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Noll KR, Bradshaw M, Sheppard D, Wefel JS. Perioperative Neurocognitive Function in Glioma Surgery. Curr Oncol Rep 2024:10.1007/s11912-024-01522-9. [PMID: 38573439 DOI: 10.1007/s11912-024-01522-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW This review provides a concise overview of the recent literature regarding preoperative and postoperative neurocognitive functioning (NCF) in patients with glioma. Brief discussion also covers contemporary intraoperative brain mapping work, with a focus on potential influence of mapping upon NCF outcomes following awake surgery. RECENT FINDINGS Most patients with glioma exhibit preoperative NCF impairment, with severity varying by germ line and tumoral genetics, tumor grade, and lesion location, among other characteristics. Literature regarding postoperative NCF changes is mixed, though numerous studies indicate a majority of patients exhibit immediate and short-term worsening. This is often followed by recovery over several months; however, a substantial portion of patients harbor persisting declines. Decline appears related to surgically-induced structural and functional brain alterations, both local and distal to the tumor and resection cavity. Importantly, NCF decline may be mitigated to some extent by intraoperative brain mapping, including mapping of both language-mediated and nonverbal functions. Research regarding perioperative NCF in patients with glioma has flourished over recent years. While this has increased our understanding of contributors to NCF and risk of decline associated with surgical intervention, more work is needed to better preserve NCF throughout the disease course.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA.
| | - Mariana Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - David Sheppard
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Noll KR, Asman P, Tasnim I, Hall M, Connelly K, Swamy C, Ene C, Tummala S, Grasu RM, Liu HL, Kumar VA, Muir M, Prinsloo S, Michener H, Wefel JS, Ince NF, Prabhu SS. Intraoperative language mapping guided by real-time visualization of gamma band modulation electrocorticograms: Case report and proof of concept. Neurooncol Pract 2024; 11:92-100. [PMID: 38222047 PMCID: PMC10785572 DOI: 10.1093/nop/npad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Electrocorticography (ECoG) language mapping is often performed extraoperatively, frequently involves offline processing, and relationships with direct cortical stimulation (DCS) remain variable. We sought to determine the feasibility and preliminary utility of an intraoperative language mapping approach guided by real-time visualization of electrocorticograms. Methods A patient with astrocytoma underwent awake craniotomy with intraoperative language mapping, utilizing a dual iPad stimulus presentation system coupled to a real-time neural signal processing platform capable of both ECoG recording and delivery of DCS. Gamma band modulations in response to 4 language tasks at each electrode were visualized in real-time. Next, DCS was conducted for each neighboring electrode pair during language tasks. Results All language tasks resulted in strongest heat map activation at an electrode pair in the anterior to mid superior temporal gyrus. Consistent speech arrest during DCS was observed for Object and Action naming tasks at these same electrodes, indicating good correspondence with ECoG heat map recordings. This region corresponded well with posterior language representation via preoperative functional MRI. Conclusions Intraoperative real-time visualization of language task-based ECoG gamma band modulation is feasible and may help identify targets for DCS. If validated, this may improve the efficiency and accuracy of intraoperative language mapping.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priscella Asman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Israt Tasnim
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Matthew Hall
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Katherine Connelly
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chandra Swamy
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roxana M Grasu
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hayley Michener
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Catalino MP, Noll KR, Wefel JS, Michener H, Prinsloo S, Tummala S, Prabhu S. Decoding the clinical effects of low-grade glioma-induced cortical excitability. J Neurosurg 2024; 140:18-26. [PMID: 37439490 DOI: 10.3171/2023.5.jns23747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Patients with low-grade glioma (LGG) in eloquent regions often present with seizures, and findings on detailed neuropsychological testing are often abnormal. This study evaluated the association between cortical excitability, seizures, and cognitive function in patients with LGG. METHODS LGG patients who underwent transcranial magnetic stimulation (TMS) from January 2021 to December 2022 were studied. Cortical excitability was measured using the resting motor thresholds (RMTs) of the upper and lower extremities. Early postoperative seizures served as the seizure endpoint. Neuropsychological assessment was completed prior to surgery contemporaneous with the TMS studies. RESULTS A total of 31 patients were analyzed for seizure outcome. Median (interquartile range [IQR]) upper-extremity RMT was 39% (34%-46%) of maximum stimulator output, and the median (IQR) lower-extremity RMT was 69% (51%-79%). Lower-extremity RMT was higher in patients with early postoperative seizures, especially in those with motor region tumors (p = 0.02); however, RMT was not associated with seizures at presentation or long-term seizure control. A total of 26 patients completed neuropsychological assessment. There were significant negative correlations between upper-extremity RMT and psychomotor processing speed (Wechsler Adult Intelligence Scale-Fourth Edition [WAIS-IV] Processing Speed Index r = -0.42, p = 0.031; WAIS-IV Coding r = -0.41, p = 0.036; WAIS-IV Symbol Search r = -0.39, p = 0.048), executive function (Trail Making Test Part B r = -0.41, p = 0.036), and hand dexterity (Grooved Pegboard Test r = -0.50, p = 0.047). CONCLUSIONS RMT was positively correlated with early postoperative seizure risk and negatively correlated with psychomotor processing speed, executive function, and hand dexterity. These findings support the theory of local and regional resting oscillatory network dysfunction from a glioma-brain network.
