Parietal association deficits in patients harboring parietal lobe gliomas: a prospective study

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OBJECTIVE

Although the parietal lobe is a common site for glioma formation, current literature is scarce, consists of retrospective studies, and lacks consistency with regard to the incidence, nature, and severity of parietal association deficits (PADs). The aim of this study was to assess the characteristics and incidence of PADs in patients suffering from parietal lobe gliomas through a prospective study and a battery of comprehensive neuropsychological tests.

METHODS

Between 2012 and 2016 the authors recruited 38 patients with glioma confined in the parietal lobe. Patients were examined for primary and secondary association deficits with a dedicated battery of neuropsychological tests. The PADs were grouped into 5 categories: visuospatial attention, gnosis, praxis, upper-limb coordination, and language. For descriptive analysis tumors were divided into high- and low-grade gliomas and also according to patient age and tumor size.

RESULTS

Parietal association deficits were elicited in 80% of patients, thus being more common than primary deficits (50%). Apraxia was the most common PAD (47.4%), followed by anomic aphasia and subcomponents of Gerstmann’s syndrome (34.2% each). Other deficits such as hemineglect, stereoagnosia, extinction, and visuomotor ataxia were also detected, albeit at lower rates. There was a statistically nonsignificant difference between PADs and sex (72.2% males, 85% females) and age (77.8% at ≤ 60 years, 80% at age > 60 years), but a statistically significant difference between the > 4 cm and the ≤ 4 cm diameter group (p = 0.02, 94.7% vs 63.2%, respectively). There was a tendency (p = 0.094) for low-grade gliomas to present with fewer PADs (50%) than high-grade gliomas (85.7%). Tumor laterality showed a strong correlation with hemineglect (p = 0.004, predilection for right hemisphere), anomia (p = 0.001), and Gerstmann’s symptoms (p = 0.01); the last 2 deficits showed a left (dominant) hemispheric preponderance.

CONCLUSIONS

This is the first study to prospectively evaluate the incidence and nature of PADs in patients with parietal gliomas. It could be that the current literature may have underestimated the true incidence of deficits. Dedicated neuropsychological examination detects a high frequency of PADs, the most common being apraxia, followed by anomia and subcomponents of Gerstmann’s syndrome. Nevertheless, a direct correlation between the clinical deficit and its anatomical substrate is only possible to a limited extent, highlighting the need for intraoperative cortical and subcortical functional mapping.

ABBREVIATIONS DTI = diffusion tensor imaging; HGG = high-grade glioma; LGG = low-grade glioma; PAD = parietal association deficit; SLF = superior longitudinal fasciculus.

Article Information

Correspondence Lampis C. Stavrinou: Hellenic Center for Neurosurgical Research “Prof. Petros Kokkalis,” Athens, Greece. mplam@hotmail.com.

INCLUDE WHEN CITING Published online May 4, 2018; DOI: 10.3171/2017.12.JNS171799.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References

1

Ardila A: A proposed reinterpretation of Gerstmann’s syndrome. Arch Clin Neuropsychol 29:8288332014

2

Benton AL: Gerstmann’s syndrome. Arch Neurol 49:4454471992

3

Benton AL: Reflections on the Gerstmann syndrome. Brain Lang 4:45621977

4

Buxbaum LJHaaland KYHallett MWheaton LHeilman KMRodriguez A: Treatment of limb apraxia: moving forward to improved action. Am J Phys Med Rehabil 87:1491612008

5

Buxbaum LJSirigu ASchwartz MFKlatzky R: Cognitive representations of hand posture in ideomotor apraxia. Neuropsychologia 41:109111132003

6

Chang EFRaygor KPBerger MS: Contemporary model of language organization: an overview for neurosurgeons. J Neurosurg 122:2502612015

7

Cochereau JHerbet GDuffau H: Patients with incidental WHO grade II glioma frequently suffer from neuropsychological disturbances. Acta Neurochir (Wien) 158:3053122016

8

Duffau H: The error of Broca: from the traditional localizationist concept to a connectomal anatomy of human brain. J Chem Neuroanat [epub ahead of print]2017

