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Together, these information sources would like to continue its series of interviews with neuro-science leaders. In this series, Professor Hughes Defow is going to talk about brain surgery of the

future, redefining unco-functional outcomes and the quality of life. In session one, he'll talk about cerebral plasticity, neuromedia networks, which is a necessary step to understand and

operating on the brain

Dr. Defow is at the Gui Deshawn Leach Hospital

in Montpier, France. His telephone and contact information are listed.

The two moderators are first is James Osmond, who's the creator and founder of CEO of SI and SI Digital, former professor at the University of Minnesota, Michigan, Illinois UCLA in. and former

head of neurosurgery at Henry Ford Health Systems in the UIC of Chicago. He's a futurist, entrepreneur, and health care consultant.

The second moderator and co-moderator is Estrada Bernard, who is on the Duke University nerve surgery. Faculty is formerly head of neurosurgery at the University of North Carolina

He's a member of the neurosurgeon's spine brain

and pain LLC. He's on the board of directors of SI Digital, head of its SI Digital Grand Rounds programs, serving sub-Saharan Africa and Latin America, where there are almost 2 billion people.

Mike Chealy is the chief technology officer for both SI and SI Digital As the principal in his own firm called GraphTech and can be reached at the phone number listed.

Professor Dufau will be introduced by Andre Servio who is the head of neurosurgery at Flenny Healthcare in Buenos Aires, Argentina and worked with Dr. Dufau 20 years

ago. So I was just saying we're pleased to have - We're going to follow. We're going to follow

We're talking to us about the future, but I think it's going to be a strata that thinks it's really the future of brain surgery redefining the unco-functional outcomes and quality of life. This

session number one is on cerebral plasticity and neuromata networks. It's a necessary step to operate on the brain He's going to basically have an introductory lecture to the work he's done for 25

years. And this is a picture of Dr. Fau. He's at the Guidish Sholia. Well,

I was like, You put me in Schumplicant, no port, but. And Montpellier and France.

You put me in Schumplicant, no port, you guys, so I'll leave it with.

Okay. You know, the

guy's talking about the town, guys 'Cause when you police it, they didn't see it. I guess you'll know what the

fuck's going on. Oh, okay. Just a minute in He's. France. I've given you his phone number and his email. I'm Jim Olesman, and one of the moderators, along with my colleague, who is Estrada

Bernard. See, I got your picture Estrada.

formerly a Duke University and former head of neurosurgery at the University of North Carolina. He's interested in general neurosurgery, spine, particularly brain and pain. He's on the board of

directors. He's nice. Digital. And he's heads our programs in Grand Rounds. We've had one now for two years and Sub-Saharan Africa. And one of those members is on the call now and Nim is there,

we'll talk to him in a minute And then our third Grand Rounds is coming up this month in Latin America. And we have here on the call, he don't have his picture, but Mike Chile is a Chief Technology

Officer who's helped us put all these things together in modern technology for SI and SI Digital. Mike is on the call here. And Andre, we have the pleasure Andre is a great, great friend of ours.

Buenos Aires. He just gave us a talk, actually, about a week or two ago on the

Latin American Congress. He visited Professor DuFoe in 2006. And I think Hughes did his work before that in the early 2000s, late 1990s. And Andre's head's neurosurgery at Flenny, a major

hospital and Buenos Aires. And I'm going to stop at this point. And I'm

going to stop at this point. Oh, okay. Now, there we go. Andre, would you like to? We've got

to thank Professor Osmond for thinking of us to introduce Professor DuFoe. Professor DuFoe doesn't need in formal introduction because he's a very warm, renowned neurosurgeon known for maybe all

over the world for his extensive experience in glioma surgery field. He was one of the main actors for me in popularizing the tips in the awake surgery.

His neurosurgical experience is not only regarding to his surgical skills, which I can say we invited him in 2006 and then we had the possibility to visit him. And everything he said in his lecture,

believe me, is true because we saw him in the operating room. He operated in an awake fashion, always using maybe loops, sometimes microscope and bipolar, saturation I said someone

else don't be able to.

He has

also an incredible experience doing research, not only in the neurosurgical field, also in related areas like neurology and neuropsychology, he put to the whole community of neurosurgeons the new

theories about the language system, which was very revolutionary, and it's incredible to see young neurosurgeons speaking now about in a language typical from neuropsychologists. When we see or we

hear that our residents speaking about the fasciculus, arquatus, eye-foam, the possibility to preserve the tracks during surgery, maybe much

of this is because of professional works. So he has more, almost more than 500 papers in the very region. leading neurosurgical publications. All over the world, he visit different countries in

South America, Asia, Europe, United States. So for us, it's really a great pleasure to introduce Hughes to this nine lecture, which I think will be very outstanding. Last but not least, James,

I'd like to congratulate

Surgical Neurology International for thinking in this type of

academic activities. It's very important to have these lectures in this way for everybody all over the world because I think it's a very useful way to democratize the knowledge in the surgical field

So, thank you very much, everybody, I'm Professor of the Fall, please. We leave the space open for your lectures. Thank you very much.

Thank you very much. I'm very happy to have the support in the team, not only to give one talk, but a series of lectures dedicated to the better understanding of brain processing and brain surgery

in different fields, especially look like leoma, but we'll be speaking some lectures about high-grade leoma, avianemasurgical approach to other diseases.

We like to thank very much, James Osman, for its kind invitation and support. And also, Andres, thank you so much. You remember very well when we met first time 20 years ago already in

Montpellier. The first time was in Paris because I moved to Montpellier just. a few months later, and I hope you will not be disappointed, because the goal was to continue to understand what we

call now to say about connect to them and meet them before. And this is the reason why. So it was absolutely critical to start these lectures series by first of all brain surgeons should better

understand brain processing before to say that we can operate the brain And I will show in another lecture that the technology will never replace the lack of knowledge. To start, I would like to

show the case report.

Here we see that it was already 20 years ago, but still very connected to the current management of patients. I mean a 39 year old woman, Professor of Linguistic, was critical in this specific

tumor and this specific location, as you will see. No previous medical history of disease and the patient had a speech arrest for a few seconds. And despite a normal clinical examination, of

course an MRI was performed, not with a very good quality, I'm sorry about that, but it was 20 years ago, the real life And you can see, I'm sure, left a frontal insulin, a great glioma,

especially a center within and around what we call the left inferior frontal gyrus, so the so-called broccoli reacts, playing perfectly at the center metallurgy, the first portion seizures.

In fact, this patient at that time was managed in another department, and as you can see, that patient had a big biopsy or very partial resistance. You can call it as you want. Under general

anesthesia and the colleague decided just to

benefit from sample for histone molecular analysis, even if at that time there was not yet genetics. And as you can see, he did the surgical approach very entirely at the

room of the flare hypersignal And why, because he considered as 99 from the ascension that the tumor was inoperable due to

the location within broke the rear, especially in a patient who enjoyed an active life as a professor of linguistic and speaking different languages But, in fact, the vision was not going to return

to work after this big biopsy, because she experienced many seizures or despite two antipleptic drugs. And finally, so Kimo and Raya therapy was proposed at the later.