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Affiliation(s)
| | | | | | - Hayley Michener
- 4Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah Prinsloo
- Departments of1Neurosurgery
- 4Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Yeh MY, Chen HS, Hou P, Kumar VA, Johnson JM, Noll KR, Prabhu SS, Ferguson SD, Schomer DF, Peng HH, Liu HL. Cerebrovascular Reactivity Mapping Using Resting-State Functional MRI in Patients With Gliomas. J Magn Reson Imaging 2022; 56:1863-1871. [PMID: 35396789 DOI: 10.1002/jmri.28194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recently, a data-driven regression analysis method was developed to utilize the resting-state (rs) blood oxygenation level-dependent signal for cerebrovascular reactivity (CVR) mapping (rs-CVR), which was previously optimized by comparing with the CO2 inhalation-based method in health subjects and patients with neurovascular diseases. PURPOSE To investigate the agreement of rs-CVR and the CVR mapping with breath-hold MRI (bh-CVR) in patients with gliomas. STUDY TYPE Retrospective. POPULATION Twenty-five patients (12 males, 13 females; mean age ± SD, 48 ± 13 years) with gliomas. FIELD STRENGTH/SEQUENCE Dynamic T2*-weighted gradient-echo echo-planar imaging during a breath-hold paradigm and during the rs on a 3-T scanner. ASSESSMENT rs-CVR with various frequency ranges and resting-state fluctuation amplitude (RSFA) were assessed. The agreement between each rs-based CVR measurement and bh-CVR was determined by voxel-wise correlation and Dice coefficient in the whole brain, gray matter, and the lesion region of interest (ROI). STATISTICAL TESTS Voxel-wise Pearson correlation, Dice coefficient, Fisher Z-transformation, repeated-measure analysis of variance and post hoc test with Bonferroni correction, and nonparametric repeated-measure Friedman test and post hoc test with Bonferroni correction were used. Significance was set at P < 0.05. RESULTS Compared with bh-CVR, the highest correlations were found at the frequency bands of 0.04-0.08 Hz and 0.02-0.04 Hz for rs-CVR in both whole brain and the lesion ROI. RSFA had significantly lower correlations than did rs-CVR of 0.02-0.04 Hz and a wider frequency range (0-0.1164 Hz). Significantly higher correlations and Dice coefficient were found in normal tissues than in the lesion ROI for all three methods. DATA CONCLUSION The optimal frequency ranges for rs-CVR are determined by comparing with bh-CVR in patients with gliomas. The rs-CVR method outperformed the RSFA. Significantly higher correlation and Dice coefficient between rs- and bh-CVR were found in normal tissue than in the lesion. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Mei-Yu Yeh
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Henry S Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hsu-Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Noll KR, Wefel J. On the classification of impairment in neuropsychological research and practice in the neuro-oncological setting. Neurooncol Pract 2022; 9:255-256. [PMID: 35859538 PMCID: PMC9290879 DOI: 10.1093/nop/npac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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Quirarte JA, Kumar VA, Liu HL, Noll KR, Wefel JS, Lang FF. Language supplementary motor area syndrome correlated with dynamic changes in perioperative task-based functional MRI activations: case report. J Neurosurg 2021; 134:1738-1742. [DOI: 10.3171/2020.4.jns193250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/03/2020] [Indexed: 11/06/2022]
Abstract
Supplementary motor area (SMA) syndrome is well known; however, the mechanism underlying recovery from language SMA syndrome is unclear. Herein the authors report the case of a right-handed woman with speech aphasia following resection of an oligodendroglioma located in the anterior aspect of the left superior frontal gyrus. The patient exhibited language SMA syndrome, and functional MRI (fMRI) findings 12 days postoperatively demonstrated a complete shift of blood oxygen level–dependent (BOLD) activation to the contralateral right language SMA/pre-SMA as well as coequal activation and an increased volume of activation in the left Broca’s area and the right Broca’s homolog. The authors provide, to the best of their knowledge, the first description of dynamic changes in task-based hemispheric language BOLD fMRI activations across the preoperative, immediate postoperative, and more distant postoperative settings associated with the development and subsequent complete resolution of the clinical language SMA syndrome.
