Abstract
Objective: Resting-state functional MRI (rs-fMRI) has been used to evaluate brain network connectivity as a result of intracranial surgery but has not been used to compare different neurosurgical procedures. Laser interstitial thermal therapy (LITT) is an alternative to conventional craniotomy for the treatment of brain lesions such as tumors and epileptogenic foci. While LITT is thought of as minimally invasive, its effect on the functional organization of the brain is still under active investigation and its impact on network changes compared to conventional craniotomy has not yet been explored. We describe a novel computational method for quantifying and comparing the impact of two neurosurgical procedures on brain functional connectivity.Methods: We used a previously described seed-based correlation analysis to generate resting-state network (RSN) correlation matrices, and compared changes in correlation patterns within and across RSNs between LITT and conventional craniotomy for treatment of 24 patients with singular intracranial tumors at our institution between 2014 and 2017. Specifically, we analyzed the differences in patient-specific changes in the within-hemisphere correlation patterns of the contralesional hemisphere.Results: In a post-operative follow-up period up to 2 years within-hemisphere connectivity of the contralesional hemisphere after surgery was more highly correlated to the pre-operative state in LITT patients when compared to craniotomy patients (P = 0.0287). Moreover, 4 out of 11 individual RSNs demonstrated significantly higher degrees of correlation between pre-operative and post-operative network connectivity in patients who underwent LITT (all P < 0.05).Conclusion: Rs-fMRI may be used as a quantitative metric to determine the impact of different neurosurgical procedures on brain functional connectivity. Global and individual network connectivity in the contralesional hemisphere may be more highly preserved after LITT when compared to craniotomy for the treatment of brain tumors.
Highlights
Resting-state functional MRI is an imaging technique that has provided significant insight into the functional organization of the brain in both healthy and pathologic states
We demonstrate for the first time the use of a simple yet reproducible quantitative approach using rs-fMRI to illustrate the differences in impact that two surgical approaches have on the functional organization of the brain in patients with singular intra-axial brain tumors
Patients who underwent laser interstitial thermal therapy (LITT) trended toward being likely to have had a prior needle biopsy compared to craniotomy patients
Summary
Resting-state functional MRI (rs-fMRI) is an imaging technique that has provided significant insight into the functional organization of the brain in both healthy and pathologic states. Extensive analyses of the correlation patterns of BOLD fluctuations have revealed networks such as the somatosensory, language, visual and auditory networks, among others (Power et al, 2011; Yeo et al, 2011) These resting-state networks (RSNs) correspond anatomically to the topography of task-based fMRI activity (Smith et al, 2009; Hacker et al, 2019; Park et al, 2020). The functional connectivity between the contralesional primary sensorimotor cortex and the bilateral primary sensorimotor cortex in patients who experienced stroke was found to initially decrease increase over time and correlated with clinical recovery of motor function (Xu et al, 2014) This suggests that functional connectivity and neuroplasticity can be dynamically quantified after neurologic injury using rs-fMRI. Combined with diffusion tensor imaging for tractography, rs-fMRI is an emerging tool for preoperative neurosurgical planning as well as an intra-operative navigational technique for avoidance of eloquent structures (Dierker et al, 2017; Roland et al, 2017, 2019; Leuthardt et al, 2018)
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