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MODL-37. DISCERNIBLE INTERINDIVIDUAL PATTERNS OF GLOBAL EFFICIENCY DECLINE DURING THEORETICAL BRAIN SURGERY


 Resection of infiltrating brain tumors, such as diffuse gliomas, generally involves resecting a portion of a lobe of the brain. While the concept of localized functions, and the risk to removing these areas, is well established in neurosurgical thinking, the potential that the overall global efficiency of the connectome could be disproportionately disturbed by an intervention in ways which are not immediately obvious have not been formally studied. The current article provides evidence that structural patterns exist in the impact resection of various lobes of the brain has, which also differs between subjects. We utilized diffusion tractography to create structural connectivity graphs from the brains of 80 healthy adults, and then performed every plausible brain surgery in every gross anatomic region of the cerebrum by deleting every possible combination of nodes in the graph which were adjacent to each other, and measured the drop in global efficiency (GE) at each nodal deletion. Not surprisingly, the deletion of some nodes was worse than others, such that in every lobe we studied in every subject, there were combinations of deletions which were worse for GE than removing a greater number of nodes in a different part of the brain. Interestingly, while the worst nodes differed between subjects, there were specific nodes which typically showed up as particularly detrimental regardless of which node was the worst in that person, but that there were patterns of so-called ―connectotype, which could determine which nodes were the worst. Progressive removal of a lobe of the brain leads to patterns of global efficiency decline which are reasonably predictable, but which are not the same between subjects. Given evidence that global efficiency relates to specific neuro-cognitive abilities, this provides a path towards reducing the cognitive footprint of brain surgery.