Presurgical Neural Energy Landscapes Predict Postoperative Working Memory Outcome After Brain Tumor Resection

Abstract

Surgical resection is the primary treatment option for brain tumor patients, but it carries the risk of postoperative cognitive impairments. This study investigates how tumor-induced alterations in presurgical neural dynamics relate to postoperative working memory outcome assessed by Spatial Span (SSP) test. We analyzed functional magnetic resonance imaging (fMRI) of brain tumor patients before surgery and extracted energy landscapes of high-order brain interactions. We then examined the relation between these energy features and postoperative working memory performance using statistical and machine learning (random forest) models. Patients with lower postoperative SSP Scores (2 to 5) exhibited fewer but more extreme transitions between local energy minima and maxima, whereas patients with higher SSP Scores (6 to 9) showed more frequent but less extreme shifts. Furthermore, the presurgical high-order energy features were able to accurately predict postoperative working memory outcome with a mean accuracy of 90%, F1 score of 87.5%, and an AUC of 0.95. Our study suggests that the brain tumor-induced disruptions in high-order neural dynamics before surgery are predictive of postoperative working memory outcome. Our findings pave the path for personalized surgical planning and targeted interventions to mitigate cognitive risks associated with brain tumor resection.