AUTHOR=Zheng Wenjian , Guan Xueyi , Zhang Xianchang , Gong Jian 

TITLE=Early recovery of cognition and brain plasticity after surgery in children with low-grade frontal lobe tumors

JOURNAL=Frontiers in Pediatrics

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1127098

DOI=10.3389/fped.2023.1127098

ISSN=2296-2360

ABSTRACT=<sec><title>Background</title><p>Low-grade frontal lobe tumors (LGFLT) can be cured through total resection, but surgical trauma could impair higher-order cognitive function. We aim to characterize the short-term natural cognitive recovery and brain plasticity in surgically-treated pediatric patients with LGFLT.</p></sec><sec><title>Methods</title><p>Ten pediatric patients with LGFLT were enrolled. Their cognitive function was assessed before the surgery (S0), in the first month post-surgery (S1), and 3–6 months post-surgery (S2), using the CNS Vital Signs battery. DTI and rs-fMRI were performed during the same time periods. Changes of cognition and image metrics between S1&gt;S0 and S2&gt;S1 were analyzed.</p></sec><sec><title>Results</title><p>The Motor Speed (MotSp) and Reaction Time (RT) scores significantly decreased in S1 and recovered in S2. Rs-fMRI showed decreased functional connectivity (FC) between the bilateral frontal lobes and bilateral caudates, putamina, and pallidi in S1&gt;S0 (voxel threshold <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM1"><mml:mi>p</mml:mi><mml:mtext>-unc</mml:mtext><mml:mo>&lt;</mml:mo><mml:mn>0.001</mml:mn></mml:math></inline-formula>, cluster threshold <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM2"><mml:mi>p</mml:mi><mml:mtext>-FDR</mml:mtext><mml:mo>&lt;</mml:mo><mml:mn>0.05</mml:mn></mml:math></inline-formula>). In S2&gt;S1, FC recovery was observed in the neighboring frontal cortex areas (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM3"><mml:mi>p</mml:mi><mml:mtext>-unc</mml:mtext><mml:mo>&lt;</mml:mo><mml:mn>0.001</mml:mn></mml:math></inline-formula>, <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM4"><mml:mi>p</mml:mi><mml:mtext>-FDR</mml:mtext><mml:mo>&lt;</mml:mo><mml:mn>0.05</mml:mn></mml:math></inline-formula>). Among them, the FC in the caudates-right inferior frontal gyri was positively correlated to the RT (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM5"><mml:mi>p</mml:mi><mml:mtext>-FDR</mml:mtext><mml:mo>&lt;</mml:mo><mml:mn>0.05</mml:mn></mml:math></inline-formula>). A DTI Tract-based spatial statistics (TBSS) analysis showed decreased fractional anisotropy and axial diffusivity mainly in the corticospinal tracts, cingulum, internal capsule, and external capsule at 0–6 months post-surgery (TFCE-<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM6"><mml:mi>p</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>0.05</mml:mn></mml:math></inline-formula>). The DTI metrics were not associated with the cognitive data.</p></sec><sec><title>Conclusion</title><p>Processing speed impairment after an LGFLT resection can recover naturally within 3–6 months in school-age children. Rs-fMRI is more sensitive to short-term brain plasticity than DTI TBSS analysis. “Map expansion” plasticity in the frontal-basal ganglia circuit may contribute to the recovery.</p></sec>