At that time, it was almost tradition to do chemoride therapy in so-called low-grade layer. But the patient refused to buy it early. I do not understand because I felt well before, before seizures,

maybe there is an alternative. And at that time, I met the patient, and to your opinion, what I asked first

to do in your psychological assessment. Because I said to the patient, I do not understand where, why you were not able to return to work, despite a few seizures, of course. So I have to

understand better the pattern of cognitive deficit you could exhibit and not visible at classical neurological examination. And indeed, the patient had disorders of verbal work in memory. So

attention on processing, deficit and deficit of attention.

By doing also complete verbal language assessment, the patient doesn't know any deficit. So it could seem paradoxical to have a patient with a lesion-willing so-called broker's area, why she's

right-handed. And finally, no language deficit, but problems regarding the executive functions critical for multitasking, for decision-making, for

transitory memory, and manipulation of items in order to have adaptive behavior. And everything seemed, in fact, very logical when we did it. And again, poor resolution But finally, the cons -

well, they're already 20 years ago, showing that, unfortunately, it's so huge. advances made in this field since 20 years, because at that time we understood, you can see the green arrow, that

the patient had a compensation of the so-called broken area, which does not exist as I will show you just after that. In the right non-dominant hemisphere, which means nothing because for her,

this right hemisphere was critical to compensate language, but still the only cause area activated in the so-called left-dominant hemisphere, which means nothing because you see that we need both in

order to compensate language, but not executive functions. So I say to the patient, in fact, you have no activation around the tumor. You compensate the thanks to a network involving both

hemispheres. I'm sure I cannot write you And of course, I will propose to do it under. with mapping in order to understand making is also a reorganization allowing you to continue to enjoy my life

even if you are not able to return to work because of attention and executive deficits. She accepted and we did the week surgery and you can see that 26, 27, 25 corresponding to the lateral part of

the presound trial of cherries, the so-called ventral premodal cortex, but in front of that in the birth of bercularies, triangularies and orbitaries there was no positive mapping. 23 and 24

corresponded to the dorsolateral prefrontal cortex, so the proper part of the rosacea. In other words, I was able to remove completely the inferior frontal gyrus, plus the anterior part of the

insula, already invaded by the tumor, as you have seen in preoperative right? And the most important. was to preserve the connectivity in the depth, 50, 49, you will see in the talk, the

crossing fibers between the ventral semantic pathway, the inferior fontic spatial fasciculus, 50,

and the dorsal pathway, involving the articulatory and phonological processing, so there are complex with the combination between the superior longitudinal fasciculus and the archaic fasciculus.

Here's, can I interrupt you for a minute? Okay, can you go back to that slide? The number is 26, 25, 27, is that an interior?

This is posterior. It's posterior. It's posterior. Okay, please. It's like gyros. Oh, okay. The inferior fontal gyros, which was invaded, you know, the words broke as a wrapper of say, the

vasoparcularies and triangularis, When I did stimulation, nothing happened. So I preserved, of course, the prefrontal gyrus behind the tumor. And you can see the phosphorytibium array with an

extensive resization of the left ventilum because my goal was to try to do a hypothetical resization. But also, of course, the two involving left in front of

gyrus at the level of bruccus era plus the anterior and two.

So what we did is of course a positive functional rehabilitation. So you see that in all cases, my specificity, when I met the patient was to say, first of all, we have to do cognitive assessment,

which was not performed in the first center, who initially took care of the patient, and to do a positive cognitive rehabilitation

So, condition, condition, and in the middle, during. surgery when mapping with cognitive monitoring, cognition, cognition, cognition. This is the spread of these philosophy. So you did the

cognitive assessment before surgery, end surgery, and after surgery, correct? Exactly. To perform rehabilitation according to the deficit, exhibited by the patient before surgery, not language,

executive functions, working memory, attention, and processing as well. So, broke the rea, that exists. It's not involved in language. In this case, language, we do not share executive

functions. What happened? The patient improved the neuropsychological assessment three months after surgery with no visual anymore. because I did this laboratory authorization. We were able to

decrease the number of anti-aplectic drugs. So of course, the patient continued to improve because you know that with seizures and two anti-aplectic drugs, you have a risk to have some negative

impact on the condition and then the patient returned to work by removing progress error. So the patient improved thanks to the rejection of the left inferior fontagellaris.

And this is not a topic today, but the patient did not benefit from adjuvant treatment. Only 10 years later, the Muslims were mine and finally ready for a P14 years later with now 15 years or so.

So before to explain what happened, the comments is that surgery is possible We think Broca's a rat. We think so cool, eloquent a rat. Not only by preserving the function, but with an improvement

of the functional status. And for

97 of your surgeons, I know today, it seems impossible. Do you feel you are telling me that you will remove Brook's era in a patient with well-before surgery, and the patient will improve? Yes,

it's exactly what I'm telling, because the patient was not so well before surgery. She had executive functions disorders, but no one was aware about that because a systematic cognitive assessment

was not done, so neurological examination is nothing.

Second, the wake mapping and the bones to, of course, optimize the externalization, you have seen the superior authorization, but also by preserving and improving, not only the functional status,

but the quality of life. The patient was able to return to work why it was not possible after the biopsy. So when Sanjan sat telling, I will do a biopsy, it's too dangerous to operate in this

location. Not only of course, the patient will live not so long, but the patient will have a decline of the cognitive functions by doing a biopsy rather than by removing the tumor.

So be careful once again, before to say that examination is normal because we have to do a cognitive assessment before, as you say, jury And after surgery. In order to extrapolate.

And that's it. Can I ask

you some questions? We have some questions in here which we're going to get to what I was

going to. Our gentleman, Dr. Obans from Pakistan, asked you do a water test before surgery to see if there is an active speech area on the other side.

Yeah, but it was just FMRI in order for you to have a better imagination of what happened. In terms of reorganization, namely, the recruitment of the control lateral hemisphere. But finally,

FMRI, I will say that I do not share. Never I used in 30 years, the results of the FMRI to pre-plan a surgery. It was just in order for me to better understand mechanism from your plasticity In

other words, what I will expose during my talk now. But do not rely on FMRI simply because this is not the truth, even today, not only 20 years ago. And I will give a lecture about the

limitations and pitfalls of FMRI. So what was the real truth, the cognitive assessment before surgery, giving me the opportunity to say, not speech, you use the term speech. speech. This is not

speech. This is cognition. We have to stop to speak about speech. Let me ask you another question that just came up. Horatio from, from, from, uh, uh, near Buenos Aires answer the question.

Have you, did you do a foot? And I know the answer this, but have you done a full FMR functional MR after the surgery?

