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Yang ZC, Xue BW, Song XY, Yin CD, Yeh FC, Li G, Deng ZH, Sun SJ, Hou ZG, Xie J. Connectomic insights into the impact of 1p/19q co-deletion in dominant hemisphere insular glioma patients. Front Neurosci 2024; 18:1283518. [PMID: 39135733 PMCID: PMC11317282 DOI: 10.3389/fnins.2024.1283518] [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: 08/26/2023] [Accepted: 07/10/2024] [Indexed: 08/15/2024] Open
Abstract
Objectives This study aimed to elucidate the influences of 1p/19q co-deletion on structural connectivity alterations in patients with dominant hemisphere insular diffuse gliomas. Methods We incorporated 32 cases of left insular gliomas and 20 healthy controls for this study. Using diffusion MRI, we applied correlational tractography, differential tractography, and graph theoretical analysis to explore the potential connectivity associated with 1p/19q co-deletion. Results The study revealed that the quantitative anisotropy (QA) of key deep medial fiber tracts, including the anterior thalamic radiation, superior thalamic radiation, fornix, and cingulum, had significant negative associations with 1p/19q co-deletion (FDR = 4.72 × 10-5). These tracts are crucial in maintaining the integrity of brain networks. Differential analysis further supported these findings (FWER-corrected p < 0.05). The 1p/19q non-co-deletion group exhibited significantly higher clustering coefficients (FDR-corrected p < 0.05) and reduced betweenness centrality (FDR-corrected p < 0.05) in regions around the tumor compared to HC group. Graph theoretical analysis indicated that non-co-deletion patients had increased local clustering and decreased betweenness centrality in peritumoral brain regions compared to co-deletion patients and healthy controls (FDR-corrected p < 0.05). Additionally, despite not being significant through correction, patients with 1p/19q co-deletion exhibited lower trends in weighted average clustering coefficient, transitivity, small worldness, and global efficiency, while showing higher tendencies in weighted path length compared to patients without the co-deletion. Conclusion The findings of this study underline the significant role of 1p/19q co-deletion in altering structural connectivity in insular glioma patients. These alterations in brain networks could have profound implications for the neural functionality in patients with dominant hemisphere insular gliomas.
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Affiliation(s)
- Zuo-cheng Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo-wen Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-yu Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuan-dong Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang-cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gen Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zheng-hai Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sheng-jun Sun
- Neuroimaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zong-gang Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Morkovina O, Manukyan P, Sharapkova A. Picture naming test through the prism of cognitive neuroscience and linguistics: adapting the test for cerebellar tumor survivors-or pouring new wine in old sacks? Front Psychol 2024; 15:1332391. [PMID: 38566942 PMCID: PMC10985186 DOI: 10.3389/fpsyg.2024.1332391] [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: 11/02/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
A picture naming test (PNT) has long been regarded as an integral part of neuropsychological assessment. In current research and clinical practice, it serves a variety of purposes. PNTs are used to assess the severity of speech impairment in aphasia, monitor possible cognitive decline in aging patients with or without age-related neurodegenerative disorders, track language development in children and map eloquent brain areas to be spared during surgery. In research settings, picture naming tests provide an insight into the process of lexical retrieval in monolingual and bilingual speakers. However, while numerous advances have occurred in linguistics and neuroscience since the classic, most widespread PNTs were developed, few of them have found their way into test design. Consequently, despite the popularity of PNTs in clinical and research practice, their relevance and objectivity remain questionable. The present study provides an overview of literature where relevant criticisms and concerns have been expressed over the recent decades. It aims to determine whether there is a significant gap between conventional test design and the current understanding of the mechanisms underlying lexical retrieval by focusing on the parameters that have been experimentally proven to influence picture naming. We discuss here the implications of these findings for improving and facilitating test design within the picture naming paradigm. Subsequently, we highlight the importance of designing specialized tests with a particular target group in mind, so that test variables could be selected for cerebellar tumor survivors.
