Background: Glioblastoma (GBM) is an aggressive brain tumor, with surgery being an integral part of treatment. Aggressive resections improve clinical outcomes but need to be balanced against potential functional impairment. Neuropsychological (NP) testing is an important tool neurosurgeons use to assess cognitive functioning. Importantly, associations between NP test scores and imaging biomarkers could enable a testable baseline by which to track patient outcomes over time and aid in presurgical counseling.Methods: We identified 44 patients diagnosed with primary GBM and who had detailed NP testing and presurgical imaging. Regression models for NP indices were created with tumor size, hemisphere, and lobar location as predictors. Lesion–symptom mapping (LSM) analyses were used to identify more detailed structure–function relationships.Results: Larger tumor volumes predicted worse attention, immediate memory, language, visuospatial, and overall NP performance (p< 0.05 for all). Left hemisphere involvement predicted worse attention, language, and immediate memory NP performance (p< 0.01 for all). Only visuospatial testing had lobar location significantly associated with worse scores (occipital lobe;p< 0.05). The LSM analyses identified areas around the left sagittal stratum as significantly associated with language performance (p< 0.05), with no other structure–function relationships being identified.Conclusions: These findings support the growing evidence that outside of a small number of truly critical regions, high-grade gliomas impair cognition generally, likely due to progressive tumor infiltration-associated neuroplasticity of complex parallel and interconnected networks. To investigate this, future studies should incorporate larger cohort sizes and should examine the relationship of glioma-induced network-level perturbations on cognitive decline.
背景：胶质母细胞瘤（GBM）是一种侵袭性脑肿瘤，手术是其治疗的重要组成部分。积极切除可改善临床预后，但需与潜在的功能损伤相权衡。神经心理学（NP）测试是神经外科医生评估认知功能的重要工具。重要的是，NP测试分数与影像学生物标志物之间的关联可为追踪患者长期预后提供可测试的基线，并有助于术前咨询。 方法：我们确定了44例诊断为原发性GBM的患者，这些患者接受了详细的NP测试和术前影像学检查。以肿瘤大小、半球和脑叶位置为预测因子，建立了NP指标的回归模型。采用病灶-症状映射（LSM）分析来识别更详细的结构-功能关系。 结果：较大的肿瘤体积预示着更差的注意力、即时记忆、语言、视觉空间和整体NP表现（所有p < 0.05）。左半球受累预示着更差的注意力、语言和即时记忆NP表现（所有p < 0.01）。只有视觉空间测试的脑叶位置与更差的分数显著相关（枕叶；p < 0.05）。LSM分析发现左侧矢状层周围区域与语言表现显著相关（p < 0.05），未发现其他结构-功能关系。 结论：这些发现支持了越来越多的证据，即除了少数真正关键区域外，高级别胶质瘤普遍损害认知，这可能是由于进行性肿瘤浸润相关的复杂并行和互连网络的神经可塑性所致。为研究这一点，未来的研究应纳入更大的队列规模，并应检查胶质瘤诱导的网络水平扰动与认知衰退的关系。
Impact of High-Grade Glioma Lesion Location on Preoperative Neuropsychological Deficits
肿瘤(癌症)患者之家