Leveraging brain network plasticity before neurosurgery: An fMRI-based prehabilitation case study.
Poster No:
113
Submission Type:
Abstract Submission
Authors:
Kilian Abellaneda-Pérez1, Leonardo Boccuni1, Alba Roca-Ventura1, Edgar Buloz-Osorio1, David Leno-Colorado1, Jesús Martín-Fernández2, María Cabello-Toscano3, Rubén Perellón-Alfonso3, José Carlos Pariente4, Carlos Laredo4, César Garrido4, Emma Muñoz-Moreno4, Núria Bargalló4, Gloria Villalba-Martínez5, Francisco Martínez-Ricarte6, Carlo Trompetto7, Lucio Marinelli7, David Bartrés-Faz3, Alvaro Pascual-Leone8, Jose M. Tormos9
Institutions:
1Institut Guttmann, Barcelona, Spain, 2Hôpital Gui de Chauliac, Montpellier, France, 3University of Barcelona, Barcelona, Spain, 4Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, 5Hospital del Mar, Barcelona, Spain, 6Vall d'Hebron Hospital, Barcelona, Spain, 7University of Genova, Genova, Italy, 8Harvard Medical School, Boston, MA, 9Universidad Católica de Valencia, Valencia, Spain
First Author:
Co-Author(s):
José Carlos Pariente
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
Barcelona, Spain
Emma Muñoz-Moreno
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
Barcelona, Spain
Introduction:
Brain tumor surgery aims to achieve maximal tumor resection while minimizing damage to healthy brain tissue to reduce post-operative functional sequelae. Invasive prehabilitation strategies before surgery have been used but pose an increased risk of complications. Recent research has highlighted the potential of brain plasticity to non-invasively establish new brain connections and transfer functional activity from one area of the brain to another. However, the neural mechanisms underlying these plastic processes are, not yet fully understood, especially in the context of space-occupying lesions. The objective of this fMRI-based case report was twofold: first, to investigate whether brain functional patterns at risk, as evidenced by task-based fMRI, can be modified through a non-invasive prehabilitation protocol; and second, to examine the role of functional connectivity, assessed during resting-state fMRI, as a putative mechanism underlying the observed changes in brain network topography.
Methods:
A 48-year-old male with a large tumor affecting multiple brain regions, particularly entailing the left frontal lobe and the frontotemporal opercular region was admitted for non-invasive prehabilitation (Fig.1A). A functional magnetic resonance imaging (fMRI) was conducted before prehabilitation to define the therapeutic plan, which involved inhibitory non-invasive brain stimulation over the language fMRI task accompanied with intensive language and cognitive training. fMRI data was also collected after prehabilitation and after surgery. Neuroimaging data was analyzed using the SPM12 and CONN Toolbox software tools.
Results:
Prehabilitation resulted in an increment of the distance between the tumor and the nearest fMRI cluster during the language task by 15.9mm, returning to a similar distance as baseline after surgery (Fig.1B-C). Further, the volume of the closest activation fMRI cluster decreased after prehabilitation in 12,432 mm3 and normalized after surgery (Fig.1B-D). Besides, there was an increase in the resting-state functional connectivity between the left inferior frontal gyrus, which overlapped with the transcranial magnetic stimulation target, and the other regions of the language network (Fig.2). This pattern, which was maintained after surgery, was not observed in a control visual network.
Conclusions:
This study investigated non-invasive prehabilitation in a brain tumor patient, revealing how externally-guided neuroplasticity can reorganize the topography of the language network before surgery, while also shedding light on its potential neural underpinnings. This fMRI-based case study exposes two key findings: firstly, prehabilitation may establish a plasticity window, thereby hypothetically optimizing surgical outcomes. Second, functional connectivity emanating from the stimulation site may amplify to other regions of the network, potentially strengthening network-specific functional pathways. While these outcomes are auspicious, prudence dictates the need for more comprehensive cohorts to authenticate and broaden these insights.
Brain Stimulation:
Non-invasive Magnetic/TMS
TMS 1
Language:
Speech Production 2
Language Other
Modeling and Analysis Methods:
Connectivity (eg. functional, effective, structural)
Keywords:
FUNCTIONAL MRI
Language
Plasticity
Transcranial Magnetic Stimulation (TMS)
1|2Indicates the priority used for review
Provide references using author date format
Barcia, J. (2012b). ‘rTMS stimulation to induce plastic changes at the language motor area in a patient with a left recidivant brain tumor affecting Broca's area’, Neurocase vol. 18,2, pp. 132-138.
Boccuni, L. (2023). ‘Neuromodulation-induced prehabilitation to leverage neuroplasticity before brain tumor surgery: a single-cohort feasibility trial protocol’, Frontiers in neurology vol. 14 1243857.
Miller, D. (2021). ‘Brain and other central nervous system tumor statistics, 2021’, CA: a cancer journal for clinicians vol. 71,5, pp. 381-406.
Rivera-Rivera, P. (2017). ‘Cortical plasticity catalyzed by prehabilitation enables extensive resection of brain tumors in eloquent areas’, Journal of neurosurgery vol. 126,4, pp. 1323-1333.
Serrano-Castro, P. (2020). ‘Neuroplasticity and Epilepsy Surgery in Brain Eloquent Areas: Case Report’, Frontiers in neurology vol. 11 698.
Whitfield-Gabrieli, S. (2012). ‘Conn: a functional connectivity toolbox for correlated and anticorrelated brain networks’, Brain connectivity vol. 2,3, pp. 125-141.