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Affiliation(s)
| | | | - Ho-Ling Liu
- Imaging Physics, University of Texas MD Anderson Cancer Center; and
| | - Kyle R. Noll
- Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S. Wefel
- Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
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7
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Noll KR, Chen HS, Wefel JS, Kumar VA, Hou P, Ferguson SD, Rao G, Johnson JM, Schomer DF, Suki D, Prabhu SS, Liu HL. Alterations in Functional Connectomics Associated With Neurocognitive Changes Following Glioma Resection. Neurosurgery 2021; 88:544-551. [PMID: 33080024 PMCID: PMC7884148 DOI: 10.1093/neuros/nyaa453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Decline in neurocognitive functioning (NCF) often occurs following brain tumor resection. Functional connectomics have shown how neurologic insults disrupt cerebral networks underlying NCF, though studies involving patients with brain tumors are lacking. OBJECTIVE To investigate the impact of brain tumor resection upon the connectome and relationships with NCF outcome in the early postoperative period. METHODS A total of 15 right-handed adults with left perisylvian glioma underwent resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological assessment before and after awake tumor resection. Graph theoretical analysis was applied to rs-fMRI connectivity matrices to calculate network properties. Network properties and NCF measures were compared across the pre- to postoperative periods with matched pairs Wilcoxon signed-rank tests. Associations between pre- to postoperative change in network and NCF measures were determined with Spearman rank-order correlations (ρ). RESULTS A majority of the sample showed postoperative decline on 1 or more NCF measures. Significant postoperative NCF decline was found across measures of verbal memory, processing speed, executive functioning, receptive language, and a composite index. Regarding connectomic properties, betweenness centrality and assortativity were significantly smaller postoperatively, and reductions in these measures were associated with better NCF outcomes. Significant inverse associations (ρ = -.51 to -.78, all P < .05) were observed between change in language, executive functioning, and learning and memory, and alterations in segregation, centrality, and resilience network properties. CONCLUSION Decline in NCF was common shortly following resection of glioma involving eloquent brain regions, most frequently in verbal learning/memory and executive functioning. Better postoperative outcomes accompanied reductions in centrality and resilience connectomic measures.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Henry S Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dima Suki
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chen HSM, Kumar VA, Johnson JM, Chen MM, Noll KR, Hou P, Prabhu SS, Schomer DF, Liu HL. Effect of brain normalization methods on the construction of functional connectomes from resting-state functional MRI in patients with gliomas. Magn Reson Med 2021; 86:487-498. [PMID: 33533052 DOI: 10.1002/mrm.28690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Spatial normalization is an essential step in resting-state functional MRI connectomic analysis with atlas-based parcellation, but brain lesions can confound it. Cost-function masking (CFM) is a popular compensation approach, but may not benefit modern normalization methods. This study compared three normalization methods with and without CFM and determined their impact on connectomic measures in patients with glioma. METHODS Fifty patients with glioma were included. T1 -weighted images were normalized using three different methods in SPM12, with and without CFM, which were then overlaid on the ICBM152 template and scored by two neuroradiologists. The Dice coefficient of gray-matter correspondence was also calculated. Normalized resting-state functional MRI data were parcellated using the AAL90 atlas to construct an individual connectivity matrix and calculate connectomic measures. The R2 among the different normalization methods was calculated for the connectivity matrices and connectomic measures. RESULTS The older method (Original) performed significantly worse than the modern methods (Default and DARTEL; P < .005 in observer ranking). The use of CFM did not significantly improve the normalization results. The Original method had lower correlation with the Default and DARTEL methods (R2 = 0.71-0.74) than Default with DARTEL (R2 = 0.96) in the connectivity matrix. The clustering coefficient appears to be the most, and modularity the least, sensitive connectomic measures to normalization performance. CONCLUSION The spatial normalization method can have an impact on resting-state functional MRI connectome and connectomic measures derived using atlas-based brain parcellation. In patients with glioma, this study demonstrated that Default and DARTEL performed better than the Original method, and that CFM made no significant difference.
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Affiliation(s)
- Henry Szu-Meng Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa M Chen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Noll KR. Commentary: Presurgical Identification of Patients With Glioblastoma at Risk for Cognitive Impairment at 3-Month Follow-up. Neurosurgery 2020; 87:E621-E622. [DOI: 10.1093/neuros/nyaa234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/12/2022] Open
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Abstract
Abstract
Background
Operating a motor vehicle involves multiple cognitive and sensorimotor faculties. Neurological conditions pose driving risk, but this has not been examined in patients with primary brain tumors.
Methods
Sixty-four patients with primary brain tumors (32 left hemisphere; 69% glioblastoma) completed the Cognitive Behavioral Driver’s Inventory (CBDI). A subset also completed broader cognitive testing. Patient characteristics, CBDI measures, and broader neuropsychological test scores were compared between Passing and Nonpassing groups. Follow-up logistic regression analyses identified patient characteristics and CBDI measures predictive of Pass/Nonpass outcome. Point-biserial correlations determined associations between neuropsychological tests and CBDI outcome.
Results
Sixty-nine percent of patients were classified as passing the CBDI. Nonpassing patients were older and more likely to have WHO grade IV and temporal lobe tumors. Age was the most salient predictor of CBDI performance. CBDI measures of speeded visual search and set-shifting, speeded response inhibition, vigilance and freedom from distractibility, and basic visual scanning speed were predictive of Pass/Nonpass outcome. Neuropsychological tests of memory in particular, but also speeded visual scanning and discrimination, executive function, basic visual attention, visuoconstruction, and manual dexterity (dominant hand), were associated with CBDI outcome.
Conclusions
A sizeable proportion of patients with primary brain tumors appear at risk of driving difficulty, particularly those with higher-grade tumors and of older age. Memory, visual attention, and executive difficulties appear to contribute most to driving safety risk as determined by the CBDI. These results highlight the importance of driving safety screening in this population.
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Affiliation(s)
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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11
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Hsu AL, Chen HSM, Hou P, Wu CW, Johnson JM, Noll KR, Prabhu SS, Ferguson SD, Kumar VA, Schomer DF, Chen JH, Liu HL. Presurgical resting-state functional MRI language mapping with seed selection guided by regional homogeneity. Magn Reson Med 2019; 84:375-383. [PMID: 31793025 DOI: 10.1002/mrm.28107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/24/2019] [Accepted: 11/14/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Resting-state functional MRI (rs-FMRI) has shown potential for presurgical mapping of eloquent cortex when a patient's performance on task-based FMRI is compromised. The seed-based analysis is a practical approach for detecting rs-FMRI functional networks; however, seed localization remains challenging for presurgical language mapping. Therefore, we proposed a data-driven approach to guide seed localization for presurgical rs-FMRI language mapping. METHODS Twenty-six patients with brain tumors located in left perisylvian regions had undergone task-based FMRI and rs-FMRI before tumor resection. For the seed-based rs-FMRI language mapping, a seeding approach that integrates regional homogeneity and meta-analysis maps (RH+MA) was proposed to guide the seed localization. Canonical and task-based seeding approaches were used for comparison. The performance of the 3 seeding approaches was evaluated by calculating the Dice coefficients between each rs-FMRI language mapping result and the result from task-based FMRI. RESULTS With the RH+MA approach, selecting among the top 6 seed candidates resulted in the highest Dice coefficient for 81% of patients (21 of 26) and the top 9 seed candidates for 92% of patients (24 of 26). The RH+MA approach yielded rs-FMRI language mapping results that were in greater agreement with the results of task-based FMRI, with significantly higher Dice coefficients (P < .05) than that of canonical and task-based approaches within putative language regions. CONCLUSION The proposed RH+MA approach outperformed the canonical and task-based seed localization for rs-FMRI language mapping. The results suggest that RH+MA is a robust and feasible method for seed-based functional connectivity mapping in clinical practice.
