈的 Motor 和表达性语言任务 fMRI 和 DTI 序列检查，以证实 SMAC 的主要皮质-皮质下成分。数据分别使用 Brainwave（GE Medical Systems）和 Iplan Fiber Tracking 工具（MEDTRONIC）进行处理。
我们的患者在第一次或第二次功能手术后均未出现永久性神经功能缺损。3 例部分或完全切除左侧额中、下回和/或左侧额斜束的患者出现了新的右侧半球皮质活动。在未切除左侧额中回的患者中未观察到这种右移，而左侧额斜束部分缺失。
SMAC 是一种潜在的皮质-皮质下双侧网络，它可以根据特定的神经功能缺损进行自身重组。我们强调了 SMAC 中左侧额中回在皮质重组中的重要性，该区域与该区域的重要语言区域密切相关，但我们也关注了皮质下变化以代偿 FAT 的功能的潜在变化。
