Price Sally-Ann, Kalaitzoglou Dimitrios, Rajwani Kapil, Patel Sabina, Wren Hilary, Gullan Richard, Ashkan Keyoumars, Bhangoo Ranjeev, Vergani Francesco, Lavrador José Pedro
Department of Neurosurgery, King's College Hospital, Denmark Hill, SE5 9RS, London, UK.
Acta Neurochir (Wien). 2024 Dec 13;166(1):500. doi: 10.1007/s00701-024-06396-1.
Neuroplasticity is well established in low grade glioma patients. Less is known about functional plasticity in glioblastomas. A 56-year-old lady presented with a recurrent speech deficit seventeen months after her initial craniotomy for a language eloquent glioblastoma (GBM). Pre-operative navigated trans-cranial magnetic stimulation (n-TMS) for language mapping, tractography and intra-operative language mapping were performed. During her second admission, preoperative n-TMS revealed positive responses anterior and posterior to the tumour recurrence. Tractography revealed a decrease in the anterior extension of the Arcuate Fasciculus (AF) in the inferior frontal gyrus and a more anterior component of the Frontal-Aslant Tract (FAT) showed anterior to the tumour itself. A second resection was carried out and the patient was discharged with no language deficit for second line treatment with Lomustine. Intraoperatively, speech arrest was found in a new position posterior to the previous surgical cavity and away from tumour recurrence (where speech arrest was previously located). This case report shows language function neuroplasticity in glioblastoma. This is supported by preoperative cortical and subcortical mapping.
神经可塑性在低级别胶质瘤患者中已得到充分证实。而关于胶质母细胞瘤中的功能可塑性，人们了解得较少。一名56岁女性在因语言功能区胶质母细胞瘤（GBM）首次开颅手术后17个月出现复发性言语缺陷。进行了术前导航经颅磁刺激（n-TMS）语言映射、神经纤维束成像和术中语言映射。在她第二次入院期间，术前n-TMS显示在肿瘤复发部位的前后均有阳性反应。神经纤维束成像显示，额下回的弓状束（AF）向前延伸减少，额斜束（FAT）更靠前的部分位于肿瘤本身前方。进行了二次切除，患者出院时无语言缺陷，随后接受洛莫司汀二线治疗。术中发现，言语停顿出现在先前手术腔后方的一个新位置，且远离肿瘤复发部位（先前言语停顿所在位置）。本病例报告显示了胶质母细胞瘤中的语言功能神经可塑性。术前皮层和皮层下映射也支持了这一点。
