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Stålnacke M, Eriksson J, Salami A, Andersson M, Nyberg L, Sjöberg RL. Functional connectivity of sensorimotor network before and after surgery in the supplementary motor area. Neuropsychologia 2024; 204:109004. [PMID: 39299453 DOI: 10.1016/j.neuropsychologia.2024.109004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/13/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
After resective glioma surgery in the Supplementary Motor Area (SMA), patients often experience a transient disturbance of the ability to initiate speech and voluntary motor actions, known as the SMA syndrome (SMAS). It has been proposed that enhanced interhemispheric functional connectivity (FC) within the sensorimotor system may serve as a potential mechanism for recovery, enabling the non-resected SMA to assume the function of the resected region. The purpose of the present study was to investigate the extent to which changes in FC can be observed in patients after resolution of the SMAS. Eight patients underwent resection of left SMA due to suspected gliomas, resulting in various levels of the SMA syndrome. Resting-state functional MR images were acquired prior to the surgery and after resolution of the syndrome. At the group level we found an increased connectivity between the unaffected (right) SMA and the primary motor cortex on the same side following surgery. However, no significant increase in interhemispheric connectivity was observed. These findings challenge the prevailing notion that increased interhemispheric FC serves as the only mechanism underlying recovery from SMA syndrome and suggest the presence of one or more alternative mechanisms.
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Affiliation(s)
| | - Johan Eriksson
- Department of Medical and Translational Biology, Umeå University, Sweden; Umeå Center for Functional Brain Imaging, Umeå University, Sweden
| | - Alireza Salami
- Department of Medical and Translational Biology, Umeå University, Sweden; Umeå Center for Functional Brain Imaging, Umeå University, Sweden; Aging Research Center, Karolinska Institutet & Stockholm University, Sweden; Wallenberg Center for Molecular Medicine (WCMM), Umeå University, Sweden
| | - Micael Andersson
- Department of Medical and Translational Biology, Umeå University, Sweden; Umeå Center for Functional Brain Imaging, Umeå University, Sweden
| | - Lars Nyberg
- Department of Medical and Translational Biology, Umeå University, Sweden; Umeå Center for Functional Brain Imaging, Umeå University, Sweden; Department of Diagnostics and Intervention, Umeå University, Sweden
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Herbet G, Duffau H, Mandonnet E. Predictors of cognition after glioma surgery: connectotomy, structure-function phenotype, plasticity. Brain 2024; 147:2621-2635. [PMID: 38573324 DOI: 10.1093/brain/awae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/19/2024] [Accepted: 03/09/2024] [Indexed: 04/05/2024] Open
Abstract
Determining preoperatively the maximal extent of resection that would preserve cognitive functions is the core challenge of brain tumour surgery. Over the past decade, the methodological framework to achieve this goal has been thoroughly renewed: the population-level topographically-focused voxel-based lesion-symptom mapping has been progressively overshadowed by machine learning (ML) algorithmics, in which the problem is framed as predicting cognitive outcomes in a patient-specific manner from a typically large set of variables. However, the choice of these predictors is of utmost importance, as they should be both informative and parsimonious. In this perspective, we first introduce the concept of connectotomy: instead of parameterizing resection topography through the status (intact/resected) of a huge number of voxels (or parcels) paving the whole brain in the Cartesian 3D-space, the connectotomy models the resection in the connectivity space, by computing a handful number of networks disconnection indices, measuring how the structural connectivity sustaining each network of interest was hit by the resection. This connectivity-informed reduction of dimensionality is a necessary step for efficiently implementing ML tools, given the relatively small number of patient-examples in available training datasets. We further argue that two other major sources of interindividual variability must be considered to improve the accuracy with which outcomes are predicted: the underlying structure-function phenotype and neuroplasticity, for which we provide an in-depth review and propose new ways of determining relevant predictors. We finally discuss the benefits of our approach for precision surgery of glioma.
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Affiliation(s)
- Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier 34090, France
- Praxiling lab, UMR5267 CNRS & Paul Valéry University, Montpellier 34090, France
- Department of Medicine, University of Montpellier, Montpellier 34090, France
- Institut Universitaire de France, Paris 75000, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier 34090, France
- Department of Medicine, University of Montpellier, Montpellier 34090, France
- Team 'Plasticity of Central Nervous System, Stem Cells and Glial Tumors', U1191 Laboratory, Institute of Functional Genomics, National Institute for Health and Medical Research (INSERM), University of Montpellier, Montpellier 34000, France
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, Paris 75010, France
- Frontlab, CNRS UMR 7225, INSERM U1127, Paris Brain Institute (ICM), Paris 75013, France
- Université de Paris Cité, UFR de médecine, Paris 75005, France
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Maurer S, Butenschoen VM, Kelm A, Schramm S, Schröder A, Meyer B, Krieg SM. Permanent deterioration of fine motor skills after the resection of tumors in the supplementary motor area. Neurosurg Rev 2024; 47:114. [PMID: 38480549 PMCID: PMC10937754 DOI: 10.1007/s10143-024-02330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
Supplementary motor area syndrome (SMAS) represents a common neurosurgical sequela. The incidence and time frame of its occurrence have yet to be characterized after surgery for brain tumors. We examined patients suffering from a brain tumor preoperatively, postoperatively, and during follow-up examinations after three months, including fine motor skills testing and transcranial magnetic stimulation (TMS). 13 patients suffering from a tumor in the dorsal part of the superior frontal gyrus underwent preoperative, early postoperative, and 3-month follow-up testing of fine motor skills using the Jebsen-Taylor Hand Function Test (JHFT) and the Nine-Hole Peg Test (NHPT) consisting of 8 subtests for both upper extremities. They completed TMS for cortical motor function mapping. Test completion times (TCTs) were recorded and compared. No patient suffered from neurological deficits before surgery. On postoperative day one, we detected motor deficits in two patients, which remained clinically stable at a 3-month follow-up. Except for page-turning, every subtest indicated a significant worsening of function, reflected by longer TCTs (p < 0.05) in the postoperative examinations for the contralateral upper extremity (contralateral to the tumor manifestation). At 3-month follow-up examinations for the contralateral upper extremity, each subtest indicated significant worsening compared to the preoperative status despite improvement to the immediate postoperative level. We also detected significantly longer TCTs (p < 0.05) postoperatively in the ipsilateral upper extremity. This study suggests a long-term worsening of fine motor skills even three months after SMA tumor resection, indicating the necessity of targeted physical therapy for these patients.
