Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas
When diffuse gliomas (DG) affect the brain’s potential to reorganize functional networks, patients can exhibit seizures and/or language/cognitive impairment. The tumor–brain interaction and the individual connectomic organization cannot be predicted preoperatively. We aimed to, first, investigate th...
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doaj-d2a7a3f0dce1467fb59d84c3da5788eb2021-03-08T00:00:11ZengMDPI AGJournal of Clinical Medicine2077-03832021-03-01101108110810.3390/jcm10051108Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse GliomasFrancesco Latini0Hans Axelson1Markus Fahlström2Malin Jemstedt3Åsa Alberius Munkhammar4Maria Zetterling5Mats Ryttlefors6Department of Neuroscience, Section of Neurosurgery, Uppsala University, 75185 Uppsala, SwedenDepartment of Neuroscience, Section of Clinical Neurophysiology, Uppsala University, 75185 Uppsala, SwedenDepartment of Surgical Sciences, Section of Radiology, Uppsala University, 75185 Uppsala, SwedenDepartment of Neuroscience, Speech-Language Pathology, Uppsala University, 75185 Uppsala, SwedenRehabilitation and Pain Centre, Uppsala University Hospital, 75185 Uppsala, SwedenDepartment of Neuroscience, Section of Neurosurgery, Uppsala University, 75185 Uppsala, SwedenDepartment of Neuroscience, Section of Neurosurgery, Uppsala University, 75185 Uppsala, SwedenWhen diffuse gliomas (DG) affect the brain’s potential to reorganize functional networks, patients can exhibit seizures and/or language/cognitive impairment. The tumor–brain interaction and the individual connectomic organization cannot be predicted preoperatively. We aimed to, first, investigate the relationship between preoperative assessment and intraoperative findings of eloquent tumors in 36 DG operated with awake surgery. Second, we also studied possible mechanisms of tumor-induced brain reorganization in these patients. FLAIR-MRI sequences were used for tumor volume segmentation and the Brain-Grid system (BG) was used as an overlay for infiltration analysis. Neuropsychological (NPS) and/or language assessments were performed in all patients. The distance between eloquent spots and tumor margins was measured. All variables were used for correlation and logistic regression analyses. Eloquent tumors were detected in 75% of the patients with no single variable able to predict this finding. Impaired NPS functions correlated with invasive tumors, crucial location (A4C2S2/A3C2S2-voxels, left opercular-insular/sub-insular region) and higher risk of eloquent tumors. Epilepsy was correlated with larger tumor volumes and infiltrated A4C2S2/A3C2S2 voxels. Language impairment was correlated with infiltrated A3C2S2 voxel. Peritumoral cortical eloquent spots reflected an early compensative mechanism with age as possible influencing factor. Preoperative NPS impairment is linked with high risk of eloquent tumors. A systematic integration of extensive cognitive assessment and advanced neuroimaging can improve our comprehension of the connectomic brain organization at the individual scale and lead to a better oncological/functional balance.https://www.mdpi.com/2077-0383/10/5/1108diffuse gliomaseloquent tumorsawake surgeryneuropsychological assessmentlanguage assessmentepilepsy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Francesco Latini Hans Axelson Markus Fahlström Malin Jemstedt Åsa Alberius Munkhammar Maria Zetterling Mats Ryttlefors |
spellingShingle |
Francesco Latini Hans Axelson Markus Fahlström Malin Jemstedt Åsa Alberius Munkhammar Maria Zetterling Mats Ryttlefors Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas Journal of Clinical Medicine diffuse gliomas eloquent tumors awake surgery neuropsychological assessment language assessment epilepsy |
author_facet |
Francesco Latini Hans Axelson Markus Fahlström Malin Jemstedt Åsa Alberius Munkhammar Maria Zetterling Mats Ryttlefors |
author_sort |
Francesco Latini |
title |
Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas |
title_short |
Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas |
title_full |
Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas |
title_fullStr |
Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas |
title_full_unstemmed |
Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas |
title_sort |
role of preoperative assessment in predicting tumor-induced plasticity in patients with diffuse gliomas |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-03-01 |
description |
When diffuse gliomas (DG) affect the brain’s potential to reorganize functional networks, patients can exhibit seizures and/or language/cognitive impairment. The tumor–brain interaction and the individual connectomic organization cannot be predicted preoperatively. We aimed to, first, investigate the relationship between preoperative assessment and intraoperative findings of eloquent tumors in 36 DG operated with awake surgery. Second, we also studied possible mechanisms of tumor-induced brain reorganization in these patients. FLAIR-MRI sequences were used for tumor volume segmentation and the Brain-Grid system (BG) was used as an overlay for infiltration analysis. Neuropsychological (NPS) and/or language assessments were performed in all patients. The distance between eloquent spots and tumor margins was measured. All variables were used for correlation and logistic regression analyses. Eloquent tumors were detected in 75% of the patients with no single variable able to predict this finding. Impaired NPS functions correlated with invasive tumors, crucial location (A4C2S2/A3C2S2-voxels, left opercular-insular/sub-insular region) and higher risk of eloquent tumors. Epilepsy was correlated with larger tumor volumes and infiltrated A4C2S2/A3C2S2 voxels. Language impairment was correlated with infiltrated A3C2S2 voxel. Peritumoral cortical eloquent spots reflected an early compensative mechanism with age as possible influencing factor. Preoperative NPS impairment is linked with high risk of eloquent tumors. A systematic integration of extensive cognitive assessment and advanced neuroimaging can improve our comprehension of the connectomic brain organization at the individual scale and lead to a better oncological/functional balance. |
topic |
diffuse gliomas eloquent tumors awake surgery neuropsychological assessment language assessment epilepsy |
url |
https://www.mdpi.com/2077-0383/10/5/1108 |
work_keys_str_mv |
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