Résumé
Low-grade gliomas are primary brain tumors, which grow slowly; inducing mechanisms of neuroplasticity (reorganization of neuro-synaptic maps) and allowing prolonged functional compensation until the onset of inaugural seizures. Due to unescapable malignant transformation if these tumors are left untreated, functional then vital prognosis is usually engaged within about 6-7 years after diagnosis. Early and maximal surgical resection has significantly increased overall survival approximate to 20 years while preserving or even improving quality of life. Such surgeries have been performed in awake patients with the goal of benefiting from an individual mapping of networks mediating movement, language, cognition (visuospatial awareness, executive functions, attention. . .) and emotion. The surgical risk has been reduced to about 1%, including within structures classically considered as "unresectable", with 94% of return to work. These mapping results also resulted in a better understanding of the human connectome, organized in parallel and distributed large-scale neural networks, able to communicate and to compensate themselves, at least to some extend - explaining the neuroplastic potential. Observations gained from intraoperative stimulation also led in the elaboration of a meta -networking theory of brain processing, relying on dynamic interactions within and across neural systems which can be transitorily generated to enable adapted behavior in response to environmental demands - which breaks with the localizationist tradition. This integrated view opens new avenues to original cognitive models in basic neurosciences as well as to innovative treatment strategies for brain -damaged patients, in the fields of neurosurgery, neurology, functional rehabilitation and psychiatry. (c) 2024 l'Acad & eacute;mie nationale de m & eacute;decine. Published by Elsevier Masson SAS. All rights reserved.