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Affiliation(s)
- Stefanie Maurer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Vicki M Butenschoen
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Anna Kelm
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Severin Schramm
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Axel Schröder
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
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Voets NL, Bartsch AJ, Plaha P. Functional MRI applications for intra-axial brain tumours: uses and nuances in surgical practise. Br J Neurosurg 2023; 37:1544-1559. [PMID: 36148501 DOI: 10.1080/02688697.2022.2123893] [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: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Functional MRI (fMRI) has well-established uses to inform risks and plan maximally safe approaches in neurosurgery. In the field of brain tumour surgery, however, fMRI is currently in a state of clinical equipoise due to debate around both its sensitivity and specificity. MATERIALS AND METHODS In this review, we summarise the role and our experience of fMRI in neurosurgery for gliomas and metastases. We discuss nuances in the conduct and interpretation of fMRI that, based on our practise, most directly impact fMRI's usefulness in the neurosurgical setting. RESULTS Illustrated examples in which fMRI in our hands directly influences the neurosurgical treatment of brain tumours include evaluating the probability and nature of functional risks, especially for language functions. These presurgical risk assessments, in turn, help to predict the resectability of tumours, select or deselect patients for awake surgery, indicate the need for neurophysiological monitoring and guide the optimal use of intra-operative stimulation mapping. A further emerging application of fMRI is in measuring functional adaptation of functional networks after (partial) surgery, of potential use in the timing of further surgery. CONCLUSIONS In appropriately selected patients with a clearly defined surgical question, fMRI offers a valuable complementary tool in the pre-surgical evaluation of brain tumours. However, there is a great need for standards in the administration and analysis of fMRI as much as in the techniques that it is commonly evaluated against. Surprisingly little data exists that evaluates the accuracy of fMRI not just against complementary methods, but in terms of its ultimate clinical aim of minimising post-surgical morbidity.
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Affiliation(s)
- Natalie L Voets
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- GenesisCare Ltd, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Neurosurgery, University of Oxford, Oxford, UK
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Pasquini L, Peck KK, Jenabi M, Holodny A. Functional MRI in Neuro-Oncology: State of the Art and Future Directions. Radiology 2023; 308:e222028. [PMID: 37668519 PMCID: PMC10546288 DOI: 10.1148/radiol.222028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 09/06/2023]
Abstract
Since its discovery in the early 1990s, functional MRI (fMRI) has been used to study human brain function. One well-established application of fMRI in the clinical setting is the neurosurgical planning of patients with brain tumors near eloquent cortical areas. Clinical fMRI aims to preoperatively identify eloquent cortices that serve essential functions in daily life, such as hand movement and language. The primary goal of neurosurgery is to maximize tumor resection while sparing eloquent cortices adjacent to the tumor. When a lesion presents in the vicinity of an eloquent cortex, surgeons may use fMRI to plan their best surgical approach by determining the proximity of the lesion to regions of activation, providing guidance for awake brain surgery and intraoperative brain mapping. The acquisition of fMRI requires patient preparation prior to imaging, determination of functional paradigms, monitoring of patient performance, and both processing and analysis of images. Interpretation of fMRI maps requires a strong understanding of functional neuroanatomy and familiarity with the technical limitations frequently present in brain tumor imaging, including neurovascular uncoupling, patient compliance, and data analysis. This review discusses clinical fMRI in neuro-oncology, relevant ongoing research topics, and prospective future developments in this exciting discipline.
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Affiliation(s)
- Luca Pasquini
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Kyung K. Peck
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Mehrnaz Jenabi
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Andrei Holodny
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
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Boerger TF, Pahapill P, Butts AM, Arocho-Quinones E, Raghavan M, Krucoff MO. Large-scale brain networks and intra-axial tumor surgery: a narrative review of functional mapping techniques, critical needs, and scientific opportunities. Front Hum Neurosci 2023; 17:1170419. [PMID: 37520929 PMCID: PMC10372448 DOI: 10.3389/fnhum.2023.1170419] [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: 02/20/2023] [Accepted: 05/16/2023] [Indexed: 08/01/2023] Open
Abstract
In recent years, a paradigm shift in neuroscience has been occurring from "localizationism," or the idea that the brain is organized into separately functioning modules, toward "connectomics," or the idea that interconnected nodes form networks as the underlying substrates of behavior and thought. Accordingly, our understanding of mechanisms of neurological function, dysfunction, and recovery has evolved to include connections, disconnections, and reconnections. Brain tumors provide a unique opportunity to probe large-scale neural networks with focal and sometimes reversible lesions, allowing neuroscientists the unique opportunity to directly test newly formed hypotheses about underlying brain structural-functional relationships and network properties. Moreover, if a more complete model of neurological dysfunction is to be defined as a "disconnectome," potential avenues for recovery might be mapped through a "reconnectome." Such insight may open the door to novel therapeutic approaches where previous attempts have failed. In this review, we briefly delve into the most clinically relevant neural networks and brain mapping techniques, and we examine how they are being applied to modern neurosurgical brain tumor practices. We then explore how brain tumors might teach us more about mechanisms of global brain dysfunction and recovery through pre- and postoperative longitudinal connectomic and behavioral analyses.
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Affiliation(s)
- Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Peter Pahapill
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Alissa M. Butts
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
- Mayo Clinic, Rochester, MN, United States
| | - Elsa Arocho-Quinones
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Max O. Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, Milwaukee, WI, United States
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Engelhardt M, Kern G, Karhu J, Picht T. Protocol for mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation. Front Neurosci 2023; 17:1185483. [PMID: 37332876 PMCID: PMC10272366 DOI: 10.3389/fnins.2023.1185483] [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: 03/13/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Background Damage to the supplementary motor area (SMA) can lead to impairments of motor and language function. A detailed preoperative mapping of functional boarders of the SMA could therefore aid preoperative diagnostics in these patients. Objective The aim of this study was the development of a repetitive nTMS protocol for non-invasive functional mapping of the SMA while assuring effects are caused by SMA rather than M1 activation. Methods The SMA in the dominant hemisphere of 12 healthy subjects (28.2 ± 7.7 years, 6 females) was mapped using repetitive nTMS at 20 Hz (120% RMT), while subjects performed a finger tapping task. Reductions in finger taps were classified in three error categories (≤15% = no errors, 15-30% = mild, >30% significant). The location and category of induced errors was marked in each subject's individual MRI. Effects of SMA stimulation were then directly compared to effects of M1 stimulation in four different tasks (finger tapping, writing, line tracing, targeting circles). Results Mapping of the SMA was possible for all subjects, yet effect sizes varied. Stimulation of the SMA led to a significant reduction of finger taps compared to baseline (BL: 45taps, SMA: 35.5taps; p < 0.01). Line tracing, writing and targeting of circles was less accurate during SMA compared to M1 stimulation. Conclusion Mapping of the SMA using repetitive nTMS is feasible. While errors induced in the SMA are not entirely independent of M1, disruption of the SMA induces functionally distinct errors. These error maps can aid preoperative diagnostics in patients with SMA related lesions.