Yes, but you can imagine that at the level, I have not to show you today. But at the level of the cavity, what we can see is nothing because this is a cavity. So we had an activation in the

contralateral misfer and in the left hemisphere more posteriorly. So a larger network. But you have seen already on the preoperative MRI. In other words, the job was done by the brain thanks to

the slow growth of the tumor before surgery. Otherwise, the patient would have been aphasic before surgery. And this is the reason why it was not - And it was not - Was unable to say to the patient,

I cannot pray to you because involving broke his area, because the patient was well before surgery. It's a fantastic case, another question we have. Always agree to the tumor after the biopsy.

Great too. This is the reason why I did not perform chemo or RIA therapy, be careful before to propose RIA and orchemo therapy too early. In my experience, we are doing a German treatment in

low-grade glioma in less than 10 of cases, at least within the years following surgery. And of course, we can discuss five, 10, 15, 20 years later. This patient on the MR that you showed us, I

had a cystic component right where they were doing the biopsy, which you can get cystic components and ask your cytomas. One would wonder if it isn't beginning to degenerate, but there was no

evidence of that, right?

To be honest, I do not share. Because the message will be, when I operate, I do not see the tumor. I see the brain. Could you do me a pointer? I'll talk to you in the middle of the tumor. It's

not my topic. I will remove as much as I can, till the brain will turn me stop. Can I get you to go back? You had the two, the operative photos Could you go back to that a little bit before

several slides before this?

That's post-operative, okay.

There we go. Okay. Just, oh, you've just passed back to the operative photograph. Are the opera out one? No, no, that's good. Okay. That's one more, one more, one more, one more, one

more after this. Oh, another one.

Okay, stop there.

Stop at the operative photograph. We want to see that Yes, I'm sorry because there is a delay. Okay, that's terrific. Now, can you point out the anatomy for us here? Because some of us are a

little disoriented. This is the temporal lobe, which shows where the temporal lobe is. Is that B, C, D, and E? The

temporal lobe is below So that's the answer underneath the civilian fissure here. You find on the left you have the prefrontal geribs. Of course. Okay, back. Form product, pre-modern cortex.

It's stimulated that this level you can have articulatory disorders. So you're looking at the left side. Well, this is the left side, the patient's left side, right?

Of course, this is a left tumor involved in the body. Yes, and I understand. We're trying to get oriented. Now, the point you're making is, first of all, you're operating on this woman who is

a language professor who really didn't have any much language deficit at all. And so neuroplasticity is a term that you, your coining, has already taken over and moved those functions to another

part of the brain. Is that correct?

Exactly. And this is what I can develop if you want in my slides now in order to explain what happened in this vision. Okay, and then we're seeing the cavity that you have you made here. which you

did with removal and stimulation, right, to determine where the tracks were. Of course, because the limitation of neuroplasticity is definitely represented by the connectivity in the depth. So

that means that if you cut the arcuate fasciculus plus the inferior font executable fasciculus in

the depth to vision, we start to speak. And that's why we recover. And that's why you don't use and rely on the functional MR or fiber tract imaging because it may not be exactly what you're gonna

find at surgery, isn't that right?

It's not, it may not. Chryctography is not the function of fibers. This is a fact. It's just based on movement of water, molecule. So Nivver or DTI, we give you any functional information.

This is the imagination of your surgeons I'm glad to believe in it. the experts in this field are the first to say, do not rely on the TI. Tractography is not done to give you a function at the

individual level. This is just extrapolation, which is why you do the neuropsychologic testing before surgery to begin to get a mental picture of where the fiber tracks are, which is involved

during surgery and after surgery. Is that correct?

Exactly. This is what I will illustrate on these slides now. OK. And then what I learned in 30 years,

this is that neurosurgeons continue to think that when they operate a tumor, they remove a tumor mask. This is true, maybe regarding meningoma, but not for diffuse lemma. This is the reason why I

do not care to know if there are some hate the virginity in the middle of the tumor because my goal will be to try to take a margin around. Indeed, what I have learned is that you have no tumor mass.

If you remove just the middle of the tumor, that's what I've done, you will not change the natural story of the disease. You will not have an impact. But if you accept that this is a diffuse,

chronic disease diffusing for beyond what you can see on the prior part of your MRI, which is the truth in 1480. And if you accept the fact that the brain around reorganized, not just speaking

about perilisional areas, but the full brain including the large network within the same hemisphere of the tumor and the contralateral hemisphere through the corpus chasm, then you will start to see

this dynamic reorganization. within and between networks which occurred before to have the first time tool in the vast majority of cases, seizures. In other words, we have to match the habit to

think that we will remove just a ball, and that because this ball is located within the same area than yesterday, for instance, in the left inferior fontageres, today in this new patient, and

because the volume is the same, and because the molecular pattern is the same, if you want, then we are doing the same surgery. This is totally wrong, because the brain reorganize differently for

many months to many years before the first symptoms, and we are brain surgery. So we have first the phone to deal with the brain by forgetting the tumor in the middle, And then we will remove as

much as we can according to the mechanisms. a free organization which occurred before to go to the world. So before the first symptoms, add the individual level. And it could be more perilisional,

more epsilisional, remotely, more control agent. And everything is changing from one patient to another one. Let me ask you a question, Dr. Avash from Pakistan asked, do you rely on microscopic

resolution to see the extent of tumor? In other words, there is no limit of tumor. Of course not. You cannot. It's an imagination of your surgeon.

There are no limit. There are no boundaries. How to explain that? You have tumor and sense. Two centimeters far away, the flare eye per signal.

So basically, what you're saying is to determine your deceptions. is the location of the fiber tracks, not what the microscope says. And if it turns out that you have some tumor left, you'll

leave it if it's in the middle of a fiber track and wait for brain neuroplasticity to develop. Is that correct?

Yeah, because if you get the pathways in the depth, you will disconnect.

13 to 23 of the hemisphere and your patient will have a permanent deficit after surgery. So you cannot get that. Right, so in that - But then, for optatively, you're being guided by your

functional assessment, correct? Not necessarily by anatomy. It's because you're doing a continual functional assessment to

guide the extent of your resection. I mean, as you say, the gliomas or diffuse and pathologies studies clearly show that, but because of the diffused nature. you're wanting to take out as much

tissue as you can to preserve function irrespective of what it looks like to the eye. Is that correct? Exactly, exactly. And this is the reason why I do not use microscope. In my operating

theater, but I will explain that in another talk how I do it, I do not use DTI. I do not use ephemera. I do not use neon navigation. I do not use intra-apartive MRI. I do not use a robot I do

not use microscope. I do not use e-cork. Because they are useless. If you think you will remove the tumor mask, you will not reach my results more than 20 years of median survival in the great

lemma, which is unique in the literature. And why? Not because I am a good surgeon, but because, as you said, I will listen the brain, talking to me, Please continue, continue. Or now it's

time to start according to the individual functional boundaries. And if I cannot not remove completely the tumor, because invasion of the connectivity, I will leave it. But if I can take two

centimeters of margin around the preoperative flare, I per signal, I will do it. This is the concept of super totalization. And in this subgroup, the rate of death is zero. Several more

questions here.