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Affiliation(s)
- Ai-Ling Hsu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Henry Szu-Meng Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, Shuang Ho Hospital, New Taipei, Taiwan
| | - Jason M Johnson
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kyle R Noll
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinodh A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donald F Schomer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jyh-Horng Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Noll KR, Bradshaw ME, Parsons MW, Dawson EL, Rexer J, Wefel JS. Monitoring of Neurocognitive Function in the Care of Patients with Brain Tumors. Curr Treat Options Neurol 2019; 21:33. [PMID: 31250277 DOI: 10.1007/s11940-019-0573-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW A detailed characterization of the nature of neurocognitive impairment in patients with brain tumors is provided, as well as considerations for clinical practice regarding neuropsychological assessment throughout the disease course. RECENT FINDINGS Neurocognitive impairment is common in patients with brain tumors and may result from the tumor itself, as a consequence of treatment, including surgery, chemotherapy, and radiation, or in association with supportive care medications (e.g., anticonvulsant and pain medications). Serial surveillance of neurocognitive functioning in this population can facilitate medical decision-making and inform recommendations to improve patient daily functioning and quality of life. Neuropsychological assessment is increasingly recognized as a critical component of the multidisciplinary care of patients with brain tumors and has already had practice-changing effects. Further understanding of genetic risk factors for neurocognitive decline along with the development of novel assessment and intervention strategies may further enhance functioning and general well-being in this patient population.
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Affiliation(s)
- Kyle R Noll
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Mariana E Bradshaw
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Michael W Parsons
- Department of Neuro-Oncology, Psychology Assessment Center, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Erica L Dawson
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Jennie Rexer
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Jeffrey S Wefel
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA. .,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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Noll KR, Sullaway CM, Wefel JS. Depressive symptoms and executive function in relation to survival in patients with glioblastoma. J Neurooncol 2019; 142:183-191. [PMID: 30680509 DOI: 10.1007/s11060-018-03081-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/15/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Depression and neurocognitive function, particularly executive functioning (EF), have been associated with overall survival (OS) in patients with glioblastoma (GBM). However, the combined effect of depressive symptoms and impaired EF upon OS has not been reported. METHODS Patients with GBM (N = 102) completed neuropsychological assessment postoperatively, including the Beck Depression Inventory-Second Edition (BDI-II) and the Trail Making Test Part B (TMTB). Median splits were used to determine cut-points denoting elevated depressive symptoms on the BDI-II and impaired EF on TMTB. Patients were stratified into four groups: low depressive symptoms/low EF impairment (- Dep/- Imp; N = 23), high depressive symptoms/low EF impairment (+ Dep/- Imp; N = 28), low depressive symptoms/high EF impairment (- Dep/+Imp; N = 28), and high depressive symptoms/high EF impairment (+ Dep/+Imp; N = 23). The Kaplan-Meier method, log-rank test, and Cox regression were used to examine differences in survival between groups. RESULTS Relative to - Dep/- Imp patients (median OS = 22.8 months), median OS in all other patient groups was shorter (+ Dep/- Imp OS = 16.6; - Dep/+Imp OS = 14.8; +Dep/+Imp OS = 10.8; all p < .05). With the exception of KPS and age, groups did not differ in distribution of clinical and demographic characteristics. Neither KPS nor age modified the independent effect of BDI-II and TMTB on OS in Cox regression models. CONCLUSIONS The presence of depressive symptoms and impaired EF are independently associated with shorter OS in patients with GBM. These results suggest that routine neuropsychological assessment of mood and cognition may help refine prognosis and facilitate initiation of psychological and cognitive interventions, which can improve patient quality of life, and warrants further investigation.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Catherine M Sullaway
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA. .,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA.
