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Fang S, Li L, Weng S, Guo Y, Fan X, Jiang T, Wang Y. Altering patterns of sensorimotor network in patients with different pathological diagnoses and glioma-related epilepsy under the latest glioma classification of the central nervous system. CNS Neurosci Ther 2023; 29:1368-1378. [PMID: 36740245 PMCID: PMC10068458 DOI: 10.1111/cns.14109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/16/2022] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
AIMS We aimed to clarify the relationship between alterations in functional networks and glioma-related epilepsy (GRE) in patients with different molecular diagnoses. METHODS We enrolled 160 patients with prefrontal gliomas and different histories of GRE. The patients were grouped based on the latest pathological glioma classification and GRE history. Graph theory analysis was applied to reveal alterations in the sensorimotor networks among various subgroups. Binary logistic regression was used to identify risk factors for preoperative GRE onset. RESULTS Decreasing shortest path length was found in patients with GRE, regardless of the chromosome 1p/19q status. Nodes located in the premotor and supplementary motor areas showed decreased nodal betweenness centrality and vulnerability in patients with GRE and chromosome 1p/19q intact. Additionally, the node on the primary motor area showed decreased nodal vulnerability but the node on the sensory-related thalamus increased in patients with GRE and chromosome 1p/19q co-deletion. Decreased shortest path length, grade 2, and decreased nodal betweenness centrality of the premotor area were risk factors for GRE. CONCLUSION Decreased shortest path length was a characteristic alteration in GRE and prefrontal glioma. Alterations in global properties were similar, but nodal properties were different in patients with GRE and different chromosome 1p/19q statuses.
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Affiliation(s)
- Shengyu Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Beijing, China
| | - Lianwang Li
- Beijing Neurosurgical Institute, Beijing, China
| | | | - Yuhao Guo
- Beijing Neurosurgical Institute, Beijing, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Beijing, China.,Research Unit of Accurate Diagnosis, Treatment, and Translational Medicine of Brain Tumors, Chinese Academy of Medical Sciences, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Larkin CJ, Yerneni K, Karras CL, Abecassis ZA, Zhou G, Zelano C, Selner AN, Templer JW, Tate MC. Impact of intraoperative direct cortical stimulation dynamics on perioperative seizures and afterdischarge frequency in patients undergoing awake craniotomy. J Neurosurg 2022; 137:1853-1861. [PMID: 35535844 DOI: 10.3171/2022.3.jns226] [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: 01/02/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative stimulation is used as a crucial adjunct in neurosurgical oncology, allowing for greater extent of resection while minimizing morbidity. However, limited data exist regarding the impact of cortical stimulation on the frequency of perioperative seizures in these patients. METHODS A retrospective chart review of patients undergoing awake craniotomy with electrocorticography data by a single surgeon at the authors' institution between 2013 and 2020 was conducted. Eighty-three patients were identified, and electrocorticography, stimulation, and afterdischarge (AD)/seizure data were collected and analyzed. Stimulation characteristics (number, amplitude, density [stimulations per minute], composite score [amplitude × density], total and average stimulation duration, and number of positive stimulation sites) were analyzed for association with intraoperative seizures (ISs), ADs, and postoperative clinical seizures. RESULTS Total stimulation duration (p = 0.005), average stimulation duration (p = 0.010), and number of stimulations (p = 0.020) were found to significantly impact AD incidence. A total stimulation duration of more than 145 seconds (p = 0.04) and more than 60 total stimulations (p = 0.03) resulted in significantly higher rates of ADs. The total number of positive stimulation sites was associated with increased IS (p = 0.048). Lesions located within the insula (p = 0.027) were associated with increased incidence of ADs. Patients undergoing repeat awake craniotomy were more likely to experience IS (p = 0.013). Preoperative antiepileptic drug use, seizure history, and number of prior resections of any type showed no impact on the outcomes considered. The charge transferred to the cortex per second during mapping was significantly higher in the 10 seconds leading to AD than at any other time point examined in patients experiencing ADs, and was significantly higher than any time point in patients not experiencing ADs or ISs. Although the rate of transfer for patients experiencing ISs was highest in the 10 seconds prior to the seizure, it was not significantly different from those who did not experience an AD or IS. CONCLUSIONS The data suggest that intraoperative cortical stimulation is a safe and effective technique in maximizing extent of resection while minimizing neurological morbidity in patients undergoing awake craniotomies, and that surgeons may avoid ADs and ISs by minimizing duration and total number of stimulations and by decreasing the overall charge transferred to the cortex during mapping procedures.