Dr. Abbas, what he's doing is everything's really upside down. In other words, his goal is to remove as much tumor as he can, leaving all the fiber tracks and connections intact, which preserves

quality of life. Rather than what we were trained in the past, was just to take the tumor out. And no matter where it is, you go and you cut the tracks and they, you can say that I had gross

total removal, but the patient has a gross, grossly bad quality of life. Is that, did you, do you understand that, Bass?

I say that when the patients are not so well, they are living shorter. It was demonstrated by everyone who applies the concept you have just developed now. I am telling the reverse, if the patient

is one, enjoying a native life, familiarly, proficiently, socially, artistically, sportively, they will live longer. And I will publish that in John M. Neusager in two months, about more

than 500 look regular human patients. My secret is that, if they have one, then I will have the possibility to reapprate. A few years later, because in the meantime, they will continue to push

their plasticity, because if you work, you continue to learn. So I will come back, I will remove more at that time, and I will prevent mackling non-transformation. So there is no dilemma between

the function versus the oncological considerations. Everything is linked if we start by accepting the brain perspective first, the functional point of view as a priority, and not the oncological

considerations because the diffuse feature of this tumor. It's not a tumor mass. This is not a meningerma. This is not a pylocytic, a societoma. We have another question. what do you do? I know

you're going to get to this in another talk. What are you going to do if it's a high-grade tumor? Do you still do this similar approach? Of course. If the patient is one, why not before surgery?

I mean, why not to remove according to the functional boundaries? And I will show in another talk, definitely, that I proposed the concept of super totalization 15 years ago. I published that in

word in our surgery. By removing the flare as much as you can around the transplant, because just remove the transplant in glioblastoma, we know the benefit. Three to six more months. In my

patients, the glioblastoma patients, the median survival, is three years because I removed the flare. Where to stop? According to the functional boundaries. Of course, not if the patient is

already a fuzzy kidney plaging before surgery. But if the patient is one, I can preserve the function by removing more humerone cells, not the core of the tumor. We do not care. It will change

nothing to remove just the core of the glioma per se.

So the core from a practical, from a practical point of

view, intraoperatively, what is your cadence for reassessing the functional status as you go along with the resection?

The function I have to be able to show you now.

Just to tell you that the brain is magic.

New one is aware about that in fertility. When you write a

glioma, for instance, using Broca's area or the insula, because in the example I showed, I removed all the other insula. We have to imagine. because this is the truth we demonstrated that. That

theconcralatieral insula

is increased. I mean, morphologically, I mean in adults, the brain is magic. It can change its shape even at 30-year-old. So of course, the functional and connectivity, this is the reason why

the contralatieral hemisphere can do the job before and after surgery And this is the reason why you can remove the vast majority of the cortex with in so-called eloquent areas which that do not exist,

the duty level, because everything was reorganized. So to answer your question, exactly what I have in my mental memory during surgery, it's not one area corresponding to one function. You can

forget, you can burn localizationism It never existed. Just in the mind, in the imagination of neurologists and your surgeons.

That's terrific. Not that

one function is supported by one network, for instance, to earthquake fasciculus. You can tell me, I haven't understood, Broker's a rat does not exist. We need to earthquake fasciculus between

Broker's and Verneke. No, it's not enough

But the interactions between different networks. Typically, in this patient, she had no language deficit before surgery, but executive function deficits. Why? Because she had some disorders,

disruption between the interactions, between the executive function network, and the point by the superlantitude in fasciculus,

the semantic processing, and the pine by the inferior fontox bin the fasciculus,

Okay, I create fasciculus, but which was not impaired, explaining why the patient was able to speak before during and after surgery. So, it was not a surgery within language area. It was a

surgery within a meta network, which changed throughout the restriction too. And I can show you that Because when you do this kind of look back to me, now we understood what happened before and

after surgery if you preserve the connectivity. And when I published as a neurosurgeon in nature, by telling this is the connectivity between areas, cortical areas, it's because I made the

dissection by myself, like many neurosurgeons who did that before, but by adding the function. when I stimulated into the operating theater, disrupting transitorally the function while the patient

did a real-time cognitive assessment. Then I made online anatomofunctional correlation and I was able to reconstitute a network not just of language, but a network of movement, language, the

motion, cognition, behavior. And the goal now is to predict at the individual level the limitation of interactions between networks telling you during surgery. Now be careful, you have to stop.

Otherwise your patient will keep severe permanent deficit. So I will finish to answer your question by telling for younger surgeons What they have to do, first of all, is to do dissection, of

course. but not only to see the fibers, but the cortical termination. The goal is, of course, for the mosaic of cortical areas in the same and contralateral hemisphere to communicate. So, of

course, to use functional imaging, but not into the operating heather for this patient, because it does that work, but as a didactic tool to build their own multilimetry. And then to use what

happens in 2D or the electrophysiology by doing corticone and axonal stimulation. And, of course, with the neuropsychological,

the transitory does it, okay? A of stimulated the power three of the superior lunges in the fasciculus, so I know exactly what happened. And if you put everything on together, you can predict. I

will show you a very simple example I mean, movement.

I will go to the Dublinist meeting in one month. I will co-organize with Mitch Berger and

Dr. Bime. Of course, dedicated to brain mapping. And I'm sure that in the US, everyone will tell me if the patient is able to do it after surgery, I'm happy. Because he's not a mid-tragic. No,

me, I'm not happy. I want to give them one generation of normal life and we will detail that in another lecture, including sport, creativity, and so on. So if we speak about movement, it could

be, I want to avoid a mid-pleasure. Of course, everyone understood that we have not to cut the pyramidal pathways. You see, if you cut the corticose spinelab track, then the patient will not

recover. Everyone can understand that. So it's true on so-for-the associative pathway Now, you can consider that movement as a surgeon. is more complex because I operated on a lot of surgeons,

maybe a bias of recruitment. And one, what they asked me before surgery is, you think that I really have a chance to return to my work as a new surgeon, as a surgeon. So by manual coordination,

it could be a golf player, it could be a plan of player and so on. We have to understand the functionality I will say it, for younger people, no one knows the functionality. No near a surgeon,

it's pathetic. The first majority of them do, does not know that. The frontal striatum tract, connecting the supplementary model area, the pre-motor cortex to the head of the cudate, when you

stimulate it, you will block movement bilaterally And this is critical because you can decide to induce or not. the supplementary motor area after surgery, according to the wishes of the patient

before surgery. It's a la carte. But speaking about movement, if you want to pray, you need somatosensory feedback. And I know that 99 of your surgeon in the world would have proposed to pray it.

These look great leoma within the so-called right non-dominant parietal lobe under general anesthesia How can you be sure that the patient will not have somatosensory protopatic and

so on and so on, that's it after surgery? You cannot. If the patient is awake, yes, I answer to your question. The patient will tell you a tingling, okay, we'll start. But you need also the

vision field, the right non-dominant hemisphere, okay? But if you get the vision pathway, you will have a left amiennaptia, you cannot drive, you cannot pray it you need on soon. to have

the awareness of the environment. Otherwise, you'll have an immediate neglect. And once again, you cannot play golf or you cannot drive. But you need to continue to be attentive. Exactly what

you are doing now. I'm giving a lot of information. And the goal is to try to maintain this information in your mental inventory in order to manipulate them and finally to have holistic view This is

the principle of connection. The intention, intention of complex action. What you are doing in the morning when you will do a complex surgery or a sportsman before to start to ski in Olympic games.

