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Tumor location and neurocognitive function-Unravelling the association and identifying relevant anatomical substrates
Kanchi Shah1,2, Vinayak Bhartia3, Chandrima Biswas1,2
1Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.
Background:
Neurocognitive function is a key outcome indicator of therapy in brain tumors. Understanding the underlying anatomical substrates involved in domain function and the pathophysiological basis of dysfunction can help ameliorate the effects of therapy and tailor directed rehabilitative strategies.
Methods:
Hundred adult diffuse gliomas were co-registered onto a common demographic-specific brain template to create tumor localization maps. Voxel-based lesion symptom (VLSM) technique was used to assign an association between individual voxels and neuropsychological dysfunction in various domains (attention and executive function (A & EF), language, memory, visuospatial/constructive abilities, and visuomotor speed). The probability maps thus generated were further co-registered to cortical and subcortical atlases. A permutation-based statistical testing method was used to evaluate the statistically and clinically significant anatomical parcels associated with domain dysfunction and to create heat maps.
Results:
Neurocognition was affected in a high proportion of subjects (93%), with A & EF and memory being the most affected domains. Left-sided networks were implicated in patients with A & EF, memory, and language deficits with the perisylvian white matter tracts being the most common across domains. Visuospatial dysfunction was associated with lesions involving the right perisylvian cortical regions, whereas deficits in visuomotor speed were associated with lesions involving primary visual and motor output pathways.
Conclusions:
Significant baseline neurocognitive deficits are prevalent in gliomas. These are multidomain and the perisylvian network especially on the left side seems to be very important, being implicated in dysfunction of many domains.
Insights
Neurocognitive deficits are common in glioma patients, impacting attention, executive function, and memory. Left-sided perisylvian networks are crucial for multiple cognitive domains, highlighting their importance in brain tumor rehabilitation.
Area of Science:
- Neuroscience
- Oncology
- Neuroimaging
Background:
- Neurocognitive function is a critical indicator of treatment outcomes in brain tumor patients.
- Understanding the anatomical basis of cognitive dysfunction aids in therapy amelioration and rehabilitation.
- Diffuse gliomas significantly impact neurocognition, necessitating detailed anatomical correlation.
Purpose of the Study:
- To map tumor locations in diffuse gliomas and correlate them with specific neurocognitive deficits.
- To identify critical brain networks associated with various cognitive domains affected by gliomas.
- To create heat maps illustrating the anatomical substrates of neurocognitive dysfunction.
Main Methods:
- Co-registration of 100 adult diffuse gliomas onto a brain template to create tumor localization maps.
- Voxel-based lesion symptom mapping (VLSM) to associate voxel-wise lesion data with neuropsychological test performance.
- Statistical analysis using permutation testing to identify significant anatomical correlates of cognitive deficits and generate heat maps.
Main Results:
- A high prevalence (93%) of neurocognitive deficits was observed, with attention/executive function (A & EF) and memory being most affected.
- Left-sided perisylvian white matter tracts were frequently implicated in A & EF, memory, and language deficits.
- Visuospatial deficits correlated with right perisylvian cortical lesions, and visuomotor speed deficits with primary visual/motor pathway lesions.
Conclusions:
- Baseline neurocognitive deficits are prevalent and multidomain in glioma patients.
- The left-sided perisylvian network is critically important, contributing to dysfunction across multiple cognitive domains.
- Identifying these anatomical correlates can guide targeted neuro-rehabilitation strategies for glioma survivors.
