Abstract
Simple SummaryConnectomics enables us to map whole brain networks that can be applied to operative neurosurgery to improve neuro-oncological outcomes. Damage to the superior frontal gyrus during frontal lobe surgery is thought to induce supplementary motor area (SMA) syndrome in patients. However, network-based modeling may provide a more accurate cortical model of SMA syndrome, including the Frontal Aslant Tract (FAT). The aim of our study was to retrospectively assess if surgical tractography with diffusion tensor imaging (DTI) decreases the likelihood of SMA syndrome. Compared to patients who underwent surgery preserving the SFG (n = 23), patients who had their FAT and SMA networks mapped through DTI and subsequently preserved were less likely to experience transient SMA syndrome. Preserving the FAT and SMA improves functional outcomes in patients following medial frontal glioma surgery and demonstrates how network-based approaches can improve surgical outcomes.Connectomics is the use of big data to map the brain’s neural infrastructure; employing such technology to improve surgical planning may improve neuro-oncological outcomes. Supplementary motor area (SMA) syndrome is a well-known complication of medial frontal lobe surgery. The ‘localizationist’ view posits that damage to the posteromedial bank of the superior frontal gyrus (SFG) is the basis of SMA syndrome. However, surgical experience within the frontal lobe suggests that this is not entirely true. In a study on n = 45 patients undergoing frontal lobe glioma surgery, we sought to determine if a ‘connectomic’ or network-based approach can decrease the likelihood of SMA syndrome. The control group (n = 23) underwent surgery avoiding the posterior bank of the SFG while the treatment group (n = 22) underwent mapping of the SMA network and Frontal Aslant Tract (FAT) using network analysis and DTI tractography. Patient outcomes were assessed post operatively and in subsequent follow-ups. Fewer patients (8.3%) in the treatment group experienced transient SMA syndrome compared to the control group (47%) (p = 0.003). There was no statistically significant difference found between the occurrence of permanent SMA syndrome between control and treatment groups. We demonstrate how utilizing tractography and a network-based approach decreases the likelihood of transient SMA syndrome during medial frontal glioma surgery. We found that not transecting the FAT and the SMA system improved outcomes which may be important for functional outcomes and patient quality of life.
Highlights
Frontal lobe surgery has long been performed with respecting local neuroanatomy and avoiding eloquent brain areas
Lateral Lateral to this basic plane, plane, we focused on amaking coronal inwhite the deep white matter astoproximal to the we focused on making coronalacut in the cut deep matter as proximal the precentral gyrus as motor mapping would allow
Approximately two-thirds of patients (67%) had tumours directly invading the region of the Supplementary motor area (SMA) proper, while approximately one-third of patients (33%) had tumours located in the postero-medial superior frontal gyrus (SFG), involving the frontal aslant tract (FAT)
Summary
Frontal lobe surgery has long been performed with respecting local neuroanatomy and avoiding eloquent brain areas. Intra-axial cortical neurosurgery has primarily focused on avoiding motor deficits [1]. The challenge for neurosurgeons when operating on the frontal lobe is that the functional anatomy is poorly understood [2], often resulting in unpredictable post-operative functional outcomes [3]. There is a dire clinical need to surgically approach the frontal lobes with a neuroscientific framework and consider spatially distributed functional brain networks governing frontal lobe function. With rapid advances in imaging and high-throughput technologies [4], neurosurgery is entering a new era of connectome-based surgical targeting [5] and whole-brain operative planning [6], enabling us to better map the brain and begin to potentially improve neurooncological outcomes
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