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Noll KR, Bradshaw ME, Rexer J, Wefel JS. Neuropsychological Practice in the Oncology Setting. Arch Clin Neuropsychol 2018; 33:344-353. [PMID: 29718081 DOI: 10.1093/arclin/acx131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/04/2017] [Indexed: 11/14/2022] Open
Abstract
Oncology has experienced positive shifts in survival curves for many cancers largely due to the development of earlier diagnostics and better therapeutics. This has increased the visibility and need for survivorship services, including clinical neuropsychology. Patients with cancer frequently experience cognitive dysfunction related to the presence of cancer itself and treatment neurotoxicity. These cognitive difficulties can profoundly impact patient functioning and autonomy with accompanying declines in quality of life. Clinical neuropsychologists are uniquely positioned to evaluate the cognitive and affective sequelae of cancer and treatment and provide interventions and recommendations that can benefit well-being and potentially alter the disease course. Despite increasing recognition of the importance of neuropsychological issues to cancer survivorship, many neuropsychologists have limited training and guidance regarding navigating and implementing services within the oncology setting. This article provides the basic rationale for neuropsychological practice and research activities in oncology, as well as the experience of the Section of Neuropsychology at The University of Texas MD Anderson Cancer Center.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennie Rexer
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Noll KR, Bradshaw ME, Weinberg JS, Wefel JS. Neurocognitive functioning is associated with functional independence in newly diagnosed patients with temporal lobe glioma. Neurooncol Pract 2018; 5:184-193. [PMID: 30094046 PMCID: PMC6075221 DOI: 10.1093/nop/npx028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cancer and treatment-related neurocognitive dysfunction has the potential to significantly disrupt the lives of survivors. While neurocognitive functioning is known to predict aspects of patient-reported quality of life in individuals with glioma, little is known regarding the association between neurocognitive functioning and clinician-rated functional independence. METHODS Newly diagnosed patients with glioma in the left (n = 73; 49% glioblastoma) or right (n = 30; 57% glioblastoma) temporal lobe completed comprehensive neuropsychological testing. Clinicians rated patient functional independence using the Functional Independence Measure (FIM) and Karnofsky Performance Status (KPS) scale. Correlational and regression analyses were conducted to determine relationships between neurocognitive functioning and functional independence. RESULTS Tests of verbal learning, executive function, and language comprehension were moderately to strongly associated with clinician-rated functional independence, particularly for items pertaining to need for assistance with memory, problem-solving, and language functions. Stepwise linear regression showed that tests of verbal learning, executive functioning, and language comprehension predicted FIM ratings, together accounting for 40% of variance (P < .001). A test of executive functioning also predicted KPS scores and accounted for 19% of variance (P < .001). CONCLUSIONS In patients with newly diagnosed temporal lobe glioma, neurocognitive functioning is associated with functional independence. Verbal learning, executive functioning, and language comprehension demonstrated the strongest associations across both measures of functional independence. These findings provide support for the ecological validity of neuropsychological assessment by demonstrating the real-world clinical significance of objectively assessed neurocognitive functioning in glioma patients.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Hsu AL, Hou P, Johnson JM, Wu CW, Noll KR, Prabhu SS, Ferguson SD, Kumar VA, Schomer DF, Hazle JD, Chen JH, Liu HL. IClinfMRI Software for Integrating Functional MRI Techniques in Presurgical Mapping and Clinical Studies. Front Neuroinform 2018; 12:11. [PMID: 29593520 PMCID: PMC5854683 DOI: 10.3389/fninf.2018.00011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/23/2018] [Indexed: 01/25/2023] Open
Abstract
Task-evoked and resting-state (rs) functional magnetic resonance imaging (fMRI) techniques have been applied to the clinical management of neurological diseases, exemplified by presurgical localization of eloquent cortex, to assist neurosurgeons in maximizing resection while preserving brain functions. In addition, recent studies have recommended incorporating cerebrovascular reactivity (CVR) imaging into clinical fMRI to evaluate the risk of lesion-induced neurovascular uncoupling (NVU). Although each of these imaging techniques possesses its own advantage for presurgical mapping, a specialized clinical software that integrates the three complementary techniques and promptly outputs the analyzed results to radiology and surgical navigation systems in a clinical format is still lacking. We developed the Integrated fMRI for Clinical Research (IClinfMRI) software to facilitate these needs. Beyond the independent processing of task-fMRI, rs-fMRI, and CVR mapping, IClinfMRI encompasses three unique functions: (1) supporting the interactive rs-fMRI mapping while visualizing task-fMRI results (or results from published meta-analysis) as a guidance map, (2) indicating/visualizing the NVU potential on analyzed fMRI maps, and (3) exporting these advanced mapping results in a Digital Imaging and Communications in Medicine (DICOM) format that are ready to export to a picture archiving and communication system (PACS) and a surgical navigation system. In summary, IClinfMRI has the merits of efficiently translating and integrating state-of-the-art imaging techniques for presurgical functional mapping and clinical fMRI studies.