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Affiliation(s)
- Olga Morkovina
- Laboratory of Diagnostics and Advancing Cognitive Functions, Research Institute for Brain Development and Peak Performance, RUDN University, Moscow, Russia
- Department of English, Faculty of Computational Mathematics and Cybernetics, Lomonosov Moscow State University, Moscow, Russia
| | - Piruza Manukyan
- Laboratory of Diagnostics and Advancing Cognitive Functions, Research Institute for Brain Development and Peak Performance, RUDN University, Moscow, Russia
| | - Anastasia Sharapkova
- Laboratory of Diagnostics and Advancing Cognitive Functions, Research Institute for Brain Development and Peak Performance, RUDN University, Moscow, Russia
- Department of English Linguistics, Faculty of Philology, Lomonosov Moscow State University, Moscow, Russia
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Friedrich M, Filss CP, Lohmann P, Mottaghy FM, Stoffels G, Weiss Lucas C, Ruge MI, Shah NJ, Caspers S, Langen KJ, Fink GR, Galldiks N, Kocher M. Structural connectome-based predictive modeling of cognitive deficits in treated glioma patients. Neurooncol Adv 2024; 6:vdad151. [PMID: 38196739 PMCID: PMC10776208 DOI: 10.1093/noajnl/vdad151] [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] [Indexed: 01/11/2024] Open
Abstract
Background In glioma patients, tumor growth and subsequent treatments are associated with various types of brain lesions. We hypothesized that cognitive functioning in these patients critically depends on the maintained structural connectivity of multiple brain networks. Methods The study included 121 glioma patients (median age, 52 years; median Eastern Cooperative Oncology Group performance score 1; CNS-WHO Grade 3 or 4) after multimodal therapy. Cognitive performance was assessed by 10 tests in 5 cognitive domains at a median of 14 months after treatment initiation. Hybrid amino acid PET/MRI using the tracer O-(2-[18F]fluoroethyl)-L-tyrosine, a network-based cortical parcellation, and advanced tractography were used to generate whole-brain fiber count-weighted connectivity matrices. The matrices were applied to a cross-validated machine-learning model to identify predictive fiber connections (edges), critical cortical regions (nodes), and the networks underlying cognitive performance. Results Compared to healthy controls (n = 121), patients' cognitive scores were significantly lower in 9 cognitive tests. The models predicted the scores of 7/10 tests (median correlation coefficient, 0.47; range, 0.39-0.57) from 0.6% to 5.4% of the matrix entries; 84% of the predictive edges were between nodes of different networks. Critically involved cortical regions (≥10 adjacent edges) included predominantly left-sided nodes of the visual, somatomotor, dorsal/ventral attention, and default mode networks. Highly critical nodes (≥15 edges) included the default mode network's left temporal and bilateral posterior cingulate cortex. Conclusions These results suggest that the cognitive performance of pretreated glioma patients is strongly related to structural connectivity between multiple brain networks and depends on the integrity of known network hubs also involved in other neurological disorders.
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Affiliation(s)
- Michel Friedrich
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
| | - Christian P Filss
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, RWTH University Hospital Aachen, RWTH University Aachen, Aachen, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
| | - Carolin Weiss Lucas
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Maximilian I Ruge
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
- Juelich-Aachen Research Alliance (JARA), Section JARA-Brain, Juelich, Germany
- Department of Neurology, RWTH University Hospital Aachen, RWTH University Aachen, Aachen, Germany
| | - Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
- Institute for Anatomy I, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Nuclear Medicine, RWTH University Hospital Aachen, RWTH University Aachen, Aachen, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Gereon R Fink
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Kocher
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4, INM-11), Forschungszentrum Juelich, Juelich, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Shams B, Reisch K, Vajkoczy P, Lippert C, Picht T, Fekonja LS. Improved prediction of glioma-related aphasia by diffusion MRI metrics, machine learning, and automated fiber bundle segmentation. Hum Brain Mapp 2023. [PMID: 37318944 PMCID: PMC10365236 DOI: 10.1002/hbm.26393] [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: 01/20/2023] [Revised: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
White matter impairments caused by gliomas can lead to functional disorders. In this study, we predicted aphasia in patients with gliomas infiltrating the language network using machine learning methods. We included 78 patients with left-hemispheric perisylvian gliomas. Aphasia was graded preoperatively using the Aachen aphasia test (AAT). Subsequently, we created bundle segmentations based on automatically generated tract orientation mappings using TractSeg. To prepare the input for the support vector machine (SVM), we first preselected aphasia-related fiber bundles based on the associations between relative tract volumes and AAT subtests. In addition, diffusion magnetic resonance imaging (dMRI)-based metrics [axial diffusivity (AD), apparent diffusion coefficient (ADC), fractional anisotropy (FA), and radial diffusivity (RD)] were extracted within the fiber bundles' masks with their mean, standard deviation, kurtosis, and skewness values. Our model consisted of random forest-based feature selection followed by an SVM. The best model performance achieved 81% accuracy (specificity = 85%, sensitivity = 73%, and AUC = 85%) using dMRI-based features, demographics, tumor WHO grade, tumor location, and relative tract volumes. The most effective features resulted from the arcuate fasciculus (AF), middle longitudinal fasciculus (MLF), and inferior fronto-occipital fasciculus (IFOF). The most effective dMRI-based metrics were FA, ADC, and AD. We achieved a prediction of aphasia using dMRI-based features and demonstrated that AF, IFOF, and MLF were the most important fiber bundles for predicting aphasia in this cohort.
