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Yueh-Hsin L, Dadario NB, Tang SJ, Crawford L, Tanglay O, Dow HK, Young I, Ahsan SA, Doyen S, Sughrue ME. Discernible interindividual patterns of global efficiency decline during theoretical brain surgery. Sci Rep 2024; 14:14573. [PMID: 38914649 PMCID: PMC11196730 DOI: 10.1038/s41598-024-64845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 06/13/2024] [Indexed: 06/26/2024] Open
Abstract
The concept of functional localization within the brain and the associated risk of resecting these areas during removal of infiltrating tumors, such as diffuse gliomas, are well established in neurosurgery. Global efficiency (GE) is a graph theory concept that can be used to simulate connectome disruption following tumor resection. Structural connectivity graphs were created from diffusion tractography obtained from the brains of 80 healthy adults. These graphs were then used to simulate parcellation resection in every gross anatomical region of the cerebrum by identifying every possible combination of adjacent nodes in a graph and then measuring the drop in GE following nodal deletion. Progressive removal of brain parcellations led to patterns of GE decline that were reasonably predictable but had inter-subject differences. Additionally, as expected, there were deletion of some nodes that were worse than others. However, in each lobe examined in every subject, some deletion combinations were worse for GE than removing a greater number of nodes in a different region of the brain. Among certain patients, patterns of common nodes which exhibited worst GE upon removal were identified as "connectotypes". Given some evidence in the literature linking GE to certain aspects of neuro-cognitive abilities, investigating these connectotypes could potentially mitigate the impact of brain surgery on cognition.
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Affiliation(s)
- Lin Yueh-Hsin
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 19, Level 7 Prince of Wales Private Hospital, Randwick, Sydney, NSW, 2031, Australia
| | - Nicholas B Dadario
- Robert Wood Johnson Medical School, Rutgers University, 125 Paterson St, New Brunswick, NJ, 08901, USA
| | - Si Jie Tang
- School of Medicine, 21772 University of California Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Lewis Crawford
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia
| | - Onur Tanglay
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia
| | - Hsu-Kang Dow
- School of Computer Science and Engineering, University of New South Wales (UNSW), Building K17, Sydney, NSW, 2052, USA
| | - Isabella Young
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia
| | - Syed Ali Ahsan
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 19, Level 7 Prince of Wales Private Hospital, Randwick, Sydney, NSW, 2031, Australia
| | - Stephane Doyen
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia
| | - Michael E Sughrue
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 19, Level 7 Prince of Wales Private Hospital, Randwick, Sydney, NSW, 2031, Australia.
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia.
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 3, Level 7 Barker St, Randwick, NSW, 2031, USA.
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Lei Y, Zhang X, Ni W, Gao C, Li Y, Yang H, Gao X, Xia D, Zhang X, Osipowicz K, Doyen S, Sughrue ME, Gu Y, Mao Y. Application of individual brain connectome in chronic ischemia: mapping symptoms before and after reperfusion. MedComm (Beijing) 2024; 5:e585. [PMID: 38832213 PMCID: PMC11144839 DOI: 10.1002/mco2.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 04/06/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
How brain functions in the distorted ischemic state before and after reperfusion is unclear. It is also uncertain whether there are any indicators within ischemic brain that could predict surgical outcomes. To alleviate these issues, we applied individual brain connectome in chronic steno-occlusive vasculopathy (CSOV) to map both ischemic symptoms and their postbypass changes. A total of 499 bypasses in 455 CSOV patients were collected and followed up for 47.8 ± 20.5 months. Using multimodal parcellation with connectivity-based and pathological distortion-independent approach, areal MR features of brain connectome were generated with three measurements of functional connectivity (FC), structural connectivity, and PageRank centrality at the single-subject level. Thirty-three machine-learning models were then trained with clinical and areal MR features to obtain acceptable classifiers for both ischemic symptoms and their postbypass changes, among which, 11 were deemed acceptable (AUC > 0.7). Notably, the FC feature-based model for long-term neurological outcomes performed very well (AUC > 0.8). Finally, a Shapley additive explanations plot was adopted to extract important individual features in acceptable models to generate "fingerprints" of brain connectome. This study not only establishes brain connectomic fingerprint databases for brain ischemia with distortion, but also provides informative insights for how brain functions before and after reperfusion.
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Gou C, Yang S, Hou Q, Rudder P, Tanglay O, Young I, Peng T, He W, Yang L, Osipowicz K, Doyen S, Mansouri N, Sughrue ME, Wang X. Functional connectivity of the language area in migraine: a preliminary classification model. BMC Neurol 2023; 23:142. [PMID: 37016325 PMCID: PMC10071619 DOI: 10.1186/s12883-023-03183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/25/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Migraine is a complex disorder characterized by debilitating headaches. Despite its prevalence, its pathophysiology remains unknown, with subsequent gaps in diagnosis and treatment. We combined machine learning with connectivity analysis and applied a whole-brain network approach to identify potential targets for migraine diagnosis and treatment. METHODS Baseline anatomical T1 magnetic resonance imaging (MRI), resting-state functional MRI(rfMRI), and diffusion weighted scans were obtained from 31 patients with migraine, and 17 controls. A recently developed machine learning technique, Hollow Tree Super (HoTS) was used to classify subjects into diagnostic groups based on functional connectivity (FC) and derive networks and parcels contributing to the model. PageRank centrality analysis was also performed on the structural connectome to identify changes in hubness. RESULTS Our model attained an area under the receiver operating characteristic curve (AUC-ROC) of 0.68, which rose to 0.86 following hyperparameter tuning. FC of the language network was most predictive of the model's classification, though patients with migraine also demonstrated differences in the accessory language, visual and medial temporal regions. Several analogous regions in the right hemisphere demonstrated changes in PageRank centrality, suggesting possible compensation. CONCLUSIONS Although our small sample size demands caution, our preliminary findings demonstrate the utility of our method in providing a network-based perspective to diagnosis and treatment of migraine.