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Affiliation(s)
- Ai-Ling Hsu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jason M Johnson
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Changwei W Wu
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kyle R Noll
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vinodh A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Donald F Schomer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jyh-Horng Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Weng HH, Noll KR, Johnson JM, Prabhu SS, Tsai YH, Chang SW, Huang YC, Lee JD, Yang JT, Yang CT, Tsai YH, Yang CY, Hazle JD, Schomer DF, Liu HL. Accuracy of Presurgical Functional MR Imaging for Language Mapping of Brain Tumors: A Systematic Review and Meta-Analysis. Radiology 2017; 286:512-523. [PMID: 28980887 DOI: 10.1148/radiol.2017162971] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To compare functional magnetic resonance (MR) imaging for language mapping (hereafter, language functional MR imaging) with direct cortical stimulation (DCS) in patients with brain tumors and to assess factors associated with its accuracy. Materials and Methods PubMed/MEDLINE and related databases were searched for research articles published between January 2000 and September 2016. Findings were pooled by using bivariate random-effects and hierarchic summary receiver operating characteristic curve models. Meta-regression and subgroup analyses were performed to evaluate whether publication year, functional MR imaging paradigm, magnetic field strength, statistical threshold, and analysis software affected classification accuracy. Results Ten articles with a total of 214 patients were included in the analysis. On a per-patient basis, the pooled sensitivity and specificity of functional MR imaging was 44% (95% confidence interval [CI]: 14%, 78%) and 80% (95% CI: 54%, 93%), respectively. On a per-tag basis (ie, each DCS stimulation site or "tag" was considered a separate data point across all patients), the pooled sensitivity and specificity were 67% (95% CI: 51%, 80%) and 55% (95% CI: 25%, 82%), respectively. The per-tag analysis showed significantly higher sensitivity for studies with shorter functional MR imaging session times (P = .03) and relaxed statistical threshold (P = .05). Significantly higher specificity was found when expressive language task (P = .02), longer functional MR imaging session times (P < .01), visual presentation of stimuli (P = .04), and stringent statistical threshold (P = .01) were used. Conclusion Results of this study showed moderate accuracy of language functional MR imaging when compared with intraoperative DCS, and the included studies displayed significant methodologic heterogeneity. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Hsu-Huei Weng
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Kyle R Noll
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jason M Johnson
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Sujit S Prabhu
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Yuan-Hsiung Tsai
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Sheng-Wei Chang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Yen-Chu Huang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jiann-Der Lee
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jen-Tsung Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Cheng-Ta Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Ying-Huang Tsai
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Chun-Yuh Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - John D Hazle
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Donald F Schomer
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Ho-Ling Liu
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
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Wefel JS, Noll KR, Rao G, Cahill DP. Reply to Freyschlag et al. Neuro Oncol 2017; 19:598-599. [DOI: 10.1093/neuonc/now296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wefel JS, Noll KR, Rao G, Cahill DP. Neurocognitive function varies by IDH1 genetic mutation status in patients with malignant glioma prior to surgical resection. Neuro Oncol 2016; 18:1656-1663. [PMID: 27576872 DOI: 10.1093/neuonc/now165] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with malignant gliomas present with variation in neurocognitive function (NCF) not attributable to lesion size or location alone. A potential contributor is the rate at which tumors grow, or "lesion momentum." Isocitrate dehydrogenase 1 wild type (IDH1-WT) are more proliferative and aggressive than IDH1-mutant (IDH1-M) tumors. We hypothesized that patients with IDH1-WT would exhibit worse NCF than patients with IDH1-M tumors. METHODS Comprehensive NCF testing was completed in 119 patients with malignant glioma prior to surgical resection. IDH1 status was determined with immunohistochemistry and sequencing. Rates of impairment and mean test performances were compared by IDH1. RESULTS NCF impairment was significantly more frequent in patients with IDH1-WT tumors in memory, processing speed, visuoconstruction, language, executive functioning, and manual dexterity. Mean performances of patients with IDH1-WT were also significantly lower than those with IDH1-M tumors on measures of learning and memory, processing speed, language, executive functioning, and dexterity. Lesion volume was not statistically different between IDH1-WT and IDH1-M tumors. Tumor and lesion volume on T1-weighted and fluid attenuated inversion recovery MRI were significantly associated with most NCF tests in patients with IDH1-WT, but only significantly associated with a single measure in patients with IDH1-M tumors. CONCLUSION Patients with IDH1-WT show reduced NCF compared with those with IDH1-M malignant gliomas. Lesion volume is inversely associated with NCF for patients with IDH1-WT, but not IDH1-M tumors. These findings are consistent with the hypothesis that patients with IDH1-WT tumors present with more severe NCF impairment due to greater lesion momentum, which may impede compensatory neuroplasticity and cerebral reorganization.
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Affiliation(s)
- Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S.W., K.R.N); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (G.R.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.P.C.)
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S.W., K.R.N); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (G.R.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.P.C.)
| | - Ganesh Rao
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S.W., K.R.N); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (G.R.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.P.C.)
| | - Daniel P Cahill
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S.W., K.R.N); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (G.R.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.P.C.)
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Noll KR, Weinberg JS, Ziu M, Benveniste RJ, Suki D, Wefel JS. Neurocognitive Changes Associated With Surgical Resection of Left and Right Temporal Lobe Glioma. Neurosurgery 2016; 77:777-85. [PMID: 26317672 DOI: 10.1227/neu.0000000000000987] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known regarding the neurocognitive impact of temporal lobe tumor resection. OBJECTIVE To clarify subacute surgery-related changes in neurocognitive functioning (NCF) in patients with left (LTL) and right (RTL) temporal lobe glioma. METHODS Patients with glioma in the LTL (n = 45) or RTL (n = 19) completed comprehensive pre- and postsurgical neuropsychological assessments. NCF was analyzed with 2-way mixed design repeated-measures analysis of variance, with hemisphere (LTL or RTL) as an independent between-subjects factor and pre- and postoperative NCF as a within-subjects factor. RESULTS About 60% of patients with LTL glioma and 40% with RTL lesions exhibited significant worsening on at least 1 NCF test. Domains most commonly impacted included verbal memory and executive functioning. Patients with LTL tumor showed greater decline than patients with RTL tumor on verbal memory and confrontation naming tests. Nonetheless, over one-third of patients with RTL lesions also showed verbal memory decline. CONCLUSION In patients with temporal lobe glioma, NCF decline in the subacute postoperative period is common. As expected, patients with LTL tumor show more frequent and severe decline than patients with RTL tumor, particularly on verbally mediated measures. However, a considerable proportion of patients with RTL tumor also exhibit decline across various domains, even those typically associated with left hemisphere structures, such as verbal memory. While patients with RTL lesions may show even greater decline in visuospatial memory, this domain was not assessed. Nonetheless, neuropsychological assessment can identify acquired deficits and help facilitate early intervention in patients with temporal lobe glioma.
