Language-Eloquent White Matter Pathway Tractography and the Course of Language Function in Glioma Patients

Ille, Sebastian; Engel, Lara; Kelm, Anna; Meyer, Bernhard; Krieg, Sandro M.

doi:10.3389/fonc.2018.00572

Cited by 36 publications

(29 citation statements)

References 46 publications

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“…Acute deficits reported immediately after surgery involving the FAT were aphasia, impairment of speech, self-initiated speech disorders, speech hesitancy, numerous pauses and delays during conversation, anomia, delays in naming and word finding difficulties, errors in verb generation tasks, perseverations, need for phonological cues, errors with reading, delay in counting, and simple calculations ( 35 , 46 – 49 ).…”

Section: Discussionmentioning

confidence: 99%

The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications

et al. 2021

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The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior frontal gyrus. Advancements in neuroimaging and refinements to anatomical dissection techniques of the human brain white matter contributed to the recent description of the FAT anatomical and functional connectivity and its role in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders. Through the application of diffusion tractography and intraoperative electrical brain stimulation, the FAT was shown to have a role in speech and language functions (verbal fluency, initiation and inhibition of speech, sentence production, and lexical decision), working memory, visual–motor activities, orofacial movements, social community tasks, attention, and music processing. Microstructural alterations of the FAT have also been associated with neurological disorders, such as primary progressive aphasia, post-stroke aphasia, stuttering, Foix–Chavany–Marie syndrome, social communication deficit in autism spectrum disorders, and attention–deficit hyperactivity disorder. We provide a systematic review of the current literature about the FAT anatomical connectivity and functional roles. Specifically, the aim of the present study relies on providing an overview for practical neurosurgical applications for the pre-operative, intra-operative, and post-operative assessment of patients with brain tumors located around and within the FAT. Moreover, some useful tests are suggested for the neurosurgical evaluation of FAT integrity to plan a safer surgery and to reduce post-operative deficits.

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Section: Discussionmentioning

confidence: 99%

The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications

et al. 2021

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“…Compared to the results of DES, navigated repetitive transcranial magnetic stimulation (nrTMS) has evolved to be a reliable tool for the non-invasive determination of language-negative sites [ 5 , 6 , 7 , 8 ]. The combination of nrTMS-based regions of interest (ROIs) with tractography algorithms has been shown to be an option for the visualization of the subcortical language network, since its correlation with the clinical status of patients has been approved [ 9 , 10 ]. Intraoperative neurophysiology, starting with nrTMS and its successful combination as an adjunct and guide for awake craniotomies, has recently been demonstrated [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Mapping for Effective Preoperative Guidance to Approach Highly Language-Eloquent Gliomas—A Large Scale Comparative Cohort Study Using a New Classification for Language Eloquence

Ille

Schroeder

Albers

et al. 2021

Cancers

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Objective: A considerable number of gliomas require resection via direct electrical stimulation (DES) during awake craniotomy. Likewise, the feasibility of resecting language-eloquent gliomas purely based on navigated repetitive transcranial magnetic stimulation (nrTMS) has been shown. This study analyzes the outcomes after preoperative nrTMS-based and intraoperative DES-based glioma resection in a large cohort. Due to the necessity of making location comparable, a classification for language eloquence for gliomas is introduced. Methods: Between March 2015 and May 2019, we prospectively enrolled 100 consecutive cases that were resected based on preoperative nrTMS language mapping (nrTMS group), and 47 cases via intraoperative DES mapping during awake craniotomy (awake group) following a standardized clinical workflow. Outcome measures were determined preoperatively, 5 days after surgery, and 3 months after surgery. To make functional eloquence comparable, we developed a classification based on prior publications and clinical experience. Groups and classification scores were correlated with clinical outcomes. Results: The functional outcome did not differ between groups. Gross total resection was achieved in more cases in the nrTMS group (87%, vs. 72% in the awake group, p = 0.04). Nonetheless, the awake group showed significantly higher scores for eloquence than the nrTMS group (median 7 points; interquartile range 6–8 vs. 5 points; 3–6.75; p < 0.0001). Conclusion: Resecting language-eloquent gliomas purely based on nrTMS data is feasible in a high percentage of cases if the described clinical workflow is followed. Moreover, the proposed classification for language eloquence makes language-eloquent tumors comparable, as shown by its correlation with functional and radiological outcomes.

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“…Previous studies have suggested that the brain structural network of patients with brain disorders (including stroke, cerebrovascular disease, and tumor‐related lesions) may be disrupted, some of which are related to cognitive dysfunction (Du et al., 2019; Ille, Engel, Kelm, Meyer, & Krieg, 2018; Urbanski et al., 2011). Despite a growing body of the literature on examining tumor‐affected brains through DTT technique (Abhinav, Yeh, Mansouri, Zadeh, & Fernandez‐Miranda, 2015; Conti Nibali et al., 2019; Incekara et al., 2018), a few studies have endeavored to study the effects of glioma from a whole‐brain perspective.…”

Section: Introductionmentioning

confidence: 99%

Alterations of white matter integrity associated with cognitive deficits in patients with glioma

Liu

et al. 2020

Brain and Behavior

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Objective This study aimed to investigate the characteristic of brain structural connections in glioma patients and further evaluate the relationship between changes in the white matter tracts and cognitive decline. Methods This retrospective study included a total of 35 subjects with glioma and 14 demographically matched healthy controls, who underwent diffusion tensor imaging scans and formal neuropsychological assessment tests. Fractional anisotropy (FA) values of white matter tracts were derived from atlas‐based analysis to compare group differences. Furthermore, subgroup‐level analysis was performed to differentiate the effects of tumor location on white matter tracts. Partial correlation analysis was used to examine the associations between neurocognitive assessments and the integrity of tracts. Region of interest‐based network analysis was performed to validate the alteration of structural brain network in subjects with glioma. Results Compared with controls, subjects with glioma exhibited reduced FA values in the right uncinate fasciculus. Besides, subjects with glioma exhibited worse performance in several cognitive assessments. Partial correlation analysis indicated that the FA value in the right superior longitudinal fasciculus temporal part was significantly positively correlated with scores of visual–spatial abilities in subjects with glioma in the right temporal lobe ( r = .932, p = .002). Region of interest‐based network analysis revealed that subjects with glioma exhibited reduced FA, fiber length (FL), and fiber number (FN) between specific brain regions compared with controls. Conclusion The present study demonstrated the reduced integrity of white matter tracts and altered structural connectivity in brain networks in patients with glioma. Notably, white matter tracts in the right hemisphere might be vulnerable to the effects of a frontal or temporal lesion and might be associated with deficient cognitive function.

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Language-Eloquent White Matter Pathway Tractography and the Course of Language Function in Glioma Patients

Cited by 36 publications

References 46 publications

The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications

The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications

Non-Invasive Mapping for Effective Preoperative Guidance to Approach Highly Language-Eloquent Gliomas—A Large Scale Comparative Cohort Study Using a New Classification for Language Eloquence

Alterations of white matter integrity associated with cognitive deficits in patients with glioma

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