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Presurgical Executive Functioning in Low-Grade Glioma Patients Cannot Be Topographically Mapped.

Maud J F Landers1,2, Lars Smolders1,3, Geert-Jan M Rutten1

  • 1Department of Neurosurgery, Elisabeth-Tweesteden Hospital Tilburg, 5022 GC Tilburg, The Netherlands.

Cancers
|February 11, 2023
PubMed
Summary

Executive dysfunction is common in low-grade glioma patients, but tumor location and white matter integrity do not predict cognitive deficits. Novel methods are needed to understand these complex executive impairments.

Keywords:
executive functionsfrontoparietal networklow-grade gliomasuperior longitudinal fasciculustractography

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Area of Science:

  • Neuroscience
  • Oncology
  • Cognitive Psychology

Background:

  • Executive dysfunctions are prevalent in patients with low-grade gliomas, potentially due to structural brain disconnections.
  • Limited research exists on preoperative executive function deficits in this patient population.
  • The frontotemporoparietal network, supported by the superior longitudinal fasciculus, is crucial for executive functions.

Purpose of the Study:

  • To investigate the relationship between structural predictors and executive functions in patients with IDH-mutated low-grade gliomas.
  • To assess the impact of tumor proximity to the superior longitudinal fasciculus and network integrity on executive performance.

Main Methods:

  • Analysis of 156 patients with IDH-mutated low-grade gliomas from two neurological centers.
  • Preoperative predictors included tumor distance to the superior longitudinal fasciculus, its structural integrity, tumor-cortical network overlap, and white matter disconnection.
  • Linear regression and random forest analyses were employed to evaluate these predictors.

Main Results:

  • Patients exhibited significantly lower executive performance and a higher prevalence of impairments compared to normative data.
  • Neither tumor structural proximity, white matter integrity, cortical network overlap, nor network disconnection significantly predicted executive performance.
  • The study yielded null results, indicating no straightforward topographical explanation for executive deficits.

Conclusions:

  • The findings suggest that executive deficits in low-grade glioma patients are not solely explained by simple topographical or structural disconnection models.
  • Plasticity-induced network-level equipotentiality is discussed as a potential explanatory mechanism.
  • There is a critical need for developing novel methodologies to elucidate the complex, interacting factors underlying executive dysfunction in these patients.