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  • Reorganization Components of Brain Functions for Optimization the Extent of Resection Near and Within Eloquent Cortex

    Final Number:

    Olena Nikolenko MD PhD; Lusiena Klaupik MD, PhD; Oleg Volodymyrovych Nikolenko PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Optimization the extent of surgical interventions near and within eloquent cortex is associated with the coordination of various factors such as achieving total resection and minimization neurological deficit. Brain can compensate its functions after traumatic, ischemic injuries and during tumor progression. Multistage surgical approach, high-frequency cortical subdural stimulation in Broca’s area, reorganization of proper names representation prior to anterior temporal lobe surgery have demonstrated the ability to reorganize neuronal networks outside of place of resection, thereby optimizing extent of resection in eloquent cortex. Variability in language localization and multiple cortical representations of movements make difficult plastic relocation for the whole brain function without its decomposition into components. This mosaic patterns also present a significant impediment to the integrated use of given methods of induction of brain plasticity for optimization resections in eloquent areas. Present study focuses on neuroscientific methodology of decomposition language functions onto components by brain mapping syntactic, semantic and pragmatic processing.

    Methods: Our approach is aimed to redistribute the networks supporting components of brain function to semantic, syntactic and pragmatic processing networks remote ipsilesional and contralateral hemisphere. This involves decomposition of cerebral functions onto system descriptors: “concept”, “structure” and “substrate” that define certain sequence for relocation brain function’s components. These components allow constructing integral system-parametric models of cerebral functions of different modalities for development of visual, auditory and linguistic compensatory training to recruitment alternative neuronal networks that could compensate functions of injured brain areas.

    Results: Relocation of brain function’s components makes the networks of affected eloquent areas less critical to surgical manipulations in cases of positive awake mapping. Integrated system-parametric model of brain function specifies: plan of preoperative training for reorganization of alternative neuronal networks, extent of resection and stages of upcoming surgery.

    Conclusions: Reorganization components of brain functions optimizes the extent of resection in eloquent cortex, improves postsurgical functional outcomes, promotes preservation quality of life.

    Patient Care: For patients undergoing surgeries in eloquent areas - plastic relocation components of cerebral functions will prevent the risk of neurologic decline, promote restoration of injured functions thereby improve neurofunctional outcomes and preserves quality of life

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of optimization extent of resection near and within eloquent cortex for median survival, postsurgical functional outcomes and health related quality of life; 2) Discuss, in small groups the ways of combining different methods of reorganization neuronal networks of eloquent cortex away from place of surgery for achieving total resection and minimization neurological deficit; 3) Identify an effective treatment of tumors, epilepsy, arteriovenous malformations localized near and within eloquent areas in the cases of positive brain mapping and intraoperative neurological dysfunction.

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