Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Neurosurgery. 2021 Feb 16;88(3):544-551. doi: 10.1093/neuros/nyaa453.
BACKGROUND: Decline in neurocognitive functioning (NCF) often occurs following brain tumor resection. Functional connectomics have shown how neurologic insults disrupt cerebral networks underlying NCF, though studies involving patients with brain tumors are lacking. OBJECTIVE: To investigate the impact of brain tumor resection upon the connectome and relationships with NCF outcome in the early postoperative period. METHODS: A total of 15 right-handed adults with left perisylvian glioma underwent resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological assessment before and after awake tumor resection. Graph theoretical analysis was applied to rs-fMRI connectivity matrices to calculate network properties. Network properties and NCF measures were compared across the pre- to postoperative periods with matched pairs Wilcoxon signed-rank tests. Associations between pre- to postoperative change in network and NCF measures were determined with Spearman rank-order correlations (ρ). RESULTS: A majority of the sample showed postoperative decline on 1 or more NCF measures. Significant postoperative NCF decline was found across measures of verbal memory, processing speed, executive functioning, receptive language, and a composite index. Regarding connectomic properties, betweenness centrality and assortativity were significantly smaller postoperatively, and reductions in these measures were associated with better NCF outcomes. Significant inverse associations (ρ = -.51 to -.78, all P < .05) were observed between change in language, executive functioning, and learning and memory, and alterations in segregation, centrality, and resilience network properties. CONCLUSION: Decline in NCF was common shortly following resection of glioma involving eloquent brain regions, most frequently in verbal learning/memory and executive functioning. Better postoperative outcomes accompanied reductions in centrality and resilience connectomic measures.
背景:神经认知功能(NCF)下降通常发生在脑肿瘤切除术后。功能连接组学已经展示了神经损伤如何破坏 NCF 相关的大脑网络,但缺乏涉及脑肿瘤患者的研究。 目的:研究脑肿瘤切除对连接组的影响,并在术后早期研究其与 NCF 结果的关系。 方法:共 15 名右利手左大脑语言区胶质瘤患者在清醒开颅肿瘤切除术前和术后接受静息态功能磁共振成像(rs-fMRI)和神经心理学评估。对 rs-fMRI 连接矩阵进行图论分析,以计算网络特性。采用配对样本 Wilcoxon 符号秩检验比较术前至术后各网络特性和 NCF 指标的变化。采用 Spearman 等级相关系数(ρ)确定术前至术后网络和 NCF 指标变化之间的相关性。 结果:大多数患者在 1 项或多项 NCF 指标上表现出术后下降。多项 NCF 指标,包括言语记忆、加工速度、执行功能、接受性语言和综合指数,均发现显著的术后下降。在连接组特性方面,术后的介数中心度和聚类系数显著降低,这些指标的降低与更好的 NCF 结果相关。语言、执行功能和学习记忆的变化与分离、中心度和弹性网络特性的改变之间存在显著的负相关(ρ=-.51 至-.78,均 P<.05)。 结论:涉及语言区的脑胶质瘤切除术后,NCF 下降较为常见,言语学习/记忆和执行功能最常受到影响。术后中心度和弹性连接组学指标降低,预示着更好的预后。
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