You imagine in San Antonio, they will speak about I want to avoid any pleasure.

I always speak about to preserve the consciousness of intention, of complex action. We're not speaking about sensing, but to enjoy normal life. You need the good nation and not just the execution

infinite, because of course, if you have preserved the cortical spinal pathway, you will move, but you will not be a surgeon or a piano player to different levels. So I answered your question,

where I stopped, according to the wishes of the patient. And if the patient is telling me before surgery, I would like to continue to be a concertist,

then I will add more sensitivity in my task for complex movement If the patient is telling me I am a mathematician, I need a better cognition. But to be honest, by manual coordination, I do not

share. I can't remove the supplementary motor area and to cut the front of a triathlon tract. And

I know that the patient we have, a post-parative SMA, if we recover, but it will never play violin, high level. But it will continue to be a mathematician. This is the concept of functional

resinction a la carte And they have to answer some questions here.

First,

it sounds like a simple question. How fast have you seen neuroplasticity occur? And

this is general. And I'm sure there may be different answers in regard to functional improvement or change. Is this yours or is it months or is it weeks?

It depends on the natural history of the disease Okay, by asking this question and. I don't know who asked the question, I can understand. We would like to have one answer, unique answer. It

depends on the patient. If the patient has 20, if the patient has a 60, it depends if it's a low grade, a high grade. It depends if the first surgery, a second surgery. It depends if the

patient had radiotherapy before. It depends if the patient is doing seizures, yes, no. I mean, it's a complex equation. Fair, fair answer Next question is when you're preserving these

associative functions. So you're talking about the neurosurgeon that wants to operate. You alter your neuropsychologic testing at surgery to help you define that at surgery. Yes, we will see that

in another talk, how I do it. And of course, I will show how the patient is doing a multi-tasking in real time, not only for movement, but for language too So, cognitive assessment.

And the patient is moving and speaking simultaneously. This is the reason why I know that Prokosirad does not exist. For instance, speaking about speech, because you use this term during your

first question. Speech is underpinned by the frontal aslan tract and the lateral part of the superior longitudinal fasciculus. I can articulate and I can initiate But this is not, I can produce

phonology or repeat. And this is the concept of fat, SLF, and create three fasciculae. And everyone has the feeling that he knows the anatomy, especially of the accurate fasciculus, the most

described fasciculus in human being. You can forget it We published in Brain, just three years ago, the fact that we do not know the function of the anatomy

and especially that there are so few fibres between the pan-supercularies, so-called broker's era, and the posterior part of the superior temporal gyrus, the so-called varnika's era, except in

monkeys, but not in humans. In humans, the vast majority of fibres are running, temporarily speaking, very bizarrely and anteriorly, that means that when you do an anterior temporal lobectomy

nepilepsy surgery, you get the accurate fasciculus, not only semantic ventral pathway, but phonological pathway. Phonological means beyond, of course, speech articulation initiation. But

without semantics, we will understand nothing when speaking about language You understand why I hate the term speech, because normally you should understand what I say and to do. that you need the

inferior frontocipiton fasciculus. And you think we know the anatomy. No, no, no. We published in brain one year ago, the first journal of neurology. The fact that we do not know the functional

anatomy of the ventral semantic pathway involved not only in language, but also in attention, immersion, and so on. So explaining why the patient I showed initially had this kind of problem,

because in fact, it was a convergence of, I thought, a great SLF. fat. And this is the reason why you have seen in the intraoperative view, so many tags in the depth, not just one fiber, four

pathways. And you need to answer the pathway involved in lexical access. That means that if you cut this inferior longitudinal in yellow here.

you can have a compensation by the

inferior fontoxypeton fasciculus. You see, in practice, I did an anterior temporal vector, you can see, in the left. And behind the la bevein, including vernicus area, which does not exist,

it depends on each patient. But the price to pay, now, if you have a diffusion on the preoperative MRI at the level of the pathway,

then how do you want to compensate the ILF through the ILF, if the ILF is already invaded when you will meet the patient for the first time. And I know so many GR surgeons who like to cut the ILF

because there is a tumor, but you will not compensate the ILF, so the patient will be a physics. But if you preserve the ILF, nonetheless, you will have a price to pay an increase of reaction

time. And then I answer your question. Into the world, I also integrate the reaction time. Each patient should do many tasks simultaneously just in five seconds. And I received 1, 000 visitors

coming from 60 countries. And they were very surprised in 99 cases when I say I will stop the rejection now But why? The patient is able to move and to speak. Yes, but now it needs more than five

seconds. So a problem regarding integration between networks. We do not do anything, are you sure? Because if you have an increase of reaction time, you have a decrease, very significant

decrease of the chance to return to work. And if the patient told you before surgery, I want to return to an active life and knowing that the patient will live longer. if it's still important to

work. I will show you that in another talk. So we have to preserve the capacity to return to work. And you think that you can predict that in your answer is yes. So what you're saying really is

we're talking about a dynamic functional, functional anatomy, not structural anatomy, right? Yes. And changing throughout the recession. Right. And as you're going and doing the surgery,

you're constantly assessing it, and it looks like you're accessing it very rapidly, repeating the tasks so that you keep getting this information about the dynamic state of the brain, and that

guides your surgery. Isn't that right?

Exactly. This is the secret. So all patients should be operated on underway mapping, even in the so-called right non-dominant hemisphere. Why? Because we do not know the anatomy. Once again, in

brain, two years ago, we reported, we described a new fasciculus. How do you want for a young year of surgeons to say, I will use the new, what you want at last by your brain lab, metronic, I

do not care, I have not. To put it into the neural navigation system, while they do not know that the underbundance exists and it's critical for lexical access. We are totally blind when we are

under germination. And I re-exist even in the right so-called non-dabenantibispora. And this is why we modeled these interactions. You spoke about not only with mobile language, but also cognition,

but also, That's to conclude if you want this meta-net work.

What do you want to enjoy in my life for 20 years if you are not your self anymore? That's the key. The key is quality of life is what you're talking about, right?

Exactly. I speak about emotion, empathy, mentalizing the ability to return to a familial and social life. And I will show the results. And definitely my patients are living longer than all series

in the world because they are well. And how is it possible to do it because we started to model the connectivity underpinning the empathy. I did that for movement, in front of you, for language.

