Plasticity of Cognition in Brain Gliomas

Abstract

Abstract The classical approach to neuro-oncology consists in studying the tumor, with few considerations regarding the brain. To select the best treatment for glioma patients, one should investigate neuroplasticity elicited by glioma progression. Strong interactions between brain and tumor result in cerebral adaptive phenomena that enable neurological and cognitive functions to be maintained. Here, the purpose is to study mechanisms underlying the plastic potential of the brain, based on lessons provided by cerebral mapping and outcomes in patients who underwent surgery for gliomas while awake. Massive brain resections, including those of eloquent areas, are possible without permanent deficits. These findings led to a hodotopical model, with the brain organized in dynamic and interactive parallel large-scale distributed networks. Cognitive neuroscience helps neurosurgeons develop new therapeutic strategies, such as multistage surgical approaches, thanks to the cerebral remapping that occurs over the span of years. Understanding neuroplasticity can enable a dramatic improvement of quality of life and survival in glioma patients.