Towards a tractography-based risk stratification model for language area associated gliomas

Mehmet Salih Tuncer; Luca Francesco Salvati; Ulrike Grittner; Juliane Hardt; Ralph Schilling; Ina Bährend; Luca Leandro Silva; Lucius S. Fekonja; Katharina Faust; Peter Vajkoczy; Tizian Rosenstock; Thomas Picht

NeuroImage: Clinical (Jan 2021)

Towards a tractography-based risk stratification model for language area associated gliomas

Mehmet Salih Tuncer,
Luca Francesco Salvati,
Ulrike Grittner,
Juliane Hardt,
Ralph Schilling,
Ina Bährend,
Luca Leandro Silva,
Lucius S. Fekonja,
Katharina Faust,
Peter Vajkoczy,
Tizian Rosenstock,
Thomas Picht

Affiliations

Mehmet Salih Tuncer: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Luca Francesco Salvati: Department of Neurosurgery, University of Turin, Turin, Italy
Ulrike Grittner: Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
Juliane Hardt: Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany; Hochschule Hannover – University of Applied Sciences and Arts, Fakultät III, Department Information and Communication, Medical Information Management, Hannover, Germany
Ralph Schilling: Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
Ina Bährend: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Neurosurgery, Vivantes-Klinikum Neukölln, Berlin, Germany
Luca Leandro Silva: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
Lucius S. Fekonja: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Cluster of Excellence: “Matters of Activity. Image Space Material”, Humboldt University, Berlin, Germany
Katharina Faust: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Peter Vajkoczy: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Tizian Rosenstock: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany; Corresponding author at: Department of Neurosurgery, Charité Universitätsmedizin Berlin, Klinik für Neurochirurgie mit Arbeitsbereich Pädiatrische Neurochirurgie, Campus Charité Mitte, Luisenstraße 64, 10117 Berlin, Germany.
Thomas Picht: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Cluster of Excellence: “Matters of Activity. Image Space Material”, Humboldt University, Berlin, Germany

Journal volume & issue: Vol. 29
p. 102541

Abstract

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Objectives: Injury to major white matter pathways during language-area associated glioma surgery often leads to permanent loss of neurological function. The aim was to establish standardized tractography of language pathways as a predictor of language outcome in clinical neurosurgery. Methods: We prospectively analyzed 50 surgical cases of patients with left perisylvian, diffuse gliomas. Standardized preoperative Diffusion-Tensor-Imaging (DTI)-based tractography of the 5 main language tracts (Arcuate Fasciculus [AF], Frontal Aslant Tract [FAT], Inferior Fronto-Occipital Fasciculus [IFOF], Inferior Longitudinal Fasciculus [ILF], Uncinate Fasciculus [UF]) and spatial analysis of tumor and tracts was performed. Postoperative imaging and the resulting resection map were analyzed for potential surgical injury of tracts. The language status was assessed preoperatively, postoperatively and after 3 months using the Aachen Aphasia Test and Berlin Aphasia Score. Correlation analyses, two-step cluster analysis and binary logistic regression were used to analyze associations of tractography results with language outcome after surgery. Results: In 14 out of 50 patients (28%), new aphasic symptoms were detected 3 months after surgery. The preoperative infiltration of the AF was associated with functional worsening (cc = 0.314; p = 0.019). Cluster analysis of tract injury profiles revealed two areas particularly related to aphasia: the temporo-parieto-occipital junction (TPO; temporo-parietal AF, middle IFOF, middle ILF) and the temporal stem/peri-insular white matter (middle IFOF, anterior ILF, temporal UF, temporal AF). Injury to these areas (TPO: OR: 23.04; CI: 4.11 – 129.06; temporal stem: OR: 21.96; CI: 2.93 – 164.41) was associated with a higher-risk of persisting aphasia. Conclusions: Tractography of language pathways can help to determine the individual aphasia risk profile pre-surgically. The TPO and temporal stem/peri-insular white matter were confirmed as functional nodes particularly sensitive to surgical injuries.

Published in NeuroImage: Clinical

ISSN: 2213-1582 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General): Computer applications to medicine. Medical informatics; Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system
Website: http://www.journals.elsevier.com/neuroimage-clinical/

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