We did that for cognition and personality. That means that we start to work with psychiatrists because we can start to understand the neural bases underpinning autism So you see far beyond the

surgery of tumor processing. But we changed the personality of some patients after removing a diffuse glioma. No one is interested by that since 30 years. We are just speaking about molecular

biology of the tumor. I do not care because I want for my patients to live longer and better. And it's exactly what we did, including metacognition, the knowledge of what you know. It's very easy

Into the world, you ask to the patient, is it sadness? Is it happiness? Can you evaluate yourself when you give an answer from one? I don't know. You stimulate it and I don't know what means,

the emotion in front of me, to six, I am sure. But you imagine if you say sadness, whatever one happiness, because I stimulate it, especially the right and relate in the non-dominant hemisphere

and the patient is telling six. The patient is still able to move, to speak, but he does not understand, and he's not aware about the fact that he's un-nuzuk-nuzik, so he cannot return to animal

life, while you can take the picture after surgery and the patient is well, not at all. So we need a cognitive assessment during and after surgery to evaluate objectively these kinds of problems

regarding also a right non-dominant hemisphere. You imagine the number of fasciculae. I show it in this slide, especially when you operate within the right stratum sagitale. Who knows that? I am

your navigator. I know where I am, but this is not the goal to know where you are. I know where I am anatomically But functionally, for this brain, in this vision at the time, what we know is.

nothing. So let me stop you for a minute. This is terrific. And give a chance for some people to answer your and ask some questions. A ratio your wife is a neuropsychologist, right?

Yes, she's

right there. Does

this seem extremely important to you? And do you see this in your work? Are functions that need to be preserved?

Yes, of course.

And what he's talking about is intraoperatively assessing these functions in great detail, depending upon the location and the motions and everything else. Does that make sense to you?

only in language. In language we did not

do any operation in surgery in right hemisphere with emotions but it's very interested and I'm asking myself how you do this during the surgery with which

assessment you can you use for this.

We will use but I will detail in another talk the semantic association task. The read the

mind in your task sometimes also reading and writing task combining putting the time pressure once again in

less than five seconds and and so on and so on, but also switching from one language to another one.

For example, I decided approximately 400 milliseconds before to switch that I would like to switch. So I increased my cognitive demand and we are asking that to the multi-lingual patients we have.

So you see, we adapt really according to their needs expectations in order to give them on chances to return to their hobbies. You designed professional life. Yes? Sorry. You designed all. Sorry.

Go ahead. I'm sorry.

No, I was asking if you designed for each patient

the

task. The task you are going to do

And it basically you choose the task. You are not using standard tests or things like that. No, the tasks. standardized, but the combination of selected tasks are specific. Okay, specifically,

to be our self, to be with our behavior, we need many things. We need to do this kind of task because I am a pianist. If you are not, you will not be a bomb. No, of course, because of that, I

was asking you if you designed each task for each patient But once again, I insist not each task, each combination of tasks. Combination of tasks, yes, that combination of tasks. Yes. There's a

question. There's a question. Why would you like to invite young your surgeons to have these kinds of cases of cortical and axonal critical networks. And of course, with a degree of variability In

their montalimetry, for at least. 16 functional domains. My brain is done like this. I have that in my mental imagery when I go pray the brain.

Oh, there's another question. That's a very important area to pursue. Another question, one of the people in the audience said, I operated on a patient with a superior frontal gyrus anterior to

the prefrontal gyrus on the left side The patient became mute for a couple of days, and though I recovered, I could not explain it. It was supposed to be far away from Broca's area. So in other

words, he's talking about what's happening as it related to white matter connections for distal areas.

They said, In fact, you cut the frontal as an tract. You have here the fibers I'm in connecting the supplementary model area. to the inferior contageris and the

premotor ventral cortex. So if you cut it, you will use mutism. The patient will recover, but if we keep some increase of reaction time. So you have to say that before surgery in order for the

patient to decide if it's compatible with its normal life or not. Typically, I will write it on a presenter on TV. And it told me I need, of course, to speak, but also to have a very fluent

language with a very, very short reaction time. I did not care the fact, otherwise, no way for him to continue to be a presenter. So it's really a la carte. And based on the knowledge of the

functionality, I mean, we cannot write a brain if we have not understood why we have SMS and room after removing the SMS. It's not related to the SMA. It's a disconnectionism syndrome.

Here's another associated question that comes up. We see it reported among the pediatric neurosurgeons in posterior fascia tumors, under as you know about this. And cerebellar mutism. Yes, you

have direct connections between the SMA,

the

deep granular cli and the cerebellum, especially the

deep granular cli of the

cerebellum. I will not insist about that because it's a much more important in my experience to apply the

cerebellum because I'm not pediatric neurosurgeon. But we haven't understood these mechanisms, and especially by using pre and

postoperative ephemeri because you can cover a full head. And to see modification in the connectivity, I speak about the functional and effective connectivity before and after surgery. And if you

use resting state, you can also benefit from this functional imagine why the patient is mutic after SMS and room or after removing a cerebellum. And then you will see a recovery of the patient

thanks to a real connectivity, I speak about functions, between the SMA and the cerebellum through the deep grind of client. So we start really to understand mechanisms of neuroplasticity at the

individual level. Excellent, Andres, do you have any thoughts? And then we have another from Said. Andres, any thoughts of yours in addition to what Hughes has said, you've been doing this for

20 years yourself.

I think you're muted,

now we can't hear you, you're muted,

okay

We can't hear

you. Oh, why don't you unmute him? Well, last side, side you wanted to ask your question. Sorry. Okay, Andrew, go ahead. Yeah, thank you very much. No, no, of course we do not have any

remarks. And now I was standing presentations, but I repeat, we will try to the last year to copy Professor Dufor's activities And we were doing little by little more lie in the functional surgery

more than in pictures. I completely agree, we use no navigation and cartography, but telling you the truth because of the brain shift and so on, always we prefer to rely in the function during

awake surgery more than in technology. It's really, really true Said you wanted to say something yes Thank you very much, first, for such a beautiful presentation and eye-opening approach for

neurosurgery. There was a paper, I'm sure you have read and the others have read in 2010, 11, from UC San Francisco with Sana'i and

Mitch Burger that they did the operation of 250 patients, the GBM with cortical recording, they showed that Baroque Center is not always at that area. There are other parts of the cortex on that

side of the brain can take care of the language. I'm sure you have read that with paper and you have seen it. And maybe the case that you represented, you may have some suggestion, maybe Baroque

Center was in another part of the cortex that you could remove, that part of the tumor of the brain. Of course, because I published that as you can see in brain,

12 years ago. with this probabilistic map showing that you have so few language areas at the level of the Passo Percolares and triangularies, but the vast majority is located at the level of the

ventral premotor cortex. So the lateral part of the prefrontal gyrus, so behind the second broker's area, exactly what you have seen on the case report I showed. Plus, of course, the

connectivity at the level of the frontal temporal eye for after eight SLF,

what we have seen. And of course, my goal was not to develop everything today, but the goal is definitely to say that broker's area can be removed. I published that for the first time in your

surgery 22 years ago, and no one would like to believe in it

And I will show you that, unfortunately, it's still true because I would like to conclude by another. case report, 61 year old man retired now, no previous medical history against speech arrest

and so on, normal clinical examination

involving Broca's area and just biopsy was performed in a university hospital in 2025, six months ago, nothing changed because Broca's area, so you cannot remove it, no one is informed about the

function of the brain, they are not brain satter, because of course I removed the tumor, I removed the tumor and the patient is one, because I knew since more than

