Lesion Symptom Mapping at the Regional Level in Patients With a Meningioma

Objective: The majority of meningioma patients suffer from presurgical cognitive deficits. Since meningiomas do not directly damage the brain, this is presumably caused by a functional integrity reduction of the surrounding brain tissue through perilesional edema and/or mass effect of the tumor. Tumor location is a key feature in determining neurological symptoms in brain tumor patients, but the relationship between meningioma location and cognitive performance remains unclear. This study aimed to identify brain areas where the presence of a meningioma forms a potential risk factor for worse cognitive performance as compared to meningiomas at other locations. Method: Neuropsychological data (CNS Vital Signs) and MRI were collected in 224 meningioma patients one day before surgery. Sociodemographically corrected scores were calculated for 7 cognitive domains. Tumors were semiautomatically segmented and mapped into MNI-space for use in Statistical Region of Interest analyses. For each cognitive domain, we tested whether larger proportions of tumor overlap with each of the 150 defined regions were associated with worse performance. Results: After multiple comparison (Bonferroni) and lesion volume correction, larger proportions of tumor overlap with both the left middle and superior frontal gyrus were associated with worse complex attention scores. Larger proportions of tumor overlap with the left middle frontal gyrus were associated with worse cognitive flexibility scores. For the other domains, no association between tumor overlap with a region and cognitive performance was found. Conclusions: The current results suggest that, compared to patients with a meningioma at other locations, patients with a meningioma at the left middle frontal gyrus are at potential risk for worse performance on cognitive flexibility and complex attention whereas patients with a meningioma at the left superior frontal gyrus are at potential risk for worse performance on complex attention. General Scientific Summary Many meningioma patients suffer from cognitive deficits in a wide range of cognitive domains. We identified regions (i.e., left middle and left superior frontal gyri) where the presence of a meningioma forms a potential risk for worse performance on cognitive flexibility and complex attention compared to meningioma on other locations. Our results can help neurosurgeons to detect patients at risk for cognitive impairment at an early stage, possibly leading to a change in