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Global effects of focal brain tumours on functional complexity and network robustness

Background Neurosurgical management of brain tumours has entered a new paradigm of supra-marginal resections that demands thorough understanding of their peri-tumoural functional effects. Historically the effects of tumours have been considered as local, and long-range effects have not been considered. This work tests the hypothesis that focal tumours affect the brain at a global level producing long-range gradients in cortical function. Methods Resting state functional (f)MRI data were acquired from 11 participants with glioblastoma and split into discovery and validation datasets. Fractal complexity was computed with a wavelet-based estimator of the Hurst exponent. Distance related effects of the tumours were tested with a tumour mask dilation technique and parcellation of the underlying Hurst maps. Functional connectivity networks were constructed and validated with different parcellation and statistical dependency methods prior to graph theory analysis. Results Fractal complexity, measured through the Hurst exponent and tumour mask dilation technique, demonstrates a penumbra of suppression in the peri-tumoural region. At a global level, as distance from the tumour increases, this initial suppression is balanced by a subsequent over-activity before finally normalizing. These effects were best fit by a quadratic model, and were consistent across different network construction pipelines. The Hurst exponent was significantly correlated with multiple graph theory measures of centrality including network robustness, but graph theory measures did not demonstrate distance dependent effects. Conclusions This work provides evidence to support the theory that focal brain tumours produce long-range and non-linear gradients in function. Consequently the effects of focal lesions, and the resultant clinical effects, need to be interpreted in terms of the global changes on whole brain functional complexity and network architecture rather than purely in terms of functional localisation. Determining whether the peri-tumoural changes represent adaption or potential plasticity, for example, may facilitate extended resection of the tumour without functional cost.