Keywords
1. Brain plasticity glioma
2. Somatosensory cortex reorganization
3. Neural adaptation brain tumor
4. Low-grade glioma treatment
5. Functional MRI brain mapping
The human brain’s remarkable plasticity has once again been illuminated through the study of a patient with a low-grade glioma. As described in an intriguing case report published in BMJ Case Reports, researchers documented the spatial reorganization of the somatosensory cortex observed during the management of a brain tumor in a 39-year-old right-handed woman (DOI: 10.1136/bcr-2018-228971).
The patient, who initially presented with intermittent tingling and twitching in her right hand, was found through structural and functional MRI studies to have a low-grade glioma that involved the somatosensory cortex. This brain region is responsible for processing sensory information from various parts of the body. MRI findings indicated that in response to the presence of the tumor, the patient’s brain had undergone significant functional plasticity.
What makes this case especially fascinating is how it underscores the dynamic nature of the brain, particularly in adapting to changes induced by diseases such as gliomas. These slow-growing brain tumors can cause subtle changes over time that may lead to the reorganization of neural networks, even before any medical intervention occurs.
The medical team proceeded with an intraoperative awake craniotomy to remove the tumor. This surgical technique requires the patient to be awake, allowing for continuous monitoring of brain functions such as speech and motor control. During the surgery, the team conducted awake mapping and identified a gyral dissociation of the somatosensory areas for the patient’s right arm and leg sensation. Such dissociation suggested that the normal anatomical organization of sensory processing for the arm and leg had become altered as a consequence of neural plasticity.
Brain mapping is an essential tool in the resection of brain tumors, especially in eloquent areas where critical functions could be compromised. In the case of the aforementioned patient, careful mapping was pivotal in avoiding significant neurological deficits while facilitating maximum tumor removal.
A review of the literature further supports the notion that neural network plasticity is a common phenomenon in the presence of low-grade gliomas. According to a diffusion tensor imaging study by Zheng et al. (2013), language pathways show a great deal of plasticity in patients with low-grade gliomas (PMC4145989). This adaptability often allows individuals to maintain language functions despite having tumors in areas typically associated with speech and comprehension.
The implications of such neural plasticity are profound, particularly when considering treatment outcomes. Duffau et al. (2003) suggest that postsurgical functional recovery can occur even after resection of gliomas in eloquent brain regions, hypothesizing that brain compensation mechanisms come into play (PMC1738559). This compensatory response is based on the rerouting of neural pathways and the recruitment of non-eloquent areas to support affected functions.
Intraoperative awake mapping procedures can reveal an in-depth understanding of individual variability in functional neuroanatomy. As described by Southwell et al. (2016), repeat awake craniotomies may uncover functional plasticity of the adult cortex, and this information can be instrumental in planning surgical strategies (PMID 26544767).
Further research by Ghinda and Duffau (2017) calls for personalized multimodal management of diffuse low-grade gliomas, recognizing that network plasticity demands a tailored approach that takes into account the unique neural adaptations existing in each patient (PMC5281570).
The case reported by Das et al. (2019) in BMJ Case Reports and the references cited within demonstrate that low-grade gliomas can induce intriguing alterations in brain function and structure. The documentation of spatial reorganization of the somatosensory cortex adds valuable knowledge to the field of neurooncology and neurosurgery, emphasizing the necessity of individualized patient care.
In conclusion, the brain’s adaptive capabilities following the growth of low-grade gliomas present both challenges and opportunities for medical intervention. With sophisticated imaging techniques and the conscientious application of brain mapping protocols, there is the potential to optimize therapeutic outcomes while minimalizing the impact on patients’ quality of life. The advancing frontier of neuroplasticity research invites continued exploration, promising to yield insights that could transform the management of CNS cancer and promote better recovery for those affected.
References
1. Garavaglia MM, Das S, Cusimano MD, et al. (2014). Anesthetic approach to high-risk patients and prolonged awake craniotomy using dexmedetomidine and scalp block. J Neurosurg Anesthesiol, 26(3), 226–33. DOI: 10.1097/ANA.0b013e3182a58aba
2. Zheng G, Chen X, Xu B, et al. (2013). Plasticity of language pathways in patients with low-grade glioma: a diffusion tensor imaging study. Neural Regen Res, 8(7), 647–54. DOI: 10.3969/j.issn.1673-5374.2013.07.009
3. Ghinda CD, Duffau H. (2017). Network plasticity and intraoperative mapping for personalized multimodal management of diffuse low-grade gliomas. Front Surg, 4, 3. DOI: 10.3389/fsurg.2017.00003
4. Duffau H, Capelle L, Denvil D, et al. (2003). Functional recovery after surgical resection of low grade gliomas in eloquent brain: hypothesis of brain compensation. J Neurol Neurosurg Psychiatry, 74(7), 901–7. DOI: 10.1136/jnnp.74.7.901
5. Southwell DG, Hervey-Jumper SL, Perry DW, et al. (2016). Intraoperative mapping during repeat awake craniotomy reveals the functional plasticity of adult cortex. J Neurosurg, 124(5), 1460–9. DOI: 10.3171/2015.5.JNS142833