ミウラ　イサム   ISAMU Miura   三浦　勇    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	Functional plasticity of language confirmed with intraoperative electrical stimulations and updated neuronavigation: case report of low-grade glioma of the left inferior frontal gyrus.
掲載誌名	正式名：Neurologia medico-chirurgica 略　 称：Neurol Med Chir (Tokyo) ISSNコード：13498029/04708105
掲載区分	国内
巻・号・頁	54(7),pp.587-92
著者・共著者	Saito Taiichi, Muragaki Yoshihiro, Miura Isamu, Tamura Manabu, Maruyama Takashi, Nitta Masayuki, Kurisu Kaoru, Iseki Hiroshi, Okada Yoshikazu
発行年月	2014
概要	Removal of glioma from the dominant side of the inferior frontal gyrus (IFG) is associated with a risk of permanent language dysfunction. While intraoperative cortical and subcortical electrical stimulations can be used for functional language mapping in an effort to reduce the risk of postoperative neurological impairment, the extent of resection is limited by the functional boundaries. Recent reports proposed that a two-stage surgical approach for low-grade glioma in eloquent areas could avoid permanent deficits via the functional plasticity that occurs between the two operations. The report describes a patient with World Health Organization (WHO) grade II oligoastrocytoma in the left IFG, in functional plasticity of language occurred in the interval between two consecutive surgeries. Intraoperative electrical stimulations suggested that a language area and related subcortical fiber crossed the pre-central sulcus during tumor progression owing to functional plasticity. In the present case, we integrated neurophysiological data into the intraoperative neuronavigation system. We also confirmed the peri-lesional shift of language area and related subcortical fiber on image findings. Consequently, the tumor was sub-totally removed with two separate resections. Permanent language disturbance did not occur, and this favorable outcome was attributed to functional plasticity. The present experience sustains the multistage approach for low-grade gliomas in the language area. A combination of intraoperative electrical stimulations and updated neuronavigation may facilitate the characterization of brain functional plasticity.
DOI	10.2176/nmc.cr.2013-0248
PMID	24584281