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Beyond eloquence and onto centrality: a new paradigm in planning supratentorial neurosurgery

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Abstract

Purpose

Minimizing post-operational neurological deficits as a result of brain surgery has been one of the most pertinent endeavours of neurosurgical research. Studies have utilised fMRIs, EEGs and MEGs in order to delineate and establish eloquent areas, however, these methods have not been utilized by the wider neurosurgical community due to a lack of clinical endpoints. We sought to ascertain if there is a correlation between graph theory metrics and the neurosurgical notion of eloquent brain regions. We also wanted to establish which graph theory based nodal centrality measure performs the best in predicting eloquent areas.

Methods

We obtained diffusion neuroimaging data from the Human Connectome Project (HCP) and applied a parcellation scheme to it. This enabled us to construct a weighted adjacency matrix which we then analysed. Our analysis looked at the correlation between PageRank centrality and eloquent areas. We then compared PageRank centrality to eigenvector centrality and degree centrality to see what the best measure of empirical neurosurgical eloquence was.

Results

Areas that are considered neurosurgically eloquent tended to be predicted by high PageRank centrality. By using summary scores for the three nodal centrality measures we found that PageRank centrality best correlated to empirical neurosurgical eloquence.

Conclusion

The notion of eloquent areas is important to neurosurgery and graph theory provides a mathematical framework to predict these areas. PageRank centrality is able to consistently find areas that we consider eloquent. It is able to do so better than eigenvector and degree central measures.

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Authors and Affiliations

  1. Center for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 3, Level 7, Barker Street, Randwick, Sydney, NSW, 2031, Australia

    Syed Ali Ahsan, Kassem Chendeb, Charles Teo & Michael Edward Sughrue

  2. Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA

    Robert G. Briggs, Luke R. Fletcher, Ryan G. Jones, Arpan R. Chakraborty, Cameron E. Nix, Christina C. Jacobs, Alison M. Lack & Daniel T. Griffin

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  1. Syed Ali Ahsan
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  2. Kassem Chendeb
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Corresponding author

Correspondence to Michael Edward Sughrue.

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Conflicts of interest

Dr Mike E. Sughrue receives a consulting fee for teaching educational courses for Medtronic and Synaptive. Dr Charles Teo is a consultant for Aesculap. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical approval

This study uses publicly available deidentified MRI data from the Human Connectome Project (HCP) and thus does not require an ethics approval.

Informed consent

The data this study utilises comes from the HCP which obtained informed consent from the participants.

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Ahsan, S.A., Chendeb, K., Briggs, R.G. et al. Beyond eloquence and onto centrality: a new paradigm in planning supratentorial neurosurgery. J Neurooncol 146, 229–238 (2020). https://doi.org/10.1007/s11060-019-03327-4

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  • DOI: https://doi.org/10.1007/s11060-019-03327-4

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