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Affiliation(s)
- Boshra Shams
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
| | - Klara Reisch
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Lippert
- Digital Health - Machine Learning, Hasso Plattner Institute, University of Potsdam, Digital Engineering Faculty, Potsdam, Germany
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
| | - Lucius S Fekonja
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
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Ntemou E, Rybka L, Lubbers J, Tuncer MS, Vajkoczy P, Rofes A, Picht T, Faust K. Lesion-symptom mapping of language impairments in people with brain tumours: The influence of linguistic stimuli. J Neuropsychol 2023; 17:400-416. [PMID: 36651346 DOI: 10.1111/jnp.12305] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/18/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
People with tumours in specific brain sites might face difficulties in tasks with different linguistic material. Previous lesion-symptom mapping studies (VLSM) demonstrated that people with tumours in posterior temporal regions have more severe linguistic impairments. However, to the best of our knowledge, preoperative performance and lesion location on tasks with different linguistic stimuli have not been examined. In the present study, we performed VLSM on 52 people with left gliomas to examine whether tumour distribution differs depending on the tasks of the Aachen Aphasia Test. The VLSM analysis revealed that single-word production (e.g. object naming) was associated with the inferior parietal lobe and that compound and sentence production were additionally associated with posterior temporal gyri. Word repetition was affected in people with tumours in inferior parietal areas, whereas sentence repetition was the only task to be associated with frontal regions. Subcortically, word and sentence production were found to be affected in people with tumours reaching the arcuate fasciculus, and compound production was primarily associated with tumours affecting the inferior longitudinal and inferior fronto-occipital fasciculus. Our work shows that tasks with linguistic stimuli other than single-word naming (e.g. compound and sentence production) relate to additional cortical and subcortical brain areas. At a clinical level, we show that tasks that target the same processes (e.g. repetition) can have different neural correlates depending on the linguistic stimuli used. Also, we highlight the importance of left temporoparietal areas.
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Affiliation(s)
- Effrosyni Ntemou
- International Doctorate for Approaches to Language and Brain (IDEALAB), University of Groningen, Groningen, The Netherlands
- International Doctorate for Approaches to Language and Brain (IDEALAB), University of Potsdam, Potsdam, Germany
- International Doctorate for Approaches to Language and Brain (IDEALAB), Newcastle University, Newcastle upon Tyne, UK
- International Doctorate for Approaches to Language and Brain (IDEALAB), Macquarie University, Sydney, New South Wales, Australia
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lena Rybka
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jocelyn Lubbers
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mehmet Salih Tuncer
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adrià Rofes
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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van Grinsven EE, Smits AR, van Kessel E, Raemaekers MAH, de Haan EHF, Huenges Wajer IMC, Ruijters VJ, Philippens MEP, Verhoeff JJC, Ramsey NF, Robe PAJT, Snijders TJ, van Zandvoort MJE. The impact of etiology in lesion-symptom mapping - A direct comparison between tumor and stroke. Neuroimage Clin 2022; 37:103305. [PMID: 36610310 PMCID: PMC9850191 DOI: 10.1016/j.nicl.2022.103305] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Lesion-symptom mapping is a key tool in understanding the relationship between brain structures and behavior. However, the behavioral consequences of lesions from different etiologies may vary because of how they affect brain tissue and how they are distributed. The inclusion of different etiologies would increase the statistical power but has been critically debated. Meanwhile, findings from lesion studies are a valuable resource for clinicians and used across different etiologies. Therefore, the main objective of the present study was to directly compare lesion-symptom maps for memory and language functions from two populations, a tumor versus a stroke population. METHODS Data from two different studies were combined. Both the brain tumor (N = 196) and stroke (N = 147) patient populations underwent neuropsychological testing and an MRI, pre-operatively for the tumor population and within three months after stroke. For this study, we selected two internationally widely used standardized cognitive tasks, the Rey Auditory Verbal Learning Test and the Verbal Fluency Test. We used a state-of-the-art machine learning-based, multivariate voxel-wise approach to produce lesion-symptom maps for these cognitive tasks for both populations separately and combined. RESULTS Our lesion-symptom mapping results for the separate patient populations largely followed the expected neuroanatomical pattern based on previous literature. Substantial differences in lesion distribution hindered direct comparison. Still, in brain areas with adequate coverage in both groups, considerable LSM differences between the two populations were present for both memory and fluency tasks. Post-hoc analyses of these locations confirmed that the cognitive consequences of focal brain damage varied between etiologies. CONCLUSION The differences in the lesion-symptom maps between the stroke and tumor population could partly be explained by differences in lesion volume and topography. Despite these methodological limitations, both the lesion-symptom mapping results and the post-hoc analyses confirmed that etiology matters when investigating the cognitive consequences of lesions with lesion-symptom mapping. Therefore, caution is advised with generalizing lesion-symptom results across etiologies.
