Esther J J Habets1, Eef J Hendriks2, Martin J B Taphoorn3,4, Linda Douw5,6, Aeilko H Zwinderman7, W Peter Vandertop8, Frederik Barkhof2,9, Philip C De Witt Hamer8, Martin Klein10. 1. Department of Neurology, Haaglanden Medical Center, Lijnbaan 32, PO BOX 432, The Hague, 2501 CK, The Netherlands. e.habets@haaglandenmc.nl. 2. Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. 3. Department of Neurology, Haaglanden Medical Center, Lijnbaan 32, PO BOX 432, The Hague, 2501 CK, The Netherlands. 4. Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands. 5. Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands. 6. Department of Radiology, Athinoula Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Charlestown, MA, USA. 7. Department of Clinical Epidemiology and Biostatistics, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. 8. Neurosurgical Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam University Medical Center, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. 9. Institutes of Neurology & Healthcare Engineering, University College London, Gower st, Bloomsbury, London WC1E 6BT, UK. 10. Department of Medical Psychology and Brain Tumor Center, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
Abstract
INTRODUCTION: Patients with diffuse glioma often experience neurocognitive impairment already prior to surgery. Pertinent information on whether damage to a specific brain region due to tumor activity results in neurocognitive impairment or not, is relevant in clinical decision-making, and at the same time renders unique information on brain lesion location and functioning relationships. To examine the impact of tumor location on preoperative neurocognitive functioning (NCF), we performed MRI based lesion-symptom mapping. METHODS: Seventy-two patients (mean age 40 years) with a radiologically suspected glioma were recruited preoperatively. For each of the six cognitive domains tested, we used tumor localization maps and voxel-based lesion-symptom mapping analyses to identify cortical and subcortical regions associated with NCF impairment. RESULTS: Compared to healthy controls, preoperative NCF was significantly impaired in all cognitive domains. Most frequently affected were attention (30% of patients) and working memory (20% of patients). Deficits in attention were significantly associated with regions in the left frontal and parietal cortex, including the precentral and parietal-opercular cortex, and in left-sided subcortical fiber tracts, including the arcuate fasciculus and corticospinal tract. Surprisingly, no regions could be related to working memory capacity. For the other neurocognitive domains, impairments were mainly associated with regions in the left hemisphere. CONCLUSIONS: Prior to treatment, patients with diffuse glioma in the left hemisphere run the highest risk to have NCF deficits. Identification of a left frontoparietal network involved in NCF not only may optimize surgical procedures but may also be integrated in counseling and cognitive rehabilitation for these patients.
INTRODUCTION:Patients with diffuse glioma often experience neurocognitive impairment already prior to surgery. Pertinent information on whether damage to a specific brain region due to tumor activity results in neurocognitive impairment or not, is relevant in clinical decision-making, and at the same time renders unique information on brain lesion location and functioning relationships. To examine the impact of tumor location on preoperative neurocognitive functioning (NCF), we performed MRI based lesion-symptom mapping. METHODS: Seventy-two patients (mean age 40 years) with a radiologically suspected glioma were recruited preoperatively. For each of the six cognitive domains tested, we used tumor localization maps and voxel-based lesion-symptom mapping analyses to identify cortical and subcortical regions associated with NCF impairment. RESULTS: Compared to healthy controls, preoperative NCF was significantly impaired in all cognitive domains. Most frequently affected were attention (30% of patients) and working memory (20% of patients). Deficits in attention were significantly associated with regions in the left frontal and parietal cortex, including the precentral and parietal-opercular cortex, and in left-sided subcortical fiber tracts, including the arcuate fasciculus and corticospinal tract. Surprisingly, no regions could be related to working memory capacity. For the other neurocognitive domains, impairments were mainly associated with regions in the left hemisphere. CONCLUSIONS: Prior to treatment, patients with diffuse glioma in the left hemisphere run the highest risk to have NCF deficits. Identification of a left frontoparietal network involved in NCF not only may optimize surgical procedures but may also be integrated in counseling and cognitive rehabilitation for these patients.
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