25 years, so that Broca's area does not exist. Fantastic, and also one comment, if you don't mind, I am sure all of you know about the pediatric epilepsy surgery. When they do complete

hemispheric to me, they had a series of them at UCLA by another neurosurgeon. They recovered, let's say if they do it after before three or four years of age, the other parts of the cortex take

care of the whole movement. They have minimal deficit. And really your point is very, very valid to also understand the plasticity of the brain. Thank you for such a beautiful presentation

This is exactly, finally, what I showed in adults when I spoke about an increase of the size, morphology, and then function in the other hemispheres when you have a look like lemma. This is true

also in adults. And this is what I think is amazing, to my opinion, because in children, I can understand because they continue their development of brain while in adults, everyone will believe

on the fact that our brain is rigid. This is totally untrue. And this is the reason why the second case reporter has shown is, in fact, in more than 60-year-old patients able to compensate workers

there are two. So it's not only in children, it's over life. Thank you, sir. Thank you very much Hey, pleasure. Thank you. I'd say, did you want to finish? Are you here more to do?

Here's, do you want to finish? I think that for the first lecture, we gave enough information regarding these dynamics of the brain and breaking with localizationism, knowing that

I would like to resist on the fact that I say that 25 years ago. And I'm not sure that things changed too much in the meantime, because your surgeons love gadget technology. Imagine.

I'm not kidding. I'm sorry about that, but it will be in another took. But I'm still waiting for their results, regarding the long-term, not only survival, but also quality of life of their

patients. And I will demonstrate you, unfortunately, that technology is helpless in the operating theater, while I was the first to use it outside by doing systematically pre - and post-operative

functional imaging, non-invasively, to track these mechanisms at the individual level of neuroplasticity. And then to use them, to use them, to re-operate the patients a few years later, without

inducing any severe permanent deficit. And these patterns of reorganization after surgery are unique for each patient is a phenomenon. We have one other question here.

Dr. Hawa asks, The tumor we see on images is usually just the tip of the iceberg. He's right. Usually, the whole brain can be diseased. In other words, it's very infiltrative. Is it true that

the connectome-based brain surgery decreases the post-op recurrence rate? I didn't understand that Avast, do you want to tell us what the question is?

Well, thanks for allowing me. Actually, as I said, the

whole brain is diseased. It's not that particular area. By just constantly removing that area, which is shown on the image, can we say that the overall survival is also decreased? I mean, with

the second thing, only that part of the brain. which is involved. Can we expect that our patients will have a 20 years regular sleep survival?

You have the answer in front of you. Show me another paper in the full literature with a survival more than 20 years. It does not exist. So please remove the brain according to the functional

connectome at the individual level and your patience will

be definitely younger. Actually, yeah, this your paper has changed a lot of my concepts.

Initially, I thought that -

Think what you said before, he was answers his question. And that is, if you're in working on a tumor and it's infiltrative, what determines your resection is the functional tracks and the

functional connectivity. not the anatomy. And so you will stop, right? And allow trauma. And then - But anatomy, I know my anatomy. I would say the functional anatomy, of course, the

structure and the function. If you don't know where you are, it will be difficult for you to do a supply elicitation into the contact, for instance, of the surface of the insula. You should know

your anatomy. I showed that I did a lot of dissection by myself on specimen But the function to, otherwise, just a structure means nothing. And if you know both, and you introduce the dynamics,

then you will have this kind of results. If you think about the tumor, you will continue to reproduce the same results, namely in the classical literature, I mean not 20 years ago. But today,

the median survival is around 10 to 15 years, not more than 20 and the quality of life is not evaluated. And you have to get the patient early though, right? In other words, if the tumor is

everywhere and infiltrated, it's much more difficult to achieve that goal, is that true?

Yes, but I wish for that in another talk. We use in this case chemotherapy in order to induce a shrinkage of the diffusion and then to reapprate after new adjuvant chemotherapy of a second or third

surgery. It's exactly what I am doing now with a 25 years after that But not radiotherapy. Otherwise, radiotherapy will burn the connectivity and will limit the mechanisms of your plasticity. But

this will be more detailed in another talk. Well, Dr. Abbas, what he's doing is to remove as much as he can, maintaining the functional status of the brain, he'll leave it. And you correct me

if I'm wrong, Hughes. And then wait until he gets plasticity, for those functions to be transferred elsewhere and go back and re-operate it on. Is that correct? Exactly. Okay. All right. Okay,

I think we've spent a tremendous hour and a half with revolutionary concepts on what to do with these kinds of lesions and what the implications are for brain surgery in the future. I Strada and I've

talked about this and I can't see how you can possibly do brain surgery in the future without incorporating these concepts. I just can't understand that. It just has to be. So all the training

programs are gonna have to change. Maybe I'm wrong, but I don't think so. Horatio, you wanted to say something. Yeah, I have a question. When you have a tumor only in the Broca's area, What do

you do?

I review it. Exactly what I showed in the last slides. I did thus.

I did thus. Sorry? And I had the patient had only a first symptom speech arrest. And after the operation, the patient was a fascic.

Myel the fascic, but he was a fascic. And with - Because you cut the connectivity

You cut the junction, you cut the connectivity in the depth. No, not, not, not, not. You be accurate on SLF. I went not very deep in the progress area. Show me the positive variety of MRI,

and we will discuss on something very, very objective. I will demonstrate to you that you had a problem in the depth. Maybe a vascular problem, I don't know, but maybe very, very small, deep

stroke.

Even in vascular stroke, it has been published in brain, but just three years ago, because I made the comment that after a stroke within so-called brookus area, the patient can recover, except if

there is the age of the connectivity in the depth, including the IFAF running to the Dorsolateron prefrontal cortex. Be careful, sometimes the IFAF can be very superficial Be careful about that. I

have dissected, I have dissected

the tract also. But I'm sure that

I have operated this patient two times. He survived, it was a glagomastoma, plastoma, and he survived three years. And I could operate him another time. And then in the second time, I did a

lesion of a little vessel.

in Broca's area, and the patient was not.

And I have also done a resection in Bernicke's area. The patient was a classic, strong aphacic, and she remained like us.

Of course, if definitely you have a vascular problem, you cannot have only a problem, a stroke, and the living of the cortex, a vascular problem, means in a sense that you have a problem at the

level of the deep, wide matter tracks. And this is the reason why the patient was a phasic. But I will show in the next talk how I do it. I never coagulate in the brain. I will say it again. I

never coagulate in the brain. Only supply elicitation, Even in glioblastoma. And then I have no stroke. These seize the subtract. No correlation. No calculation. No correlation, no microscope.