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Affiliation(s)
- Kyle R Noll
- Departments of *Neuro-Oncology and ‡Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; §Brain and Spine Institute, Seton Hospital, Austin, Texas; ¶Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Noll KR, Ziu M, Weinberg JS, Wefel JS. Neurocognitive functioning in patients with glioma of the left and right temporal lobes. J Neurooncol 2016; 128:323-31. [PMID: 27022915 DOI: 10.1007/s11060-016-2114-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
Patients with glioma frequently suffer from deficits of neurocognitive functioning (NCF), though few studies have assessed NCF in localized glioma patients prior to surgery. One hundred and three patients (M age = 52.0; M education = 14.6 years) with histologically confirmed glioma in the right (RTL: n = 30; 57 % glioblastoma) or left temporal lobe (LTL: n = 73; 49 % glioblastoma) completed presurgical neuropsychological assessment. Impairment of NCF was identified in 75 % of all patients. Notably, patients with RTL glioma were most frequently impaired on measures of verbal memory and executive functioning, and at similar rates as the LTL group. Nonetheless, χ(2) tests revealed that impairment rates were significantly higher in the LTL group on attention and object naming tests (p ≤ .05). Independent-samples t-tests revealed that mean performances of patients with LTL glioma were also significantly below RTL patients on measures of attention (p = .01), verbal learning and memory (p = .05), and language (p < .03). A trend was observed in which anterior LTL tumors were associated with reduced verbal learning and medial LTL lesions with delayed recall problems, though patients with lesions involving multiple LTL regions exhibited the greatest difficulty across all verbal memory measures. Significant group differences in NCF performances remained so after controlling for FLAIR volume and tumor histology. These findings indicate that temporal lobe glioma frequently present with impaired NCF, though impairments are often milder in RTL compared to LTL patients. Nonetheless, the relatively frequent verbal memory impairment in the RTL group underscores the bilaterality of verbal memory processes.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 431, Houston, TX, 77030, USA.
| | - Mateo Ziu
- Brain and Spine Institute, Seton Hospital, Austin, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 431, Houston, TX, 77030, USA
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Wefel JS, Noll KR, Scheurer ME. Neurocognitive functioning and genetic variation in patients with primary brain tumours. Lancet Oncol 2016; 17:e97-e108. [PMID: 26972863 PMCID: PMC5215729 DOI: 10.1016/s1470-2045(15)00380-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/10/2015] [Accepted: 09/28/2015] [Indexed: 01/09/2023]
Abstract
Impairment of neurocognitive functioning is a common result of cerebral neoplasms and treatment, although there is substantial heterogeneity in the pattern and severity of neurocognitive dysfunction across individuals and tumour types. The effects of many clinical and patient characteristics on neurocognitive functioning have been documented, but little research has been devoted to understanding the effect of genetic variation on neurocognitive outcomes in patients with brain tumours. This Review highlights preliminary evidence that suggests an association between various genes and risk of adverse neurocognitive outcomes in patients with brain tumours. Studies include genes specific to neuronal function, and those associated with more systemic cellular regulation. Related scientific literature in other disease populations is briefly discussed to indicate additional candidate genes. We consider methodological issues central to the study of neurocognitive functioning and genetic associations for patients with brain tumours, and emphasise the need for future research integrating novel investigative techniques.
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Affiliation(s)
- Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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Noll KR, Bradshaw ME, Weinberg JS, Wefel JS. Relationships between neurocognitive functioning, mood, and quality of life in patients with temporal lobe glioma. Psychooncology 2015; 26:617-624. [PMID: 26677053 DOI: 10.1002/pon.4046] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 10/02/2015] [Accepted: 11/10/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE While neurocognitive functioning (NCF) and mood disturbance share a relationship with health-related quality of life (HRQOL), few studies have examined relationships between these constructs in glioma patients prior to treatment. METHODS Newly diagnosed patients with glioma in the left (N = 73; 49% glioblastoma) or right (N = 30; 57% glioblastoma) temporal lobe completed neuropsychological testing and self-report measures of HRQOL (Functional Assessment of Cancer Therapy (FACT)-General and Brain module) and mood (Beck Depression Inventory-Second Edition and State-Trait Anxiety Inventory). RESULTS Verbal learning and memory, executive function, and language abilities were associated with various HRQOL scales. Stepwise linear regression showed that verbal learning predicted scores on the general well-being scale and brain module, processing speed predicted social well-being scores, and executive functioning predicted functional well-being scores on the FACT. Upper extremity strength also predicted scores on the functional well-being subscale and brain module. Mood was more strongly associated with HRQOL domains than NCF, with depressive symptoms accounting for a large proportion of variance across most subscales. CONCLUSIONS In patients with temporal lobe glioma, depressive symptoms are strongly related to most aspects of HRQOL but not with NCF. NCF, specifically verbal learning and memory, executive functioning, and processing speed, also show direct relationships with numerous aspects of HRQOL. These findings underscore the importance of multimodal assessment of NCF and mood in this population. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Noll KR, Weinberg JS, Ziu M, Wefel JS. Verbal Learning Processes in Patients with Glioma of the Left and Right Temporal Lobes. Arch Clin Neuropsychol 2015; 31:37-46. [PMID: 26537777 DOI: 10.1093/arclin/acv064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/14/2022] Open
Abstract
Recent research supports the utility of process variables in understanding mechanisms underlying memory impairments. The Hopkins Verbal Learning Test-Revised (HVLT-R) was administered to 84 patients with left (LTL, n = 58) or right temporal lobe glioma (RTL, n = 26) prior to surgical resection. Primary HVLT-R measures of learning and memory and numerous learning process indices were computed. Both groups exhibited frequent memory impairment (>30%), with greater severity in the LTL group. Patients with LTL glioma also exhibited lower semantic clustering scores than RTL patients, which were highly associated with Total Recall (ρ = 0.83) and Delayed Recall (ρ = 0.68). Learning slope and a novel measure of learning efficiency were also significantly associated with primary memory measures, though scores were similar across the LTL and RTL groups. While lesions to either temporal lobe impact verbal memory, semantic encoding appears to depend upon the integrity of LTL structures in particular.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mateo Ziu
- Brain and Spine Institute, Seton Hospital, Austin, TX, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Noll KR, Wefel JS. Response to "From histology to neurocognition: the influence of tumor grade in glioma of the left temporal lobe on neurocognitive function". Neuro Oncol 2015; 17:1421-2. [PMID: 26395063 DOI: 10.1093/neuonc/nov176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (K.R.N., J.S.W.)