9

Duffau HCapelle LDenvil DSichez NGatignol PTaillandier L: Usefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients. J Neurosurg 98:7647782003

10

Edgeworth JRobertson IMcMillan T: The Balloons Test. Bury St Edmunds, UK: Thames Valley Test Company1998

11

Goldenberg G: Apraxia and the parietal lobes. Neuropsychologia 47:144914592009

12

Hanna-Pladdy BHeilman KMFoundas AL: Ecological implications of ideomotor apraxia: evidence from physical activities of daily living. Neurology 60:4874902003

13

Heimburger RFDemyer WReitan RM: Implications of Gerstmann’s syndrome. J Neurol Neurosurg Psychiatry 27:52571964

14

Jager GPostma A: On the hemispheric specialization for categorical and coordinate spatial relations: a review of the current evidence. Neuropsychologia 41:5045152003

15

Kaplan EGoodglass HWeintraub S: Boston Naming Test. Philadelphia: Lea & Febiger1983

16

Klein MDuffau HDe Witt Hamer PC: Cognition and resective surgery for diffuse infiltrative glioma: an overview. J Neurooncol 108:3093182012

17

Klein MPostma TJTaphoorn MJAaronson NKVandertop WPMuller M: The prognostic value of cognitive functioning in the survival of patients with high-grade glioma. Neurology 61:179617982003

18

Leclercq DDuffau HDelmaire CCapelle LGatignol PDucros M: Comparison of diffusion tensor imaging tractography of language tracts and intraoperative subcortical stimulations. J Neurosurg 112:5035112010

19

Maldonado ILMoritz-Gasser Sde Champfleur NMBertram LMoulinié GDuffau H: Surgery for gliomas involving the left inferior parietal lobule: new insights into the functional anatomy provided by stimulation mapping in awake patients. J Neurosurg 115:7707792011

20

Meyers CAHess KRYung WKLevin VA: Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol 18:6466502000

21

Oldfield RC: The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 9:971131971

22

Rusconi EPinel PDehaene SKleinschmidt A: The enigma of Gerstmann’s syndrome revisited: a telling tale of the vicissitudes of neuropsychology. Brain 133:3203322010

23

Russell SMElliott RForshaw DKelly PJGolfinos JG: Resection of parietal lobe gliomas: incidence and evolution of neurological deficits in 28 consecutive patients correlated to the location and morphological characteristics of the tumor. J Neurosurg 103:101010172005

24

Sanai NMartino JBerger MS: Morbidity profile following aggressive resection of parietal lobe gliomas. J Neurosurg 116:118211862012

25

Schenkenberg TBradford DCAjax ET: Line bisection and unilateral visual neglect in patients with neurologic impairment. Neurology 30:5095171980

26

Schiffbauer HFerrari PRowley HABerger MSRoberts TP: Functional activity within brain tumors: a magnetic source imaging study. Neurosurgery 49:131313212001

27

Skirboll SSOjemann GABerger MSLettich EWinn HR: Functional cortex and subcortical white matter located within gliomas. Neurosurgery 38:6786851996

28

Smania NGirardi FDomenicali CLora EAglioti S: The rehabilitation of limb apraxia: a study in left-brain-damaged patients. Arch Phys Med Rehabil 81:3793882000

29

Wheaton LAHallett M: Ideomotor apraxia: a review. J Neurol Sci 260:1102007

30

Wilson SMLam DBabiak MCPerry DWShih THess CP: Transient aphasias after left hemisphere resective surgery. J Neurosurg 123:5815932015

31

Zukic SMrkonjic ZSinanovic OVidovic MKojic B: Gerstmann’s syndrome in acute stroke patients. Acta Inform Med 20:2422432012

32

Zwinkels AGeusgens Cvan de Sande PVan Heugten C: Assessment of apraxia: inter-rater reliability of a new apraxia test, association between apraxia and other cognitive deficits and prevalence of apraxia in a rehabilitation setting. Clin Rehabil 18:8198272004

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