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Affiliation(s)
- Melina Engelhardt
- Department of Neurosurgery, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- International Graduate Program Medical Neurosciences, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Giulia Kern
- Department of Neurosurgery, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jari Karhu
- Department of Physiology, University of Eastern Finland, Kuopio, Finland
| | - Thomas Picht
- Department of Neurosurgery, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Cluster of Excellence Matters of Activity, Image Space Material, Humboldt-Universität zu Berlin, Berlin, Germany
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Manso-Ortega L, De Frutos-Sagastuy L, Gisbert- Muñoz S, Salamon N, Qiao J, Walshaw P, Quiñones I, Połczyńska MM. Grey matter reshaping of language-related regions depends on tumor lateralization. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.02.526219. [PMID: 36778417 PMCID: PMC9915653 DOI: 10.1101/2023.02.02.526219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A brain tumor in the left hemisphere can decrease language laterality as assessed with fMRI. However, it remains unclear whether or not this decreased language laterality is associated with a structural reshaping of the grey matter, particularly within the language network. Here, we examine if the disruption of language hubs exclusively affects macrostructural properties of contralateral homologues (as suggested by previous research), or whether it affects both hemispheres. This study uses voxel-based morphometry applied to high-resolution MR T1-weighted MPRAGE images from 31 adult patients left-dominant for language. Eighteen patients had brain tumors in the left hemisphere, and 13 had tumors in the right hemisphere. A cohort of 71 healthy individuals matched on age and sex was used as a baseline. We defined 10 ROIs per hemisphere known to subserve language function. Two separate repeated-measures ANOVAs were conducted with the volume per region as the dependent variables. For the patients, tumor lateralization (right versus left) served as a between-subject factor. The current study demonstrated that the presence of a brain tumor generates a global volumetric change affecting left language regions and their contralateral homologues. These changes are mediated by the lateralization of the lesion. Our findings suggest that compensatory functional mechanisms are supported by the rearrangement of the grey matter, although future longitudinal research should determine the temporal course of such changes.
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Affiliation(s)
- Lucia Manso-Ortega
- Basque Center on Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
- University of the Basque Country, Bilbao, Spain
| | | | - Sandra Gisbert- Muñoz
- Basque Center on Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
- University of the Basque Country, Bilbao, Spain
| | - Noriko Salamon
- Dept. of Radiology, University of California, Los Angeles, USA
| | - Joe Qiao
- Dept. of Radiology, University of California, Los Angeles, USA
| | - Patricia Walshaw
- Dept. of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Ileana Quiñones
- Basque Center on Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
| | - Monika M. Połczyńska
- Dept. of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
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Relationship among Connectivity of the Frontal Aslant Tract, Executive Functions, and Speech and Language Impairment in Children with Childhood Apraxia of Speech. Brain Sci 2022; 13:brainsci13010078. [PMID: 36672059 PMCID: PMC9856897 DOI: 10.3390/brainsci13010078] [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: 11/23/2022] [Revised: 12/16/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
Childhood apraxia of speech (CAS) is a subtype of motor speech disorder usually co-occurring with language impairment. A supramodal processing difficulty, involving executive functions (EFs), might contribute to the cognitive endophenotypes and behavioral manifestations. The present study aimed to profile the EFs in CAS, investigating the relationship between EFs, speech and language severity, and the connectivity of the frontal aslant tract (FAT), a white matter tract involved in both speech and EFs. A total of 30 preschool children with CAS underwent speech, language, and EF assessments and brain MRIs. Their FAT connectivity metrics were compared to those of 30 children without other neurodevelopmental disorders (NoNDs), who also underwent brain MRIs. Alterations in some basic EF components were found. Inhibition and working memory correlated with speech and language severity. Compared to NoND children, a weak, significant reduction in fractional anisotropy (FA) in the left presupplementary motor area (preSMA) FAT component was found. Only speech severity correlated and predicted FA values along with the FAT in both of its components, and visual-spatial working memory moderated the relationship between speech severity and FA in the left SMA. Our study supports the conceptualization of a composite and complex picture of CAS, not limited to the speech core deficit, but also involving high-order cognitive skills.
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Quinones A, Jenabi M, Pasquini L, Peck KK, Moss NS, Brennan C, Tabar V, Holodny A. Use of longitudinal functional MRI to demonstrate translocation of language function in patients with brain tumors. J Neurosurg 2022:1-9. [DOI: 10.3171/2022.10.jns221212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE
The ability of functional MRI (fMRI) to localize patient-specific eloquent areas has proved worthwhile in efforts to maximize resection while minimizing risk of iatrogenic damage in patients with brain tumors. Although cortical reorganization has been described, the frequency of its occurrence and the factors that influence incidence are not well understood. The authors investigated changes in language laterality between 2 fMRI studies in patients with brain tumors to elucidate factors contributing to cortical reorganization.
METHODS
The authors analyzed 33 patients with brain tumors involving eloquent language areas who underwent 2 separate presurgical, language task–based fMRI examinations (fMRI1 and fMRI2). Pathology consisted of low-grade glioma (LGG) in 15, and high-grade glioma (HGG) in 18. The mean time interval between scans was 35 ± 38 months (mean ± SD). Regions of interest were drawn for Broca’s area (BA) and the contralateral BA homolog. The laterality index (LI) was calculated and categorized as follows: > 0.2, left dominance; 0.2 to –0.2, codominance; and < −0.2, right dominance. Translocation of language function was defined as a shift across one of these thresholds between the 2 scans. Comparisons between the 2 groups, translocation of language function (reorganized group) versus no translocation (constant group), were performed using the Mann-Whitney U-test.
