Briggs Robert G, Allan Parker G, Poologaindran Anujan, Dadario Nicholas B, Young Isabella M, Ahsan Syed A, Teo Charles, Sughrue Michael E
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK.
Cancers (Basel). 2021 Mar 5;13(5):1116. doi: 10.3390/cancers13051116.
Connectomics is the use of big data to map the brain's neural infrastructure; employing such technology to improve surgical planning may improve neuro-oncological outcomes. Supplementary motor area (SMA) syndrome is a well-known complication of medial frontal lobe surgery. The 'localizationist' view posits that damage to the posteromedial bank of the superior frontal gyrus (SFG) is the basis of SMA syndrome. However, surgical experience within the frontal lobe suggests that this is not entirely true. In a study on = 45 patients undergoing frontal lobe glioma surgery, we sought to determine if a 'connectomic' or network-based approach can decrease the likelihood of SMA syndrome. The control group ( = 23) underwent surgery avoiding the posterior bank of the SFG while the treatment group ( = 22) underwent mapping of the SMA network and Frontal Aslant Tract (FAT) using network analysis and DTI tractography. Patient outcomes were assessed post operatively and in subsequent follow-ups. Fewer patients (8.3%) in the treatment group experienced transient SMA syndrome compared to the control group (47%) ( = 0.003). There was no statistically significant difference found between the occurrence of permanent SMA syndrome between control and treatment groups. We demonstrate how utilizing tractography and a network-based approach decreases the likelihood of transient SMA syndrome during medial frontal glioma surgery. We found that not transecting the FAT and the SMA system improved outcomes which may be important for functional outcomes and patient quality of life.
连接组学是利用大数据来绘制大脑的神经结构；运用此类技术改善手术规划可能会提高神经肿瘤学的治疗效果。辅助运动区（SMA）综合征是额叶内侧手术的一种常见并发症。“定位主义”观点认为，额上回（SFG）后内侧缘受损是SMA综合征的基础。然而，额叶手术的经验表明并非完全如此。在一项针对45例接受额叶胶质瘤手术患者的研究中，我们试图确定“连接组学”或基于网络的方法是否能降低SMA综合征的发生可能性。对照组（23例）手术时避开SFG后缘，而治疗组（22例）使用网络分析和弥散张量成像（DTI）纤维束成像技术对SMA网络和额斜束（FAT）进行测绘。术后及后续随访中对患者的治疗效果进行评估。与对照组（47%）相比，治疗组中经历短暂性SMA综合征的患者较少（8.3%）（P = 0.003）。对照组和治疗组之间永久性SMA综合征的发生率没有统计学上的显著差异。我们证明了在额叶内侧胶质瘤手术中，利用纤维束成像和基于网络的方法可降低短暂性SMA综合征的发生可能性。我们发现不横断FAT和SMA系统可改善治疗效果，这对功能预后和患者生活质量可能很重要。
