Cortical Manifolds in Cognitive Recovery following Supratentorial Neurosurgery

The cerebral cortex is topographically organized to integrate and segregate unimodal (e.g. sensorimotor) and transmodal brain networks to scaffold cognition. Cortical gradient mapping provides a framework to examine the relationship between connectivity patterns of macroscale functional brain networks within a low-dimensional (manifold) space. Using this technique, we longitudinally examine how diffuse gliomas, their neurosurgical resection, and subsequent cognitive rehabilitation impact the topographic organization of brain networks. First, using UKBioBank data (n=4000), we validate the general assembly of cortical gradients in healthy individuals. Next, using CamCan data (n=620), we found that gradient dispersion relates to executive functions (EFs) across the lifespan. Finally, in diffuse glioma patients undergoing neurosurgery (n=17), we observed that gliomas integrate into the cortical manifold by reducing gradient dispersion compared to healthy controls. This finding was replicated in an independent cohort and contrasted with meningioma patients. Finally, long-term cognitive improvement after surgery was linked to increases in gradient dispersion, while long-term deficits were associated with decreases in gradient dispersion. Overall, diffuse gliomas minimally disrupt the assembly of cortical manifolds, but the ability to reorganize the cortical manifold post-surgery is predictive of long-term cognitive outcomes. By investigating neurosurgical patients with atypical neuroanatomy, this study contributes to the expanding literature on how aging, disease, and pharmacological interventions impact cortical gradients. Future studies are warranted to further assess the utility of mapping cortical manifolds in neurosurgical patients.