RESULTS
Nine (27%) of 33 patients demonstrated translocation of language function. Eight of 9 patients with translocation had tumor involvement of BA, compared to 5/24 patients without translocation (p < 0.0001). There was no difference in LI between the 2 groups at fMRI1. However, the reorganized group showed a decreased LI at fMRI2 compared to the constant group (−0.1 vs 0.53, p < 0.01). The reorganized cohort showed a significant difference between LI1 and LI2 (0.50 vs –0.1, p < 0.0001) whereas the constant cohort did not. A longer time interval was found in the reorganized group between fMRI1 and fMRI2 for patients with LGG (34 vs 107 months, p < 0.002). Additionally, the reorganized cohort had a greater proportion of local tumor invasion into eloquent areas at fMRI2 than the constant group. Aphasia was present following fMRI2 in 13/24 (54%) patients who did not exhibit translocation, compared to 2/9 (22%) patients who showed translocation.
CONCLUSIONS
Translocation of language function in patients with brain tumor is associated with tumor involvement of BA, longer time intervals between scans, and is seen in both LGG and HGG. The reduced incidence of aphasia in the reorganized group raises the possibility that reorganization supports the conservation of language function. Therefore, longitudinal fMRI is useful because it may point to reorganization and could affect therapeutic planning for patients.
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Affiliation(s)
- Addison Quinones
- Departments of Radiology,
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Luca Pasquini
- Departments of Radiology,
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | | | - Nelson S. Moss
- Neurosurgery, Memorial Sloan Kettering Cancer Center, New York
| | - Cameron Brennan
- Neurosurgery, Memorial Sloan Kettering Cancer Center, New York
| | - Viviane Tabar
- Neurosurgery, Memorial Sloan Kettering Cancer Center, New York
| | - Andrei Holodny
- Departments of Radiology,
- Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York; and
- Department of Radiology, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
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Contralesional Cortical and Network Features Associated with Preoperative Language Deficit in Glioma Patients. Cancers (Basel) 2022; 14:cancers14184469. [PMID: 36139629 PMCID: PMC9496725 DOI: 10.3390/cancers14184469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Gliomas that infiltrate eloquent areas can damage the corresponding cortical or subcortical structures, leading to language dysfunction. A total of 20–40% of eloquent area glioma patients have language deficits. Gliomas anchored in eloquent areas cause varying degrees of language impairment. A tumor’s size, grade, location, and contralesional compensation may explain these differences. This study aimed to retrospectively explore gray and white matter plasticity in the contralesional hemisphere of patients with gliomas in the eloquent area using VBM and DTI network analysis. Abstract Lower-grade Gliomas anchored in eloquent areas cause varying degrees of language impairment. Except for a tumor’s features, contralesional compensation may explain these differences. Therefore, studying changes in the contralateral hemisphere can provide insights into the underlying mechanisms of language function compensation in patients with gliomas. This study included 60 patients with eloquent-area or near-eloquent-area gliomas. The participants were grouped according to the degree of language defect. T1 and diffusion tensor imaging were obtained. The contralesional cortical volume and the subcortical network were compared between groups. Patients with unimpaired language function showed elevated cortical volume in the midline areas of the frontal and temporal lobes. In subcortical networks, the group also had the highest global efficiency and shortest global path length. Ten nodes had intergroup differences in nodal efficiency, among which four nodes were in the motor area and four nodes were in the language area. Linear correlation was observed between the efficiency of the two nodes and the patient’s language function score. Functional compensation in the contralesional hemisphere may alleviate language deficits in patients with gliomas. Structural compensation mainly occurs in the contralesional midline area in the frontal and temporal lobes, and manifests as an increase in cortical volume and subcortical network efficiency.
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12
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Palmisciano P, Haider AS, Balasubramanian K, Dadario NB, Robertson FC, Silverstein JW, D'Amico RS. Supplementary Motor Area Syndrome after Brain Tumor Surgery: A Systematic Review. World Neurosurg 2022; 165:160-171.e2. [PMID: 35752423 DOI: 10.1016/j.wneu.2022.06.080] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Supplementary motor area syndrome (SMAS) may occur after frontal tumor surgery, with variable presentation and outcomes. We reviewed the literature on postoperative SMAS following brain tumor resection. METHODS PubMed, Web-of-Science, Scopus, and Cochrane were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to include studies reporting SMAS after brain tumor resection. RESULTS We included 31 studies encompassing 236 patients. Most tumors were gliomas (94.5%), frequently of low-grade (61.4%). Most lesions were located on the left hemisphere (64.4%), involving the supplementary motor area (61.4%) and the cingulate gyrus (20.8%). Tractography and functional MRI evaluation were completed in 45 (19.1%) and 26 (11%) patients. Gross total resection was achieved in 46.3% cases and complete SMA resection in 69.4%. 215 procedures (91.1%) utilized intraoperative neuromonitoring mostly consisting of direct cortical/subcortical stimulation (56.4%), motor (33.9%), and somatosensory (25.4%) evoked potentials. Postoperative SMAS symptoms occurred within 24 hours after surgery, characterized by motor deficits (97%) including paresis (68.6%) and hemiplegia (16.1%), and speech disorders (53%) including hesitancy (24.2%) and mutism (22%). Average SMAS duration was 45 days (range, 1-365), with total resolution occurring in 188 patients (79.7%) and partial improvement in 46 (19.5%). 48 patients (20.3%) had persisting symptoms, mostly speech hesitancy (60.4%) and fine motor disorders (45.8%). CONCLUSION Postoperative SMAS may occur within the first 24 hours after mesial frontal tumor surgery. Preoperative mapping and intraoperative neuromonitoring may assist resection and predict outcomes. Neuroplasticity and interhemispheric connectivity play a major role in resolution.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center
| | | | - Nicholas B Dadario
- Department of Neurological Surgery, Northwell Health, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA
| | - Faith C Robertson
- Department of Neurological Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Justin W Silverstein
- Department of Neurology, Northwell Health, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA; Neuro Protective Solutions, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Northwell Health, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA
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13
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Gkiatis K, Garganis K, Benjamin CF, Karanasiou I, Kondylidis N, Harushukuri J, Matsopoulos GK. Standardization of presurgical language fMRI in Greek population: Mapping of six critical regions. Brain Behav 2022; 12:e2609. [PMID: 35587046 PMCID: PMC9226851 DOI: 10.1002/brb3.2609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mapping the language system has been crucial in presurgical evaluation especially when the area to be resected is near relevant eloquent cortex. Functional magnetic resonance imaging (fMRI) proved to be a noninvasive alternative of Wada test that can account not only for language lateralization but also for localization when appropriate tasks and MRI sequences are being used. The tasks utilized during the fMRI acquisition are playing a crucial role as to which areas will be activated. Recent studies demonstrated that key language regions exist outside the classical model of "Wernicke-Lichtheim-Geschwind," but sensitive tasks must take place in order to be revealed. On top of that, the tasks should be in mother tongue for appropriate language mapping to be possible. METHODS For that reason, in this study, we adopted an English protocol that can reveal six language critical regions even in clinical setups and we translated it into Greek to prove its efficacy in Greek population. Twenty healthy right-handed volunteers were recruited and performed the fMRI acquisition in a standardized manner. RESULTS Results demonstrated that all six language critical regions were activated in all subjects as well as the group mean map. Furthermore, activations were found in the thalamus, the caudate, and the contralateral cerebellum. CONCLUSION In this study, we standardized an fMRI protocol in Greek and proved that it can reliably activate six language critical regions. We have validated its efficacy for presurgical language mapping in Greek patients capable to be adopted in clinical setup.