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (K.R.N., J.S.W.)
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Noll KR, Fardell JE. Commentary: "Neuropsychological Assessment of Individuals with Brain Tumor: Comparison of Approaches Used in the Classification of Impairment". Front Oncol 2015; 5:188. [PMID: 26347854 PMCID: PMC4539469 DOI: 10.3389/fonc.2015.00188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/05/2015] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Joanna E Fardell
- Behavioural Sciences Unit proudly supported by Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales , Sydney, NSW , Australia
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Wefel JS, Kesler SR, Noll KR, Schagen SB. Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults. CA Cancer J Clin 2015; 65:123-38. [PMID: 25483452 PMCID: PMC4355212 DOI: 10.3322/caac.21258] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Answer questions and earn CME/CNE Over the past few decades, a body of research has emerged confirming what many adult patients with noncentral nervous system cancer have long reported-that cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). The severity of CRCI varies, and symptoms can emerge early or late in the disease course. Nonetheless, CRCI is typically mild to moderate in nature and primarily involves the domains of memory, attention, executive functioning, and processing speed. Animal models and novel neuroimaging techniques have begun to unravel the pathophysiologic mechanisms underlying CRCI, including the role of inflammatory cascades, direct neurotoxic effects, damage to progenitor cells, white matter abnormalities, and reduced functional connectivity, among others. Given the paucity of research on CRCI with other cancer populations, this review synthesizes the current literature with a deliberate focus on CRCI within the context of breast cancer. A hypothetical case-study approach is used to illustrate how CRCI often presents clinically and how current science can inform practice. While the literature regarding intervention for CRCI is nascent, behavioral and pharmacologic approaches are discussed.
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Affiliation(s)
- Jeffrey S. Wefel
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Corresponding author: Jeffrey S. Wefel, PhD, Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030;
| | - Shelli R. Kesler
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kyle R. Noll
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanne B. Schagen
- Associate Professor, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Noll KR, Sullaway C, Ziu M, Weinberg JS, Wefel JS. Relationships between tumor grade and neurocognitive functioning in patients with glioma of the left temporal lobe prior to surgical resection. Neuro Oncol 2014; 17:580-7. [PMID: 25227126 DOI: 10.1093/neuonc/nou233] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Various tumor characteristics have been associated with neurocognitive functioning (NCF), though the role of tumor grade has not been adequately examined. METHODS Seventy-two patients with histologically confirmed grade IV glioma (n = 37), grade III glioma (n = 20), and grade II glioma (n = 15) in the left temporal lobe completed preoperative neuropsychological assessment. Rates of impairment and mean test performances were compared by tumor grade with follow-up analysis of the influence of other tumor- and patient-related characteristics on NCF. RESULTS NCF impairment was more frequent in patients with grade IV tumor compared with patients with lower-grade tumors in verbal learning, executive functioning, as well as language abilities. Mean performances significantly differed by tumor grade on measures of verbal learning, processing speed, executive functioning, and language, with the grade IV group exhibiting worse performances than patients with lower-grade tumors. Group differences in mean performances remained significant when controlling for T1-weighted and fluid attenuated inversion recovery MRI-based lesion volume. Performances did not differ by seizure status or antiepileptic and steroid use. CONCLUSIONS Compared with patients with grade II or III left temporal lobe glioma, patients with grade IV tumors exhibit greater difficulty with verbal learning, processing speed, executive functioning, and language. Differences in NCF associated with glioma grade were independent of lesion volume, seizure status, and antiepileptic or steroid use, lending support to the concept of "lesion momentum" as a primary contributor to deficits in NCF of newly diagnosed patients prior to surgery.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (K.R.N., C.S., J.S. Wefel); Brain and Spine Institute, Seton Hospital, Austin, Texas (M.Z.); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S. Weinberg)
| | - Catherine Sullaway
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (K.R.N., C.S., J.S. Wefel); Brain and Spine Institute, Seton Hospital, Austin, Texas (M.Z.); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S. Weinberg)
| | - Mateo Ziu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (K.R.N., C.S., J.S. Wefel); Brain and Spine Institute, Seton Hospital, Austin, Texas (M.Z.); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S. Weinberg)
| | - Jeffrey S Weinberg
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (K.R.N., C.S., J.S. Wefel); Brain and Spine Institute, Seton Hospital, Austin, Texas (M.Z.); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S. Weinberg)
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (K.R.N., C.S., J.S. Wefel); Brain and Spine Institute, Seton Hospital, Austin, Texas (M.Z.); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S. Weinberg)
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