Objective: Gliomas disrupt functional brain networks and impair neurological functions. While left-hemispheric tumors are well-studied because of their impact on language domains, the influence of right-sided gliomas on higher cognitive functions remains less understood. This study aimed to assess pre- and postoperative neurocognitive performance and to link cognitive outcomes with structural findings derived from function-based tractography in patients with right-hemispheric gliomas. Methods: Patients with gliomas were enrolled in this prospective observational study. A structured neurocognitive test battery was administered preoperatively, postoperatively, and at 3-month follow-up. Preoperative cortical mapping using navigated transcranial magnetic stimulation (nTMS) and function-based fiber tracking, based on diffusion tensor imaging (DTI), was performed. Results: Eighteen patients aged 52.7 ± 18.3 years were included. Preoperatively, 88.8% of patients showed impairments in at least one cognitive test, most frequently in the Nine-Hole Peg Test (66.7%), Bells Test task completion time (61.1%), Trail Making Test A and B (TMT-A: 50.0%; TMT-B: 44.4%), and digit symbol substitution test (27.8%). At follow-up, task performance improved on most cognitive tests. Function-based tractography showed that involvement of the superior longitudinal fasciculi I–III (44.4% of cases) was associated with impairments in attention, executive function, visuospatial processing, and processing speed. The involvement of the inferior frontooccipital fasciculus (55.5% of cases) was related to deficits in processing speed, attention, executive function, and episodic memory. Conclusions: Neurocognitive deficits are common in patients with right-hemispheric gliomas even before surgery. Maximal safe resection and sparing of these tracts is associated with cognitive recovery at follow-up. Function-based tractography emphasizes the structural involvement of key association fibers related to these cognitive deficits.
目的：胶质瘤会破坏功能性脑网络并损害神经功能。虽然左半球肿瘤因其对语言功能区的影响已得到充分研究，但右侧胶质瘤对高级认知功能的影响仍不甚明确。本研究旨在评估右侧半球胶质瘤患者术前及术后的神经认知表现，并将认知结果与基于功能束成像的结构性发现相关联。方法：本研究为前瞻性观察性研究，纳入胶质瘤患者。在术前、术后及术后3个月随访时，采用结构化神经认知测试组合进行评估。术前通过导航经颅磁刺激（nTMS）进行皮质功能定位，并基于弥散张量成像（DTI）进行功能性纤维束追踪。结果：共纳入18例患者，年龄52.7±18.3岁。术前，88.8%的患者在至少一项认知测试中表现出障碍，最常见于九孔柱测试（66.7%）、Bells测试任务完成时间（61.1%）、连线测试A和B（TMT-A：50.0%；TMT-B：44.4%）以及数字符号替换测试（27.8%）。随访时，多数认知测试的任务表现有所改善。功能性束成像显示，上纵束I–III受累（44.4%的病例）与注意力、执行功能、视觉空间处理及处理速度障碍相关。额枕下束受累（55.5%的病例）则与处理速度、注意力、执行功能及情景记忆缺陷相关。结论：神经认知缺陷在右侧半球胶质瘤患者中普遍存在，甚至在术前即可出现。最大范围安全切除肿瘤并保留这些纤维束与随访期间的认知功能恢复相关。功能性束成像强调了与这些认知缺陷相关的关键联合纤维的结构性受累。
肿瘤(癌症)患者之家