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Affiliation(s)
- Kostakis Gkiatis
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece.,Epilepsy Monitoring Unit, St. Luke's Hospital, Thessaloniki, Greece
| | | | - Christopher F Benjamin
- Department of Neurology, Comprehensive Epilepsy Center, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Irene Karanasiou
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | | | - Jean Harushukuri
- Epilepsy Monitoring Unit, St. Luke's Hospital, Thessaloniki, Greece
| | - George K Matsopoulos
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
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14
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Cognitive deficits in adult patients with high-grade glioma: A systematic review. Clin Neurol Neurosurg 2022; 219:107296. [DOI: 10.1016/j.clineuro.2022.107296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/04/2022] [Accepted: 05/13/2022] [Indexed: 11/15/2022]
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15
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Pasquini L, Di Napoli A, Rossi-Espagnet MC, Visconti E, Napolitano A, Romano A, Bozzao A, Peck KK, Holodny AI. Understanding Language Reorganization With Neuroimaging: How Language Adapts to Different Focal Lesions and Insights Into Clinical Applications. Front Hum Neurosci 2022; 16:747215. [PMID: 35250510 PMCID: PMC8895248 DOI: 10.3389/fnhum.2022.747215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
- Radiology Department, Castelli Hospital, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Emiliano Visconti
- Neuroradiology Unit, Cesena Surgery and Trauma Department, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Kyung K. Peck
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrei I. Holodny
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, United States
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16
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Deng X, Yin H, Zhang Y, Zhang D, Wang S, Cao Y, Li M, Wang B, Zong F, Zhao J. Impairment and Plasticity of Language-Related White Matter in Patients With Brain Arteriovenous Malformations. Stroke 2021; 53:1682-1691. [PMID: 34847706 DOI: 10.1161/strokeaha.121.035506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Language dysfunction is rarely seen in patients with unruptured brain arteriovenous malformation (AVM) albeit the AVM nidus involving language areas, which provides a unique disease model to study language reorganization. The objective of this study was to investigate the impairment and reorganization patterns and characteristics of language-related white matter in AVMs located at different brain areas. METHODS Thirty-three patients with AVMs involving language areas were prospectively enrolled. Patients were categorized into 3 groups according to the lesion locations: the frontal (14 patients), temporal (15 patients), and parietal groups (4 patients). Thirty age- and sex-matched healthy controls were enrolled as comparison. All participants underwent diffusion tensor imaging scans, and automated fiber quantification method was applied to quantitatively study the difference of segmented language-related white matter connectivity between 3 AVM groups and control group. RESULTS Language functions were normal in all subjects according to Western Aphasia Battery test. In the frontal group, fractional anisotropy (FA) value decreased in the left arcuate fascicle and increased in left superior longitudinal fasciculus and uncinate fascicle; in the temporal group, FA values decreased in left inferior fronto-occipital fascicle and inferior longitudinal fascicle and increased in right anterior thalamic radiation and uncinate fascicle; in the parietal group, FA values decreased in left arcuate fascicle and inferior longitudinal fascicle and increased in bilateral anterior thalamic radiations and uncinate fascicles and right inferior fronto-occipital fascicle. In fascicles with decreased FA values, the increase of radial diffusivity was common, and fascicles with increased FA values usually presented along with increased axial diffusivity values. CONCLUSIONS Remodeling of language-related white matter occurs when traditional language areas are involved by AVM nidus, and its reorganization patterns vary with locations of AVM nidus. Fascicle impairment is mainly caused by the myelin deficits, and its plasticity may be dominated by the axon remodeling procedure.
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Affiliation(s)
- Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.)
| | - Hu Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.)
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.)
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.)
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.)
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.)
| | - Maogui Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.)
| | - Bo Wang
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, China (B.W.).,Institute of Biophysics, Chinese Academy of Sciences, Beijing (B.W., F.Z.).,University of Chinese Academy of Sciences, Beijing (B.W., F.Z.)
| | - Fangrong Zong
- Institute of Biophysics, Chinese Academy of Sciences, Beijing (B.W., F.Z.).,University of Chinese Academy of Sciences, Beijing (B.W., F.Z.)
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (X.D., H.Y., Y.Z., D.Z., S.W., Y.C., M.L., J.Z.)
