We observed an independent interaction between improved postoperative cognitive function and extent of resection: 20.0%, 43.7%, and 44.4% of improvement after partial, subtotal, and total resection, respectively (P = 0.022). We observed a significant inverse interaction between worsened postoperative cognitive function and extent of resection: 80.0%, 18.8%, and 16.7% of worsening after partial, subtotal, and total resection, respectively (P = 0.020). None of the 3 patients without preoperative cognitive deficit had postoperative worsening. We prospectively included 39 consecutive patients with diffuse isocitrate dehydrogenase-mutant low-grade glioma without preoperative and adjuvant oncologic treatment and assessed preoperative (mean, 24.1 ± 21.2 days before surgery) and postoperative (mean, 14.6 ± 13.2 months after surgery) cognitive evaluations and ability to work together with clinical, imaging, therapeutic, and follow-up characteristics before tumor progression. Electronic address: assessed the impact of surgery on postoperative cognitive function and ability to work in adult patients with a diffuse low-grade glioma involving eloquent brain regions and having a functional-based maximal surgical resection using intraoperative corticosubcortical mapping under awake conditions. 8 Department of Neurosurgery, Sainte-Anne Hospital, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France.Electronic address: 1 Department of Neurosurgery, Sainte-Anne Hospital, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France Department of Neurosurgery, Keio University School of Medicine, Minato, Tokyo, Japan. 7 Paris Descartes University, Sorbonne Paris Cité, Paris, France IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France Department of Neuropathology, Sainte-Anne Hospital, Paris, France.6 Paris Descartes University, Sorbonne Paris Cité, Paris, France Department of Neuro-Anaesthesia and Neuro-Intensive Care, Sainte-Anne Hospital, Paris, France.5 Paris Descartes University, Sorbonne Paris Cité, Paris, France IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France Department of Neuroradiology, Sainte-Anne Hospital, Paris, France.4 Department of Neurosurgery, Sainte-Anne Hospital, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France University of Texas Southwestern Medical Center, Dallas, Texas, USA.3 Department of Neurosurgery, Sainte-Anne Hospital, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France.2 Department of Neurosurgery, Sainte-Anne Hospital, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France.1 Department of Neurosurgery, Sainte-Anne Hospital, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France Department of Neurosurgery, Keio University School of Medicine, Minato, Tokyo, Japan.This brain plasticity, which decreases the long term risk of surgical morbidity, may be used to extend the limits of surgery in eloquent areas. The recruitment of compensatory areas with long term perilesional functional reshaping would explain why: before surgery, there is no clinical deficit despite the tumour growth in eloquent regions immediately after surgery, the occurrence of a deficit, which could be due to the resection of invaded areas participating (but not essential) to the function and why three months after surgery, almost complete recovery had occurred. These findings suggest that spatio-temporal functional re-organisation is possible in peritumoural brain, and that the process is dynamic. Ninety-two percent of the lesions were either totally or extensively resected on post-operative MRI. Recovery occurred within 3 months in all except four cases (definitive morbidity: 5%). All patients had immediate post-operative deficits. Tumours involved 31 supplementary motor areas, 28 insulas, 8 primary somatosensory areas, 4 primary motor areas, 4 Broca's areas, and 2 left temporal language areas. Seventy-seven right-handed patients without deficit were operated on for a LGG invading primary and/or secondary sensorimotor and/or language areas, as shown anatomically by pre-operative MRI and intraoperatively by electrical brain stimulation and cortico-subcortical mapping. To describe functional recovery after surgical resection of low grade gliomas (LGG) in eloquent brain areas, and discuss the mechanisms of compensation.
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