Damage of the right dorsal superior longitudinal fascicle by awake surgery for glioma causes persistent visuospatial dysfunction

Riho Nakajima,Masashi Kinoshita,Tetsutaro Yahata,Katsuyoshi Miyashita,Ryoji Genda,Mitsutoshi Nakada,Hirokazu Okita,Yutaka Hayashi

doi:10.1038/s41598-017-17461-4

Riho Nakajima, Masashi Kinoshita + Show 6 more

Open Access

https://doi.org/10.1038/s41598-017-17461-4

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Abstract

Patients with glioma frequently present with neuropsychological deficits preoperatively and/or postoperatively, and these deficits may remain after the chronic phase. However, little is known about postoperative recovery course of right hemispheric function. We therefore studied the characteristics and causes of persistent cognitive dysfunction in right cerebral hemispheric glioma. Eighteen patients who underwent awake surgery participated in this study. All patients who received preoperative neuropsychological examinations were assigned to two groups according to their test results: preoperative deficit and normal. They were reassessed 1 week and 3 months after surgery. The rates of remaining deficits in the deficit group at chronic phase were higher than those of the normal group for all functions. Despite preoperative normal function, the remaining rate for visuospatial cognitive deficits was the highest among all functions. The voxel-based lesion-symptom mapping analysis for visuospatial cognition revealed that a part of the medial superior and middle frontal gyri were resected with high probability in patients with low visuospatial cognitive accuracy. Our study indicates that in patients with preoperative neuropsychological deficits, these deficits tend to remain until the chronic phase. Visuospatial dysfunction frequently persists until the chronic phase, which might reflect damage to the superior longitudinal fasciclus I and II.

Highlights

Since the left cerebral hemisphere has language network, preserving its network during glioma or epilepsy surgery has been considered as essential strategy
When preoperative cognitive deficits are caused by mass effects or edema, recovery can be expected with high probability[8,9]
Several neuropsychological assessments were performed before surgery, and patients were divided into two groups; namely, the normal and preoperative deficit groups according to the results of neuropsychological assessments for every function (Fig. 1)

Summary

Introduction

Since the left cerebral hemisphere has language network, preserving its network during glioma or epilepsy surgery has been considered as essential strategy. Cognitive dysfunctions in patients with glioma are sometimes observed preoperatively because of damage by the tumor itself or by tumor-related factors such as impairments to the cortex or white matter by infiltrating tumor cells, mass effects, edema, and seizure[6,7]. When preoperative cognitive deficits are caused by mass effects or edema, recovery can be expected with high probability[8,9]. As for patients with gliomas localized in eloquent areas, while recovery of memory function occurred just after surgery and lasted for 1 year, language function was impaired just after surgery and had recovered within 3 months to 1 year[9]. The aim of this study was to examine the characteristics and causes of persistent cognitive dysfunction in patients with right cerebral hemispheric lower grade glioma

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