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17
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Adam LC, Repantis D, Konrad BN, Dresler M, Kühn S. Memory enhancement with stimulants: Differential neural effects of methylphenidate, modafinil, and caffeine. A pilot study. Brain Cogn 2021; 154:105802. [PMID: 34592684 DOI: 10.1016/j.bandc.2021.105802] [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: 05/27/2021] [Revised: 09/19/2021] [Accepted: 09/19/2021] [Indexed: 11/18/2022]
Abstract
Human memory is susceptible to manipulation in many respects. While consolidation is well known to be prone to disruption, there is also growing evidence for the enhancement of memory function. Beside cognitive strategies and mnemonic training, the use of stimulants may improve memory processing in healthy adults. In this single-dose, double-blind, within-subject, randomized, placebo-controlled pilot study, 20 mg methylphenidate (N = 13) or 200 mg modafinil (N = 12) or 200 mg caffeine (N = 14) were administrated to in total 39 healthy participants while performing a declarative memory task. Each participant received only one substance and functional magnetic resonance imaging (fMRI) was used to assess drug-dependent memory effects of the substance for encoding and recognition compared to task-related activation under placebo. While methylphenidate showed some behavioral effect regarding memory recall performance, on the neural level, methylphenidate-dependent deactivations were found in fronto-parietal and temporal regions during recognition of previously learned words. No BOLD alterations were seen during encoding. Caffeine led to deactivations in the precentral gyrus during encoding whereas modafinil did not show any BOLD signal alterations at all. These results should be interpreted with caution since this a pilot study with several limitations, most importantly the small number of participants per group. However, our main finding of task-related deactivations may point to a drug-dependent increase of efficiency in physiological response to memory processing.
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Affiliation(s)
- Lucas C Adam
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Dimitris Repantis
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany.
| | - Boris N Konrad
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany; University Medical Center Hamburg-Eppendorf (UKE), Department of Psychiatry and Psychotherapy, Hamburg, Germany
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18
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Quirarte JA, Kumar VA, Liu HL, Noll KR, Wefel JS, Lang FF. Language supplementary motor area syndrome correlated with dynamic changes in perioperative task-based functional MRI activations: case report. J Neurosurg 2021; 134:1738-1742. [PMID: 32502992 DOI: 10.3171/2020.4.jns193250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/03/2020] [Indexed: 11/06/2022]
Abstract
Supplementary motor area (SMA) syndrome is well known; however, the mechanism underlying recovery from language SMA syndrome is unclear. Herein the authors report the case of a right-handed woman with speech aphasia following resection of an oligodendroglioma located in the anterior aspect of the left superior frontal gyrus. The patient exhibited language SMA syndrome, and functional MRI (fMRI) findings 12 days postoperatively demonstrated a complete shift of blood oxygen level-dependent (BOLD) activation to the contralateral right language SMA/pre-SMA as well as coequal activation and an increased volume of activation in the left Broca's area and the right Broca's homolog. The authors provide, to the best of their knowledge, the first description of dynamic changes in task-based hemispheric language BOLD fMRI activations across the preoperative, immediate postoperative, and more distant postoperative settings associated with the development and subsequent complete resolution of the clinical language SMA syndrome.
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Affiliation(s)
| | | | - Ho-Ling Liu
- 3Imaging Physics, University of Texas MD Anderson Cancer Center; and
| | - Kyle R Noll
- 4Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Wefel
- 4Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
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19
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Pinson H, Van Lerbeirghe J, Vanhauwaert D, Van Damme O, Hallaert G, Kalala JP. The supplementary motor area syndrome: a neurosurgical review. Neurosurg Rev 2021; 45:81-90. [PMID: 33993354 DOI: 10.1007/s10143-021-01566-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
The supplementary motor area (SMA) syndrome is a frequently encountered clinical phenomenon associated with surgery of the dorsomedial prefrontal lobe. The region has a known motor sequencing function and the dominant pre-SMA specifically is associated with more complex language functions; the SMA is furthermore incorporated in the negative motor network. The SMA has a rich interconnectivity with other cortical regions and subcortical structures using the frontal aslant tract (FAT) and the frontostriatal tract (FST). The development of the SMA syndrome is positively correlated with the extent of resection of the SMA region, especially its medial side. This may be due to interruption of the nearby callosal association fibres as the contralateral SMA has a particular important function in brain plasticity after SMA surgery. The syndrome is characterized by a profound decrease in interhemispheric connectivity of the motor network hubs. Clinical improvement is related to increasing connectivity between the contralateral SMA region and the ipsilateral motor hubs. Overall, most patients know a full recovery of the SMA syndrome, however a minority of patients might continue to suffer from mild motor and speech dysfunction. Rarely, no recovery of neurological function after SMA region resection is reported.
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Affiliation(s)
- Harry Pinson
- Department of Neurosurgery, AZ Delta, Roeselare, Belgium. .,Department of Neurosurgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | | | | | | | - Giorgio Hallaert
- Department of Neurosurgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Jean-Pierre Kalala
- Department of Neurosurgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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20
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Burkhardt E, Kinoshita M, Herbet G. Functional anatomy of the frontal aslant tract and surgical perspectives. J Neurosurg Sci 2021; 65:566-580. [PMID: 33870673 DOI: 10.23736/s0390-5616.21.05344-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The frontal aslant tract (FAT) is an intralobar white matter fasciculus providing dense connections between the medial part of the superior frontal gyrus, in particular the pre-supplementary motor area (SMA) and the SMA proper, and the lateral part of the frontal lobe, especially the inferior frontal gyrus. Although this tract has been characterized belatedly, it has received important attention in recent years due notably to its increasingly evidenced role in the speech and language networks. As cerebral tumors frequently affect the frontal lobe, an improved knowledge of the functional anatomy of the FAT is mandatory to refine the way neurosurgeries are performed and to give the patients the best opportunities to recover after surgery. In this work, we first describe the spatial arrangement of the FAT and detail its cortical projections. We then provide a comprehensive review of the functions supposedly mediated by this transverse frontal connectivity. It is structured following a tripartite organization where the linguistic (i.e. speech and language), supralinguistic (i.e. functions that interact with speech and language: executive functions, working memory, and social communication) and extralinguistic implications (i.e. functions outside the linguistic domain: visuospatial processing, praxis and motor skills) are successively addressed. We lastly discussed this knowledge in the context of wide-awake neurosurgeries for brain tumors. We emphasize the need to evaluate thoroughly the functions conveyed by FAT by means of longitudinally-designed studies to first estimate its plasticity potential and then to determine which tasks should be selected to avoid lasting impairments due to its disconnective breakdown.
