A network-level approach of cognitive flexibility impairment after surgery of a right temporo-parietal glioma.
Neurochirurgie. 2017-09-01; 63(4): 308-313
DOI: 10.1016/j.neuchi.2017.03.003
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1. Neurochirurgie. 2017 Sep;63(4):308-313. doi: 10.1016/j.neuchi.2017.03.003. Epub
2017 Sep 4.
A network-level approach of cognitive flexibility impairment after surgery of a
right temporo-parietal glioma.
Mandonnet E(1), Cerliani L(2), Siuda-Krzywicka K(2), Poisson I(3), Zhi N(4),
Volle E(2), de Schotten MT(2).
Author information:
(1)Department of neurosurgery, hôpital Lariboisière, AP-HP, 75010 Paris, France;
University Paris 7, 75010 Paris, France; IMNC UMR8165, 91405 Orsay, France.
Electronic address: .
(2)Brain connectivity and behaviour group, Frontlab, 75013 Paris, France; Inserm,
CNRS, institut du cerveau et la moelle (ICM), hôpital Pitié-Salpêtrière, UPMC
université Paris 06, Sorbonne universités, 75013 Paris, France.
(3)Department of neurology, hôpital Lariboisière, AP-HP, 75010 Paris, France.
(4)University Paris 7, 75010 Paris, France; Department of neuroradiology, hôpital
Lariboisière, AP-HP, 75010 Paris, France.
OBJECTIVE: The right « non-dominant » temporo-parietal junction is usually not
considered as a highly eloquent area. This contrasts with its mirrored left
« dominant » counterpart, which is known as highly eloquent regarding language
function. The question arises about which functions should be monitored when
operating lesions of the right temporo-parietal junction under awake conditions.
METHODS: We report the case of a patient who underwent a surgical resection of a
glioma located in the right temporo-parietal junction. Cognitive evaluations were
performed preoperatively and 4 months after surgery, as well as resting state
fMRI and diffusion-based tractography.
RESULTS: Long-term postoperative cognitive examination revealed an important
deterioration of cognitive control abilities, especially regarding set-shifting
abilities as measured by Trail making test part B. Based on pre- and
postoperative resting state fMRI and diffusion-based tractography, we demonstrate
that surgical resection massively impacted structural and functional connectivity
of the right fronto-parieto-temporal network, a network that is classically
involved in cognitive control, reasoning and working memory.
CONCLUSION: This case clearly illustrates how a white matter focal lesion can
generate a neuropsychological deficit by remotely disconnecting distant cortical
areas belonging to a functional network. Furthermore, our observation strongly
supports the use of intraoperative cognitive control tests during surgery of the
right temporo-parietal junction and promote the interest of pre and postoperative
resting state functional connectivity to explore the potential mechanisms causing
cognitive deficits.
Copyright © 2017 Elsevier Masson SAS. All rights reserved.
DOI: 10.1016/j.neuchi.2017.03.003
PMID: 28882599 [Indexed for MEDLINE]