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Affiliation(s)
- Collin J Larkin
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Ketan Yerneni
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Constantine L Karras
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Zachary A Abecassis
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Guangyu Zhou
- 2Department of Neuroscience, Northwestern University, Feinberg School of Medicine, Chicago; and
| | - Christina Zelano
- 2Department of Neuroscience, Northwestern University, Feinberg School of Medicine, Chicago; and
| | - Ashley N Selner
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Jessica W Templer
- 3Department of Neurology, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Matthew C Tate
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
- 3Department of Neurology, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
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Fang S, Li L, Weng S, Zhang Z, Fan X, Jiang T, Wang Y. Increasing nodal vulnerability and nodal efficiency implied recovery time prolonging in patients with supplementary motor area syndrome. Hum Brain Mapp 2022; 43:3958-3969. [PMID: 35507429 PMCID: PMC9374886 DOI: 10.1002/hbm.25896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Supplementary motor area (SMA) syndrome is a surgery‐related complication that commonly occurs after removing SMA glioma, and needs weeks to recover. However, susceptible factors of patients suffering from SMA syndrome remain unknown. Graphic theory was applied to reveal topological properties of sensorimotor network (SMN) by processing resting‐state functional magnetic resonance images in 66 patients with SMA gliomas. Patients were classified into SMA and non‐SMA groups based on whether they suffered from SMA syndrome. We collected recovery time and used causal mediation analysis to find association between topological properties and recovery time. Compared with the non‐SMA group, higher vulnerability (left: p = .0018; right: p = .0033) and lower fault tolerance (left: p = .0022; right: p = .0248) of the whole SMN were found in the SMA group. Moreover, higher nodal properties of lesional‐hemispheric cingulate cortex (nodal efficiency: left, p = .0389; right, p = .0169; nodal vulnerability: left, p = .0185; right, p = .0085) and upper limb region of primary motor cortex (PMC; nodal efficiency: left, p = .0132; right, p = .0001; nodal vulnerability: left, p = .0091; right, p = .0209) were found in the SMA group. Nodal efficiency and nodal vulnerability of cingulate cortex and upper limb region of PMC were important predictors for SMA syndrome occurring and recovery time prolonging. Neurosurgeons should carefully deal with upper limb region of PMC and cingulate cortex, and protect them if these two region were unnecessary to damage during SMA glioma resection.
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Affiliation(s)
- Shengyu Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lianwang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shimeng Weng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhong Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Research Unit of Accurate Diagnosis, Treatment, and Translational Medicine of Brain Tumors, Chinese Academy of Medical Sciences, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Fang S, Li L, Weng S, Guo Y, Zhong Z, Fan X, Jiang T, Wang Y. Contralesional Sensorimotor Network Participates in Motor Functional Compensation in Glioma Patients. Front Oncol 2022; 12:882313. [PMID: 35530325 PMCID: PMC9072743 DOI: 10.3389/fonc.2022.882313] [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: 02/23/2022] [Accepted: 03/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Some gliomas in sensorimotor areas induce motor deficits, while some do not. Cortical destruction and reorganization contribute to this phenomenon, but detailed reasons remain unclear. This study investigated the differences of the functional connectivity and topological properties in the contralesional sensorimotor network (cSMN) between patients with motor deficit and those with normal motor function. Methods We retrospectively reviewed 65 patients (32 men) between 2017 and 2020. The patients were divided into four groups based on tumor laterality and preoperative motor status (deficit or non-deficit). Thirty-three healthy controls (18 men) were enrolled after matching for sex, age, and educational status. Graph theoretical measurement was applied to reveal alterations of the topological properties of the cSMN by analyzing resting-state functional MRI. Results The results for patients with different hemispheric gliomas were similar. The clustering coefficient, local efficiency, transitivity, and vulnerability of the cSMN significantly increased in the non-deficit group and decreased in the deficit group compared to the healthy group (p < 0.05). Moreover, the nodes of the motor-related thalamus showed a significantly increased nodal efficiency and nodal local efficiency in the non-deficit group and decreased in the deficit group compared with the healthy group (p < 0.05). Conclusions We posited the existence of two stages of alterations of the preoperative motor status. In the compensatory stage, the cSMN sacrificed stability to acquire high efficiency and to compensate for impaired motor function. With the glioma growing and the motor function being totally damaged, the cSMN returned to a stable state and maintained healthy hemispheric motor function, but with low efficiency.
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Affiliation(s)
- Shengyu Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lianwang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shimeng Weng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yuhao Guo
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhang Zhong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xing Fan, ; Tao Jiang, ; Yinyan Wang,
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Research Unit of Accurate Diagnosis, Treatment and Translational Medicine of Brain Tumors, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xing Fan, ; Tao Jiang, ; Yinyan Wang,
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- *Correspondence: Xing Fan, ; Tao Jiang, ; Yinyan Wang,
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