Anomaly changes in the functional connectome of post-operative neurosurgical patients: A case series.
Authors
Affiliations (3)
Affiliations (3)
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address: [email protected].
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
Abstract
The use of neuronavigation with superimposed mapping tools has enabled visualization of key fiber tracts and improved peri-operative planning. However, a limitation of these approaches is their reliance on a static underlying brain atlas, particularly in neurosurgical patients with brain tumors. A tool that enables qualification and quantification of brain region connectivity could refine approaches to surgical resection. We utilized a machine learning imaging platform, Quicktome™, to generate individualized functional parcels and tracts that dynamically adapt to perioperative change. The connectome was derived from a combination of diffusion tensor imaging and resting-state function magnetic resonance imaging. Matrices were generated from the functional MRI of four patients with intracranial neoplasms and the pre- and post-operative parcellation values were compared. The individual correlation and strength of regions were quantified. Hypo- and hyper-connected regions were marked as anomalous. We present a case series of four patients to illustrate the correlation of the anomaly matrices with post-operative neurological changes. These include: post-operative delirium originating associated with salience network hypoconnectivity; visual hemineglect linked to hypoconnectivity in the dorsal attention network; and quantifiable improvements in the language network following the resolution of expressive aphasia. All differences between pre-and post-operative paired correlation values were statistically significant. We demonstrate a novel approach to quantifying the extent to which anomalies in the functional connectome correlate with post-operative neurological changes. This has relevance in post-operative prognostication, provision of specialist therapy services, and could serve as a useful tool in surgical education and pre-operative planning.