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Affiliation(s)
- Eléonor Burkhardt
- Praxiling, CNRS UMR 5267, Paul Valéry Montpellier 3 University, Montpellier, France
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Guillaume Herbet
- University of Montpellier, CNRS UMR5203, INSERM U1191, Institute of Functional Genomics, Montpellier, France - .,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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21
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Krishna S, Kakaizada S, Almeida N, Brang D, Hervey-Jumper S. Central Nervous System Plasticity Influences Language and Cognitive Recovery in Adult Glioma. Neurosurgery 2021; 89:539-548. [PMID: 33476391 DOI: 10.1093/neuros/nyaa456] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023] Open
Abstract
Gliomas exist within the framework of complex neuronal circuitry in which network dynamics influence both tumor biology and cognition. The generalized impairment of cognition or loss of language function is a common occurrence for glioma patients. The interface between intrinsic brain tumors such as gliomas and functional cognitive networks are poorly understood. The ability to communicate effectively is critically important for receiving oncological therapies and maintaining a high quality of life. Although the propensity of gliomas to infiltrate cortical and subcortical structures and disrupt key anatomic language pathways is well documented, there is new evidence offering insight into the network and cellular mechanisms underpinning glioma-related aphasia and aphasia recovery. In this review, we will outline the current understanding of the mechanisms of cognitive dysfunction and recovery, using aphasia as an illustrative model.
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Affiliation(s)
- Saritha Krishna
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Sofia Kakaizada
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Nyle Almeida
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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22
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Salvati M, Armocida D, Pesce A, Palmieri M, Venditti E, D'Andrea G, Frati A, Santoro A. No prognostic differences between GBM-patients presenting with postoperative SMA-syndrome and GBM-patients involving cortico-spinal tract and primary motor cortex. J Neurol Sci 2020; 419:117188. [PMID: 33075591 DOI: 10.1016/j.jns.2020.117188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The supplementary motor area (SMA) is involved in several aspects of motor control and its can be associated to a contralateral motor deficit and speech disorders. After the resection of low-grade gliomas, this syndrome is diffusely reported but it is rarely investigated in high-grade gliomas. SMA deficits may resolve completely or with minor sequelae within weeks. Whether this condition of transient deficit affects survival, was not previously investigated, and is not currently understood. OBJECTIVE The study aimed to perform an accurate investigation concerning the real clinical and prognostic impact of the postoperative SMA syndrome in order to shed light over its relationship to survival parameters and postoperative functional status of the patients. METHODS We performed a retrospective review of a series of 176 surgically treated patients suffering from Glioblastomas. Tumors classified as Group A: Involving the SMA and Group B: Lesion located outside and distal to the SMA but in anatomical relationship to primary motor cortices (PM1) or corticospinal tract (CST), in order to investigate differences concerning immunohistochemical and molecular profiles in regard to the survival parameters. RESULTS Although lesions involving SMA demonstrated a significantly higher volume in respect to their general counterparts they did not significantly differ in concerns to the molecular patterns, pre and postoperative KPS scores and in PFS and OS findings. CONCLUSIONS In our cohort SMA-syndrome is reversible and therefore guarantees a satisfactory functional status at follow-up, apparently not compromising survival when compared to other lesions affecting the primary or cortical motor area -spinal tract.
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Affiliation(s)
- Maurizio Salvati
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy; IRCCS "Neuromed", Pozzilli (IS), Italy
| | - Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy.
| | - Alessandro Pesce
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy; IRCCS "Neuromed", Pozzilli (IS), Italy
| | - Mauro Palmieri
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
| | - Emiliano Venditti
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
| | | | | | - Antonio Santoro
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
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Cargnelutti E, Ius T, Skrap M, Tomasino B. What do we know about pre- and postoperative plasticity in patients with glioma? A review of neuroimaging and intraoperative mapping studies. NEUROIMAGE-CLINICAL 2020; 28:102435. [PMID: 32980599 PMCID: PMC7522801 DOI: 10.1016/j.nicl.2020.102435] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
Brain reorganization can take place before and after surgery of low- and high-grade gliomas. Plasticity is observed for low-grade but also for high-grade gliomas. The contralesional hemisphere can be vital for successful compensation. There is evidence of plasticity for both the language system and the sensorimotor system. Partial compensation can also occur at the white-matter level. Subcortical connectivity is crucial for brain reorganization.
Brain plasticity potential is a central theme in neuro-oncology and is currently receiving increased attention. Advances in treatment have prolonged life expectancy in neuro-oncological patients and the long-term preservation of their quality of life is, therefore, a new challenge. To this end, a better understanding of brain plasticity mechanisms is vital as it can help prevent permanent deficits following neurosurgery. Indeed, reorganization processes can be fundamental to prevent or recover neurological and cognitive deficits by reallocating brain functions outside the lesioned areas. According to more recent studies in the literature, brain reorganization taking place following neurosurgery is associated with good neurofunctioning at follow-up. Interestingly, in the last few years, the number of reports on plasticity has notably increased. Aim of the current review was to provide a comprehensive overview of pre- and postoperative neuroplasticity patterns. Within this framework, we aimed to shed light on some tricky issues, including i) involvement of the contralateral healthy hemisphere, ii) role and potential changes of white matter and connectivity patterns, and iii) reorganization in low- versus high-grade gliomas. We finally discussed the practical implications of these aspects and role of additional potentially relevant factors to be explored. Final purpose was to provide a guideline helpful in promoting increase in the extent of tumor resection while preserving the patients’ neurological and cognitive functioning.
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Affiliation(s)
- Elisa Cargnelutti
- Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, Udine, Italy
| | - Tamara Ius
- SOC Neurochirurgia, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Italy
| | - Miran Skrap
- SOC Neurochirurgia, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Italy
| | - Barbara Tomasino
- Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, Udine, Italy.
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Yuan T, Zuo Z, Ying J, Jin L, Kang J, Gui S, Wang R, Li C. Structural and Functional Alterations in the Contralesional Medial Temporal Lobe in Glioma Patients. Front Neurosci 2020; 14:10. [PMID: 32153348 PMCID: PMC7044242 DOI: 10.3389/fnins.2020.00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/08/2020] [Indexed: 01/13/2023] Open
Abstract
Background The human brain has an extraordinary ability to functionally change or reorganize its structure in response to disease. The aim of this study is to assess the structural and functional plasticity of contralesional medial temporal lobe (MTL) in patients with unilateral MTL glioma. Methods Sixty-eight patients with unilateral MTL glioma (left MTL glioma, n = 33; right MTL glioma, n = 35) and 40 healthy controls were recruited and scanned with 3D T1 MRI and rest-fMRI. We explored the structure of the contralesional MTL using voxel-based morphometry (VBM) and assessed the memory networks of the contralesional hemisphere using resting-state functional connectivity (rs-FC). The association between FC and cognitive function was assessed with partial correlation analysis. Results Compared with healthy controls, both patient groups exhibited (1) a large cluster of voxels with gray matter (GM) volume decrease in the contralesional MTL using region of interest (ROI)-based VBM analysis (cluster level p < 0.05, FDR corrected); and (2) decreased intrahemispheric FC between the posterior hippocampus (pHPC) and posterior cingulate cortex (PCC) (p < 0.01, Bonferroni corrected). Intrahemispheric FC between the pHPC and PCC was positively correlated with cognitive function in both patient groups. Conclusion Using multi-modality brain imaging tools, we found structural and functional changes in the contralesional MTL in patients with unilateral MTL glioma. These findings suggest that the contralesional cortex may have decompensation of structure and function in patients with unilateral glioma, except for compensatory structural and functional adaptations. Our study provides additional insight into the neuroanatomical and functional network changes in the contralesional cortex in patients with glioma.
