Özyurt Jale, Müller Hermann L, Warmuth-Metz Monika, Thiel Christiane M
Biological Psychology Lab, Department of Psychology, Faculty of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.
Department of Pediatrics and Pediatric Hematology and Oncology, Klinikum Oldenburg, Medical Campus University Oldenburg, Oldenburg, Germany.
Cortex. 2017 Apr;89:98-110. doi: 10.1016/j.cortex.2017.01.017. Epub 2017 Feb 3.
Patients with hypothalamic involvement of a sellar/parasellar tumor often suffer from cognitive and social-emotional deficits that a lesion in the hypothalamus cannot fully explain. It is conceivable that these deficits are partly due to distal changes in hypothalamic networks, evolving secondary to a focal lesion. Focusing on childhood-onset craniopharyngioma patients, we aimed at investigating the impact of hypothalamic lesions on gray and white matter areas densely connected to the hypothalamus, and to relate structural changes to neuropsychological deficits frequently observed in patients. We performed a voxel-based morphometric analysis based on data of 11 childhood-onset craniopharyngioma patients with hypothalamic tumor involvement, and 18 healthy controls (median age: 17.2 and 17.4 yrs.). Whole-brain analyses were used to test for volumetric differences between the groups (T-tests) and subsequent regression analyses were used to correlate neuropsychological performance with gray and white matter volumes within the patient group. Patients compared to controls had significantly reduced gray matter volumes in areas of the anterior and posterior limbic subsystems which are densely connected with the hypothalamus. In addition, a reduction in white matter volumes was observed in tracts connecting the hypothalamus to other limbic areas. Worse long-term memory retrieval was correlated with smaller gray matter volumes in the posterior cingulate cortex. Our data provide the first evidence that hypothalamic tumor involvement impacts gray and white matter volumes in limbic areas, outside the area of tumor growth. Notably, the functional range of the two limbic subsystems affected, strikingly parallels the two major domains of psychological complaints in patients i.e., deficits in episodic memory and in socio-emotional functioning. We suggest that focal hypothalamic lesions may trigger distal changes in connected brain areas, which then contribute to the impairments in cognitive, social and emotional performance often observable in patients, and not explicable by a hypothalamic lesion alone.
患有鞍区/鞍旁肿瘤且下丘脑受累的患者常常存在认知和社会情感缺陷，而下丘脑的病变无法完全解释这些缺陷。可以想象，这些缺陷部分归因于下丘脑网络的远端变化，这些变化是由局灶性病变继发而来的。以儿童期发病的颅咽管瘤患者为研究对象，我们旨在调查下丘脑病变对与下丘脑紧密相连的灰质和白质区域的影响，并将结构变化与患者中经常观察到的神经心理缺陷联系起来。我们基于11例患有下丘脑肿瘤受累的儿童期发病颅咽管瘤患者和18名健康对照者（中位年龄：17.2岁和17.4岁）的数据进行了基于体素的形态学分析。采用全脑分析来检验两组之间的体积差异（T检验），随后进行回归分析以将神经心理表现与患者组内的灰质和白质体积相关联。与对照组相比，患者在前、后边缘子系统中与下丘脑紧密相连的区域灰质体积显著减少。此外，在下丘脑与其他边缘区域相连的神经束中观察到白质体积减少。较差的长期记忆提取与后扣带回皮质较小的灰质体积相关。我们的数据首次证明下丘脑肿瘤受累会影响肿瘤生长区域之外的边缘区域的灰质和白质体积。值得注意的是，受影响的两个边缘子系统的功能范围与患者心理主诉的两个主要领域惊人地相似，即情景记忆缺陷和社会情感功能缺陷。我们认为局灶性下丘脑病变可能会引发相连脑区的远端变化，进而导致患者中经常观察到的认知、社会和情感表现受损，而这些仅由下丘脑病变无法解释。