It's all totally controversial and neurosurgery, but it makes sense. That's the point. And Horatio, what I think we can do in the future is you raised a question, and maybe we'll have on a lot of

another session at the end or in the middle of the hues where people can bring their cases, we can talk about them after you've had a chance to present some of these, okay?

Hey, Peter. So here's, I have a quick before, we're gonna have a question for you. And this is certainly a paradigm shift and I'd widely adapt it as easily shown in your example from your case

for 2025

that was felt to be inoperable, but you later operated on them

The question is, have you had no. You've got a compelling case about the neuroplasticity in patients presenting symptomatically. But have you had observations in which you had cases that were

incidental findings that may have been more at an earlier stage of the glioma development? And have you noticed any differences in the manifestations of neuroplasticity in instances like that? Yes,

it's a very good question And I will speak about that in the third talk about the reasons because I have a subgroup of incidental discovery, but to make a long history short, more you operate

earlier, I mean before symptoms, before seizures, more the brain's plastic, because seizure means that it's a first level of limitation of neuroplasticity So the paradox also. many neurosurgeons

in that they do not want to apply to early in as-and-permodic patients because they say the patients are well but because they are well the brain will compensate the possible mistakes we can do during

surgery and of course the rate of super total precision

is so significantly higher so you increase the quality of life and the median survival by rejecting the tumor earlier This is the reason why I proposed a screening policy in France and it was accepted

by the National Academy of Betsin based on these results because it's full of common sense. Well one more question Jim. Sure go ahead. So here's for places that have limited resources Obviously

they can't allocate the resources for fancy gadgets. They're not men that make a what would you say would be the minimum infrastructure capacity they have to have in place in order to pursue this

approach? I can answer also because I made this kind of surgery in North Africa in Middle East. I will go to Philippines because I trained once again so many colleagues are able to produce these

results with more or less no technology. So my recommendation is first of all for younger people to know the function ahead of me of the brain and to have in their mental imagery. It's not

cost-effective, but it's a lot of work. Second, the grim theme to have the goal of a psychologist, speech therapist, anesthesiologist. Once again, it's not expensive, but it's a lot of

work. So evolved to think too much about intraoperative MRI, brain suite, Robert and so on and so on. It just for fun. It's good for Hollywood, for Brad Pitt, not for New York surgery.

I got an notice from General Electric in their imaging department that they're not gonna talk to us anymore because of your talk. I'm kidding. Okay, you did a phenomenal job, you. So it's very

interesting. I was standing, Dr. Abbas, you asked a lot of good questions and say hello to the Shiers for me, okay, and the horror, okay? And everybody else will come back and we're gonna send

out a questionnaire to everybody, see if we can do this more frequently. It's all up to you, and we wanna get your feedback and we really wanna thank you. I

just try to do you wanna wrap it up and make some final comments? No, well, thanks Jim

Puse, thank you, this was excellent, I think. I think this serves the purpose that we want to simulate this information because as Jim has as well said, this needs to be the future and this needs

more wider adaptation. So thank you very much. I look forward to the ongoing series and we'll be sending the messages out about the date for

the next lecture. Oh, this is the last of the coming lectures, it's a week functional guided surgery, a master class, and how I do it. We want to hear that. Multistage surgical resections,

applying to basic neuroscientists to diffuse glioma, long-term unco-functional results, connect home-based surgery. So I think some of these questions will be answered in the future, redefining

quality of life. Key concept from use, key concept. Insular, low-grade gliomas. What do you do, corpus callosum, a neuroimaging? Why is, hey, what are its limitations? And what can you do

beyond using this for low-grade glioma? What are the surgery, and he'll talk about high-grade gliomas, cavernomas, epilepsy, and some others? So that's the ninth stock, and maybe we'll have

some additional talks. So thank you very much. I think we should have this up on the internet within a few days so everybody else can see it. People on podcast, Ma, might be able to hear all of

the programs are on podcast. We really appreciate it, and thank you very much for everybody, and thank you Hughes for just a phenomenal job. Very well, excellent, thank you. Thank you so much.

And, Mike, thank you very much. Thank you, thank you very much.

Okay, thank you all very much.

I'm glad you brought your wife for Rachel.

Okay, I hope it

was worthwhile. It's mind-changing. It is

absolutely, it changes everybody's concept, which is why we put it on. And I

would like to conclude with you because I think this is the first seminar I'm attending which is very interesting. I mean, the things which we can't understand, you stop the speaker and you ask him

to explain it. And I think this is a very good strategy. Otherwise, in other seminars or in other webinars, people, they are in some rapid race. They want to quickly end the webinar and they

don't care if somebody has understood thing or not, for that I congratulate you.

You're right on target because some of the scientific literature being written now, it says exactly what you said that one way teaching is not effective and that you have to have interchange and you

have to have active participation. You're absolutely right.

Thank you very much. All right, thank you very much. News, thank you very much. We'll probably talk to you soon after we get some information, okay? Okay, my pleasure. Thanks for your support.

No, just terrific, terrific. It's just revolutionary. And just we talked about that a number of times. It is just revolutionary. And that's where we want people to know about it. Okay, thank

you very much. My pleasure. Thank you very much. All right, my Andres, thank you for your help always. You're your first best guy.

I guess name left, okay.

I'm still here.

Did you enjoy that? Very much, very much.

I've got a great privilege to hear the phone, you know, elaborate on all this. Now I can get my colleagues to join because we're doing a great piece and it would be nice for them to participate and

learn from this great person. Thank you. Well, we'll have the videos, but I think the interactive part is really good. I mean, they feel they can,

you know, like Dr. Abbas said, it's more meaningful. Okay. Thank you. Thank you very much

These are some references for Dr. Duvot's

presentation. Take a screenshot for your records.

And this is the first set of references or five references here. Take a screenshot.

The first session in this interview with Dr. DeFoe is on cerebral plasticity, neuromata networks, a necessary step to operate on the brain.

The second is a Wake Functional Guided Surgery, a masterclass on how I do it. The third is a multistage surgical resection, applying basic neurosciences to diffuse glioma The fourth lecture is on

long-term, unco-functional results, connect-on-based surgical resection. Number five is on redefining quality of life and considering cognition, emotion, and behavior.

The sixth lecture and presentation and discussion is on insular low-grade gliomas, specialized awake surgery techniques. Number seven is on corpus corpus callosum glioma, navigating complex

involvement. the eighth is on neuroimaging pitfalls, limitations of imaging in the operating theater. And the last is beyond low grade gliomas where else can this be used? Awake surgery for high

grade glioma cavernoma and epilepsy.

We hope you enjoyed this presentation. The legal disclaimer indicates that the views and opinions expressed in this program are those that the author interviewee and do not necessarily reflect the

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and the foundation supporting all of this work is interested in bringing truthful medical and science news to the world, news that you can depend upon, it's the medical news network. These programs

email address. Thank you. We hope you've enjoyed this program and it's a series of programs.

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

James I. Ausman, MD, MA, PhD

Estrada Bernard, MD

Hugues Duffau, MD, PhD

SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century

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