Incontinence after brain glioma surgery: new insights into the cortical control of micturition and continence

Case report

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✓ Cortical control of micturition and continence remains poorly understood. The authors report two cases of patients who presented with prolonged urinary disturbances after resection of a brain glioma. Accurate anatomofunctional correlations determined using postoperative magnetic resonance imaging support the following: 1) the implication of the posterior portion of the right anterior cingulate gyrus in the perception of bladder sensation and maintenance of continence; 2) the involvement of the right anterior insula in bladder relaxation; and 3) the role of the right inferior frontal cortex in the decision concerning whether to initiate a micturition. On the basis of these results, a preliminary model of a cortical network associated with micturition and continence is proposed.

Article Information

Address reprint requests to: Hugues Duffau, M.D., Ph.D., Department of Neurosurgery, Hôpital Salpêtrière, 47–83 Boulevard de l' hôpital, 75651 Paris, Cedex 13, France. email: hugues.duffau@psl.ap-hop-paris.fr.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Sagittal contrast-enhanced T1-weighted MR images obtained before (left) and after (right) resection of a low-grade glioma on the right side involving the SMA and the posterior portion of the ACG.

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    Axial contrast-enhanced T1-weighted MR images obtained before (left) and after (right) resection of a low-grade glioma on the right side involving the IFG and the anterior insula.

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    Scheme demonstrating the cortical control of micturition and continence.

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