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Towards a tractography-based risk stratification model for language area associated gliomas
Mehmet Salih Tuncer1, Luca Francesco Salvati2, Ulrike Grittner3
1Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Neuroimage. Clinical
|January 5, 2021
Summary
Tractography of language pathways aids in predicting post-surgery aphasia risk. Injury to the temporo-parieto-occipital junction and temporal stem are key indicators of persistent language deficits after glioma surgery.
Area of Science:
- Neurosurgery
- Neuroimaging
- Neurolinguistics
Background:
- Glioma surgery near language areas risks permanent neurological deficits.
- Standardized tractography is crucial for predicting language outcomes.
Purpose of the Study:
- To establish standardized tractography of language pathways as a predictor of language outcome in neurosurgery.
- To identify specific white matter tracts and regions critical for language function.
Main Methods:
- Prospective analysis of 50 patients with left perisylvian gliomas.
- Preoperative Diffusion-Tensor-Imaging (DTI)-based tractography of 5 main language tracts.
- Correlation analysis of tractography results with language status assessed using the Aachen Aphasia Test and Berlin Aphasia Score.
Main Results:
- 28% of patients developed new aphasic symptoms post-surgery.
- Preoperative Arcuate Fasciculus (AF) infiltration correlated with functional worsening.
- Injury to the temporo-parieto-occipital junction (TPO) and temporal stem significantly increased aphasia risk.
Conclusions:
- Tractography of language pathways can pre-surgically determine individual aphasia risk profiles.
- The TPO and temporal stem/peri-insular white matter are critical functional nodes sensitive to surgical injury.
