Brain network changes in patients with glioma-related epilepsy after frontal resection

Clinical factors such as IDH status, preoperative seizures, and frontal tumor location influence the prognosis of postoperative glioma-related epilepsy (GRE), but the underlying network-level mechanisms remain unclear. This study aimed to identify network-based predictors of postoperative GRE.

The authors retrospectively analyzed 109 patients with frontal glioma (76 left sided). All patients underwent preoperative and 1-week postoperative resting-state functional MRI and diffusion tensor imaging. Changes in network characteristics, including structural-functional coupling and functional connectivity (FC), were evaluated. Using the left-sided cohort as the training set, Cox proportional hazards regression analysis was applied to identify network-based risk factors for postoperative GRE and construct a predictive model. The right-sided cohort served as a validation set.

Patients with postoperative GRE showed reduced structural-functional coupling between the dorsal attention network (DAN) and the frontoparietal network (FPN), along with decreased FC within and between these networks. Increased DAN-FPN coupling and higher FC between the lesional-hemisphere prefrontal thalamus and the whole brain were protective against postoperative GRE. The area under the receiver operating characteristic curve was 0.785 in the training cohort and 0.922 in the validation cohort (both p < 0.0001).

Altered structural-functional coupling and FC between attention-related networks are associated with postoperative GRE in frontal glioma. Enhanced DAN-FPN coupling and thalamocortical connectivity may serve as protective network markers.