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Affiliation(s)
- Chen Gou
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Shuangfeng Yang
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Qianmei Hou
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Peter Rudder
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | - Onur Tanglay
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | - Isabella Young
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | - Tingting Peng
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Weiwei He
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Liuyi Yang
- Shenzhen Xijia Medical Technology Company, Shenzhen, Guangdong Province, 518052, China
| | | | - Stephane Doyen
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | - Negar Mansouri
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | | | - Xiaoming Wang
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China.
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Tanglay O, Dadario NB, Chong EHN, Tang SJ, Young IM, Sughrue ME. Graph Theory Measures and Their Application to Neurosurgical Eloquence. Cancers (Basel) 2023; 15:556. [PMID: 36672504 PMCID: PMC9857081 DOI: 10.3390/cancers15020556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Improving patient safety and preserving eloquent brain are crucial in neurosurgery. Since there is significant clinical variability in post-operative lesions suffered by patients who undergo surgery in the same areas deemed compensable, there is an unknown degree of inter-individual variability in brain 'eloquence'. Advances in connectomic mapping efforts through diffusion tractography allow for utilization of non-invasive imaging and statistical modeling to graphically represent the brain. Extending the definition of brain eloquence to graph theory measures of hubness and centrality may help to improve our understanding of individual variability in brain eloquence and lesion responses. While functional deficits cannot be immediately determined intra-operatively, there has been potential shown by emerging technologies in mapping of hub nodes as an add-on to existing surgical navigation modalities to improve individual surgical outcomes. This review aims to outline and review current research surrounding novel graph theoretical concepts of hubness, centrality, and eloquence and specifically its relevance to brain mapping for pre-operative planning and intra-operative navigation in neurosurgery.
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Affiliation(s)
- Onur Tanglay
- UNSW School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW 2000, Australia
| | - Nicholas B. Dadario
- Robert Wood Johnson Medical School, Rutgers University, 125 Paterson St, New Brunswick, NJ 08901, USA
| | - Elizabeth H. N. Chong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Si Jie Tang
- School of Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Isabella M. Young
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW 2000, Australia
| | - Michael E. Sughrue
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW 2000, Australia
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Neurosurgical Clinical Trials for Glioblastoma: Current and Future Directions. Brain Sci 2022; 12:brainsci12060787. [PMID: 35741672 PMCID: PMC9221299 DOI: 10.3390/brainsci12060787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023] Open
Abstract
The mainstays of glioblastoma treatment, maximal safe resection, radiotherapy preserving neurological function, and temozolomide (TMZ) chemotherapy have not changed for the past 17 years despite significant advances in the understanding of the genetics and molecular biology of glioblastoma. This review highlights the neurosurgical foundation for glioblastoma therapy. Here, we review the neurosurgeon’s role in several new and clinically-approved treatments for glioblastoma. We describe delivery techniques such as blood–brain barrier disruption and convection-enhanced delivery (CED) that may be used to deliver therapeutic agents to tumor tissue in higher concentrations than oral or intravenous delivery. We mention pivotal clinical trials of immunotherapy for glioblastoma and explain their outcomes. Finally, we take a glimpse at ongoing clinical trials and promising translational studies to predict ways that new therapies may improve the prognosis of patients with glioblastoma.
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Dadario NB, Sughrue ME. Should Neurosurgeons Try to Preserve Non-Traditional Brain Networks? A Systematic Review of the Neuroscientific Evidence. J Pers Med 2022; 12:jpm12040587. [PMID: 35455703 PMCID: PMC9029431 DOI: 10.3390/jpm12040587] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 12/25/2022] Open
Abstract
The importance of large-scale brain networks in higher-order human functioning is well established in neuroscience, but has yet to deeply penetrate neurosurgical thinking due to concerns of clinical relevance. Here, we conducted the first systematic review examining the clinical importance of non-traditional, large-scale brain networks, including the default mode (DMN), central executive (CEN), salience (SN), dorsal attention (DAN), and ventral attention (VAN) networks. Studies which reported evidence of neurologic, cognitive, or emotional deficits in relation to damage or dysfunction in these networks were included. We screened 22,697 articles on PubMed, and 551 full-text articles were included and examined. Cognitive deficits were the most common symptom of network disturbances in varying amounts (36–56%), most frequently related to disruption of the DMN (n = 213) or some combination of DMN, CEN, and SN networks (n = 182). An increased proportion of motor symptoms was seen with CEN disruption (12%), and emotional (35%) or language/speech deficits (24%) with SN disruption. Disruption of the attention networks (VAN/DAN) with each other or the other networks mostly led to cognitive deficits (56%). A large body of evidence is available demonstrating the clinical importance of non-traditional, large-scale brain networks and suggests the need to preserve these networks is relevant for neurosurgical patients.
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Affiliation(s)
- Nicholas B. Dadario
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Michael E. Sughrue
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
- Omniscient Neurotechnology, Sydney, NSW 2000, Australia
- Correspondence:
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