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Affiliation(s)
- Taoyang Yuan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
| | - Jianyou Ying
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lu Jin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders Brain Tumour Center, Beijing, China
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Young JS, Morshed RA, Mansoori Z, Cha S, Berger MS. Disruption of Frontal Aslant Tract Is Not Associated with Long-Term Postoperative Language Deficits. World Neurosurg 2020; 133:192-195. [DOI: 10.1016/j.wneu.2019.09.128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022]
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Postoperative isolated lower extremity supplementary motor area syndrome: case report and review of the literature. Childs Nerv Syst 2020; 36:189-195. [PMID: 31705188 DOI: 10.1007/s00381-019-04362-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
The supplementary motor area (SMA) syndrome is characterized by transient weakness and akinesia contralateral to the side of the affected hemisphere. The underlying pathology of the syndrome is not fully understood but is thought to be related to lesions in the SMA, residing principally in the mesial superior frontal gyrus (Broadmann's area 6c). Although the SMA syndrome a well-characterized clinical entity, we report herein, to our knowledge, the first case of isolated lower extremity SMA syndrome in the literature. This case highlights the importance of considering this rare clinical entity in the context of new or worsening postoperative neurologic deficits. Moreover, early studies did not support somatotopic organization of the SMA as in the primary motor cortex; emerging evidence suggests that delicate somatotopic representation may underlie distinct presentations like that reported in the present case.
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Yuan B, Zhang N, Yan J, Cheng J, Lu J, Wu J. Resting-state functional connectivity predicts individual language impairment of patients with left hemispheric gliomas involving language network. NEUROIMAGE-CLINICAL 2019; 24:102023. [PMID: 31693978 PMCID: PMC6838935 DOI: 10.1016/j.nicl.2019.102023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 09/27/2019] [Indexed: 01/26/2023]
Abstract
Language deficits following brain tumors should consider the dynamic interactions between different tumor growth kinetics and functional network reorganization. We measured the resting-state functional connectivity of 126 patients with left cerebral gliomas involving language network areas, including 77 patients with low-grade gliomas (LGG) and 49 patients with high-grade gliomas (HGG). Functional network mapping for language was performed by construction of a multivariate machine learning-based prediction model of individual aphasia quotient (AQ), a summary score that indicates overall severity of language impairment. We found that the AQ scores for HGG patients were significantly lower than those of LGG patients. The prediction accuracy of HGG patients (R2 = 0.27, permutation P = 0.007) was much higher than that of LGG patients (R2 = 0.09, permutation P = 0.032). The rsFC regions predictive of LGG's AQ involved the bilateral frontal, temporal, and parietal lobes, subcortical regions, and bilateral cerebro-cerebellar connections, mainly in regions belonging to the canonical language network. The functional network of language processing for HGG patients showed strong dependence on connections of the left cerebro-cerebellar connections, limbic system, and the temporal, occipital, and prefrontal lobes. Together, our findings suggested that individual language processing of glioma patients links large-scale, bilateral, cortico-subcortical, and cerebro-cerebellar functional networks with different network reorganizational mechanisms underlying the different levels of language impairments in LGG and HGG patients.
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Affiliation(s)
- Binke Yuan
- Center for Language and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China
| | - Nan Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Yan
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junfeng Lu
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinsong Wu
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, China.
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Corrivetti F, de Schotten MT, Poisson I, Froelich S, Descoteaux M, Rheault F, Mandonnet E. Dissociating motor–speech from lexico-semantic systems in the left frontal lobe: insight from a series of 17 awake intraoperative mappings in glioma patients. Brain Struct Funct 2019; 224:1151-1165. [DOI: 10.1007/s00429-019-01827-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
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29
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Dick AS, Garic D, Graziano P, Tremblay P. The frontal aslant tract (FAT) and its role in speech, language and executive function. Cortex 2018; 111:148-163. [PMID: 30481666 DOI: 10.1016/j.cortex.2018.10.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 08/27/2018] [Accepted: 10/18/2018] [Indexed: 12/15/2022]
Abstract
In this review, we examine the structural connectivity of a recently-identified fiber pathway, the frontal aslant tract (FAT), and explore its function. We first review structural connectivity studies using tract-tracing methods in non-human primates, and diffusion-weighted imaging and electrostimulation in humans. These studies suggest a monosynaptic connection exists between the lateral inferior frontal gyrus and the pre-supplementary and supplementary motor areas of the medial superior frontal gyrus. This connection is termed the FAT. We then review research on the left FAT's putative role in supporting speech and language function, with particular focus on speech initiation, stuttering and verbal fluency. Next, we review research on the right FAT's putative role supporting executive function, namely inhibitory control and conflict monitoring for action. We summarize the extant body of empirical work by suggesting that the FAT plays a domain general role in the planning, timing, and coordination of sequential motor movements through the resolution of competition among potential motor plans. However, we also propose some domain specialization across the hemispheres. On the left hemisphere, the circuit is proposed to be specialized for speech actions. On the right hemisphere, the circuit is proposed to be specialized for general action control of the organism, especially in the visuo-spatial domain. We close the review with a discussion of the clinical significance of the FAT, and suggestions for further research on the pathway.
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Affiliation(s)
| | - Dea Garic
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Paulo Graziano
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Pascale Tremblay
- Departement de Readaptation, Université Laval, Quebec City, Quebec, Canada; CERVO Brain Research Center, Quebec City, Canada
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