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Affiliation(s)
- E E van Grinsven
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - A R Smits
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - E van Kessel
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - M A H Raemaekers
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - E H F de Haan
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; St. Hugh's College, Oxford University, UK
| | - I M C Huenges Wajer
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Department of Experimental Psychology and Helmholtz Institute, Utrecht University, the Netherlands
| | - V J Ruijters
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - M E P Philippens
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - N F Ramsey
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - P A J T Robe
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - T J Snijders
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - M J E van Zandvoort
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Department of Experimental Psychology and Helmholtz Institute, Utrecht University, the Netherlands
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Reisch K, Böttcher F, Tuncer MS, Schneider H, Vajkoczy P, Picht T, Fekonja LS. Tractography-based navigated TMS language mapping protocol. Front Oncol 2022; 12:1008442. [PMID: 36568245 PMCID: PMC9780436 DOI: 10.3389/fonc.2022.1008442] [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: 07/31/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction This study explores the feasibility of implementing a tractography-based navigated transcranial magnetic stimulation (nTMS) language mapping protocol targeting cortical terminations of the arcuate fasciculus (AF). We compared the results and distribution of errors from the new protocol to an established perisylvian nTMS protocol that stimulated without any specific targeting over the entire perisylvian cortex. Methods Sixty right-handed patients with language-eloquent brain tumors were examined in this study with one half of the cohort receiving the tractographybased protocol and the other half receiving the perisylvian protocol. Probabilistic tractography using MRtrix3 was performed for patients in the tractography-based group to identify the AF's cortical endpoints. nTMS mappings were performed and resulting language errors were classified into five psycholinguistic groups. Results Tractography and nTMS were successfully performed in all patients. The tractogram-based group showed a significantly higher median overall ER than the perisylvian group (3.8% vs. 2.9% p <.05). The median ER without hesitation errors in the tractogram-based group was also significantly higher than the perisylvian group (2.0% vs. 1.4%, p <.05). The ERs by error type showed no significant differences between protocols except in the no response ER, with a higher median ER in the tractogram-based group (0.4% vs. 0%, p <.05). Analysis of ERs based on the Corina cortical parcellation system showed especially high nTMS ERs over the posterior middle temporal gyrus (pMTG) in the perisylvian protocol and high ERs over the middle and ventral postcentral gyrus (vPoG), the opercular inferior frontal gyrus (opIFG) and the ventral precentral gyrus (vPrG) in the tractography-based protocol. Discussion By considering the white matter anatomy and performing nTMS on the cortical endpoints of the AF, the efficacy of nTMS in disrupting patients' object naming abilities was increased. The newly introduced method showed proof of concept and resulted in AF-specific ERs and noninvasive cortical language maps, which could be applied to additional fiber bundles related to the language network in future nTMS studies.
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Affiliation(s)
- Klara Reisch
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Franziska Böttcher
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Mehmet S. Tuncer
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Heike Schneider
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Peter Vajkoczy
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Thomas Picht
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
- Cluster of Excellence: “Matters of Activity. Image Space Material”, Humboldt University, Berlin, Germany
| | - Lucius S. Fekonja
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
- Cluster of Excellence: “Matters of Activity. Image Space Material”, Humboldt University, Berlin, Germany
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