Chronic spatial working memory deficit associated with the superior longitudinal fasciculus: a study using voxel-based lesion-symptom mapping and intraoperative direct stimulation in right prefrontal glioma surgery
Chronic spatial working memory deficit associated with the superior longitudinal fasciculus: a study using voxel-based lesion-symptom mapping and intraoperative direct stimulation in right prefrontal glioma surgery
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DOI：
10.3171/2015.10.jns1591
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发表时间：
2016-10-01
影响因子：
4.1
通讯作者：
Hayashi, Yutaka
中科院分区：
文献类型：
--
作者：
Kinoshita, Masashi;Nakajima, Riho;Hayashi, Yutaka
目的 尽管右前额叶区域被认为是沉默区域，但在切除右前额叶神经胶质瘤后，可能会出现执行功能（包括工作记忆（WM））的慢性缺陷。这可能会被术后标准检查所忽视，并且这种残疾可能会影响患者的职业生活。右前额叶区域是额顶叶网络的一部分，并受上纵束（SLF）的管辖；然而，SLF 在空间 WM 中的作用尚不清楚。本研究调查了接受右前额叶神经胶质瘤切除术的患者的持续空间 WM 缺陷，并评估了空间 WM 缺陷与 SLF 之间的关系。 方法 在 24 名接受前额叶神经胶质瘤切除术的患者（右侧，n = 14；左侧，n = 10）和 14 名健康志愿者中，在术后长期期间使用空间 2 背任务检查了空间 WM。使用病变映射和基于体素的病变症状映射来评估空间 WM 的神经相关性。此外，对2名右前额叶神经胶质瘤患者进行了手术期间直接皮层下电刺激下的空间2背任务。结果右前额叶病变患者具有显着的慢性空间WM缺陷。基于体素的病变症状图分析揭示了空间 WM 缺陷与 SLF 第一和第二段（SLF I 和 SLF II）重叠的区域之间存在显着相关性。两名患者接受了清醒手术，但在 SLF I 上直接皮层下电刺激的空间 2 背任务中难以提供正确的反应，这一点通过术后弥散张量成像纤维束成像得以保留和证实。这些患者在术后近期和远期期间均未表现出空间 WM 缺陷。 结论 在接受位于右前额叶脑实质的肿瘤切除术的患者中，空间 WM 缺陷可能持续存在。背侧额顶皮质下白质通路（即 SLF I 或 SLF I 和 II）的损伤可能在这种慢性缺陷中发挥因果作用。持续的空间 WM 缺陷（没有运动和语言缺陷）可能会影响患者的职业生活。在这种情况下，清醒手术将有助于在肿瘤探查过程中通过适当的任务来检测空间 WM 网络。
OBJECTIVE Although the right prefrontal region is regarded as a silent area, chronic deficits of the executive function, including working memory (WM), could occur after resection of a right prefrontal glioma. This may be overlooked by postoperative standard examinations, and the disabilities could affect the patient's professional life. The right prefrontal region is a part of the frontoparietal network and is subserved by the superior longitudinal fasciculus (SLF); however, the role of the SLF in spatial WM is unclear. This study investigated a persistent spatial WM deficit in patients who underwent right prefrontal glioma resection, and evaluated the relationship between the spatial WM deficit and the SLF.METHODS Spatial WM was examined in 24 patients who underwent prefrontal glioma resection (right, n = 14; left, n = 10) and in 14 healthy volunteers using a spatial 2 -back task during the long-term postoperative period. The neural correlates of spatial WM were evaluated using lesion mapping and voxel-based lesion-symptom mapping. In addition, the spatial 2 -back task was performed during surgery under direct subcortical electrical stimulation in 2 patients with right prefrontal gliomas.RESULTS Patients with a right prefrontal lesion had a significant chronic spatial WM deficit. Voxel-based lesion symptom mapping analysis revealed a significant correlation between spatial WM deficit and the region that overlapped the first and second segments of the SLF (SLF I and SLF II). Two patients underwent awake surgery and had difficulties providing the correct responses in the spatial 2 -back task with direct subcortical electrical stimulation on the SLF I, which was preserved and confirmed by postoperative diffusion tensor imaging tractography. These patients exhibited no spatial WM deficits during the postoperative immediate and long-term periods.CONCLUSIONS Spatial WM deficits may persist in patients who undergo resection of the tumor located in the right prefrontal brain parenchyma. Injury to the dorsal frontoparietal subcortical white matter pathway, i.e., the SLF I or SLF I and II, could play a causal role in this chronic deficit. A persistent spatial WM deficit, without motor and language deficits, could affect the professional life of the patient. In such cases, awake surgery would be useful to detect the spatial WM network with appropriate task during tumor exploration.