A network-level approach of cognitive flexibility impairment after surgery of a right temporo-parietal glioma.
Neurochirurgie. 2017-09-01; 63(4): 308-313
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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).
(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
Copyright © 2017 Elsevier Masson SAS. All rights reserved.
PMID: 28882599 [Indexed for MEDLINE]