Object: A growing number of published studies have recently demonstrated the role of resection in overall survival (OS) for patients with gliomas. In this retrospective study, the authors objectively investigated the role of the extent of resection (EOR) in OS in patients with low-grade gliomas (LGGs). Methods: Between 1998 and 2011, 190 patients underwent surgery for LGGs. All surgical procedures were conducted under corticosubcortical stimulation. The EOR was established by analyzing the pre- and postoperative volumes of the gliomas on T2-weighted MRI studies. The difference between the preoperative tumor volumes was also investigated by measuring the volumetric difference between the T2- and T1-weighted MRI images (ΔVT2T1) to evaluate how the diffusive tumor-growing pattern affected the EOR achieved. Results: The median preoperative tumor volume was 55 cm³, and in almost half of the patients the EOR was greater than 90%. In this study, patients with an EOR of 90% or greater had an estimated 5-year OS rate of 93%, those with EOR between 70% and 89% had a 5-year OS rate of 84%, and those with EOR less than 70% had a 5-year OS rate of 41% (p < 0.001). New postoperative deficits were noted in 43.7% of cases, while permanent deficits occurred in 3.16% of cases. There were 41 deaths (21.6%), and the median follow-up was 4.7 years. A further volumetric analysis was also conducted to compare 2 different intraoperative protocols (Series 1 [intraoperative electrical stimulation alone] vs Series 2 [intraoperative stimulation plus overlap of functional MRI/fiber tracking diffusion tensor imaging data on a neuronavigation system]). Patients in Series 1 had a median EOR of 77%, while those in Series 2 had a median EOR of 90% (p = 0.0001). Multivariate analysis showed that OS is influenced not only by EOR (p = 0.001) but also by age (p = 0.003), histological subtype (p = 0.005), and the ΔVT2T1 value (p < 0.0001). Progression-free survival is similarly influenced by histological subtype (fibrillary astrocytoma, p = 0.003), EOR (p < 0.0001), and ΔVT2T1 value (p < 0.0001), as is malignant progression–free survival (p = 0.003, p < 0.0001, and p < 0.0001, respectively). Finally, the study shows that the higher the ΔVT2T1 value, the less extensive the currently possible resection, highlighting an apparent correlation between the ΔVT2T1 value itself and EOR (p < 0.0001). Conclusions: The EOR and the ΔVT2T1 values are the strongest independent predictors in improving OS as well as in delaying tumor progression and malignant transformation. Furthermore, the ΔVT2T1 value may be useful as a predictive index for EOR. Finally, due to intraoperative corticosubcortical mapping and the overlap of functional data on the neuronavigation system, major resection is possible with an acceptable risk and a significant increase in expected OS.

Neuropsychological studies suggest that the human brain is endowed with two body representations: the body schema (BS), coding the orientation of one's body parts in space, and the body structural description (BSD), coding the location of body parts relative to a standard body. We used fMRI to disentangle the neural mechanisms underlying these putatively distinct body representations. Participants saw an arm or a pot's handle (stimulus: arm, handle) rotated at different angles (angle: 30–150°). If the stimulus was an arm, subjects were instructed to imagine (1) rotating their own arm until it matched the stimulus orientation (comparing the seen arm to their own) or (2) seeing the stimulus moving toward its appropriate position on a simultaneously presented human body [comparing the arm to the one of a standard body (strategy: motor, visual imagery)]. If the stimulus was a handle, subjects were instructed to imagine (1) placing the handle on its appropriate position on a simultaneously presented pot or (2) seeing it moving toward its pot's position. The analysis of the interaction stimulus × strategy revealed activation of left secondary somatosensory cortex (SII), specifically when comparing the stimulus arm to one's own. The analysis of the parameters describing the linear effect of angle revealed that neural activity of left posterior intraparietal sulcus was modulated by the stimulus's rotation, but only when relating the arm to a standard body. The results associate BS and BSD with differential neural substrates, thereby suggesting that these are independent body representations, and furthermore extend current concepts of SII function.

We could predict how an object would look like if we were to see it from different viewpoints. The brain network governing mental rotation (MR) has been studied using a variety of stimuli and tasks instructions. By using activation likelihood estimation (ALE) meta-analysis we tested whether different MR networks can be modulated by the type of stimulus (body vs. non body parts) or by the type of tasks instructions (motor imagery-based vs. non-motor imagery-based MR instructions). Testing for the bodily and non-bodily stimulus axis revealed a bilateral sensorimotor activation for bodily-related as compared to non bodily-related stimuli and a posterior right lateralized activation for non bodily-related as compared to bodily-related stimuli. A top-down modulation of the network was exerted by the MR tasks instructions frame with a bilateral (preferentially sensorimotor left) network for motor imagery- vs. non-motor imagery-based MR instructions and the latter activating a preferentially posterior right occipito-temporal-parietal network. The present quantitative meta-analysis summarizes and amends previous descriptions of the brain network related to MR and shows how it is modulated by top-down and bottom-up experimental factors.