Pre-Surgery Cognitive Performance and Voxel-Based Lesion-Symptom Mapping in Patients with Left High-Grade Glioma

Abstract

(1) Background: The literature on the effects of high-grade glioma (HGG) growth on cognition is still scarce. (2) Method: A consecutive series of 85 patients with HGG involving the left hemisphere underwent an extended neuropsychological evaluation prior to surgery. Voxel-based lesion-symptom mapping (VLSM) was used to identify regions related to cognitive performance. (3) Results: The patients’ mean level of pre-surgery accuracy was overall high. They showed the greatest difficulties in language with tasks such as naming (42.1% of patients impaired on nouns and 61.4% on verbs), reading (36.3% on words and 32.7% on pseudo-words), auditory lexical decisions (43.9%) and writing (41.3%) being most frequently impaired. VLSM analysis revealed anatomically separated areas along the temporal cortex and the white matter related to impairments on the different tasks, with voxels commonly shared by all tasks restricted to a small region in the ventral superior and middle temporal gyrus. (4) Conclusions: High-grade glioma affects cognition; nonetheless, lesions do not cause diffuse deficits but selectively impact the different language sub-domains along the ventral stream and the dorsal stream for language processing.

Chronic aphasias after left-hemisphere resective surgery

“…Unfortunately, we did not have sufficient pre-surgical CAT assessments to address this question. Recent studies in similar samples of low-and high-grade tumour patients have reported evidence of pre-surgical action naming impairments (e.g., Guarracino et al, 2021;Pisoni et al, 2018;Tomasino et al, 2019) in addition to deficits in auditory comprehension and reading (e.g., Guarracino et al, 2021) and writing (Antonsson, Johannson, et al, 2018;Guarracino et al, 2021). Consequently, it is possible that performance on these measures is related to long term outcomes given our findings.…”

Neurocognition in adults with intracranial tumors: does location really matter?

“…These findings are in line with evidence from functional MRI studies, showing activity in similar areas during memory [ 39 ] and visual processing or flexibility tasks [ 40 , 41 ]. Although previous VLSM studies also mostly reported significant findings in temporal gyri [ 23 , 25 – 27 ], the existing results remained inconsistent [ 21 , 22 , 24 , 28 ]. This heterogeneity could partly be attributed to the use of different test materials across studies, but also to the different predominant lesion locations.…”

“…The combination of neuropsychological assessment and advanced neuroimaging techniques, can result in improved detection and individual neuropsychological risk profiling. In neuro-oncology specifically, existing voxel-based lesionsymptom mapping studies have mainly focused on glioma patients so far [21][22][23][24], with lower cognitive scores in case of lesions in middle temporal gyrus [23,[25][26][27], with possibly left hemisphere dominance for language-dependent tasks [23,26] and right dominance for visual attention or processing speed [22]. However, baseline performance of the complete population of intracranial tumors has not yet received attention in this field to date.…”