Session #1: Cerebral Plasticity & Neural Meta-networks: A necessary step to operate on the brain. Hugues Duffau, MD, PhD; The Future of Brain Surgery.

SUMMARY: Dr. Hugues Duffau, a world leading expert in brain tumor surgery, presents the first of a series of interactive Lecture-Discussions on his pioneering approach to the removal of brain tumors with the preservation of QUALITY OF LIFE for the patient. In the past gross total removal of parenchymal brain tumors was preformed without much attention to the white matter tracts connecting the different brain regions which at key to the integration of motor, sensory and cognitive experiences. With the introduction of the Connectome that revealed the fiber tracts imaging anatomy combined with dissections to reveal their extent from front to back of the cerebrum and cerebellum. Functional MR imaging and tractography showed the integration of various parts of the brain during various activities. Using Penfield’s awake brain mapping techniques we learned a realtime understanding of the functions of various anatomical centers in the brain and their relationship. However most brain surgery was sensitive to the known motor, sensory , speech and visual areas as eloquent. So, awake brain mapping was used to avoid those areas. But Dr. Duffau directs our attention to the while matter tracts locally and the longer tracts connecting centers distantly which are all involved in important integrated functions of the brain. Gross Total Removals ignored these important connecting tracts until recently when the interconnected functions could be revealed realtime during awake surgery. In addition he emphasizes that the brain functional connections are constantly changing through Brain Plasticity. Furthermore the realtime functional anatomy of the brain is distorted by the static fiber tract imaging and tractography and brain shift at surgery.

He presents a case of a woman, who is a language specialist, with a tumor in Broca’s speech area of the brain. From preoperative neuro-psychological testing and also intra op and post op, his testing for crucial white matter tracts at surgery including his knowledge from preoperative imaging and anatomy, he was able to avoid interfering with these important tracts which allow the interconnection of brain functions that provide quality of life. In his patient he found that the speech areas where located elsewhere from changes and was able to grossly resect the tumor in the patient’s “Broca’s Area” without a speech deficit. He discussed in detail all of these above concepts which provide the basis of his future lecture discussions. There is extensive interaction among the members of the audience and the speaker to reach a high understanding of his revolutionary surgery. We believe that his approach will be essential in all neurosurgical training programs and that future brain surgery cannot be done without its use. (90 minutes of lecture and discussion.) Excellent for Video and has value for Podcast in the discussion.