Sex Effect on Presurgical Language Mapping in Patients With a Brain Tumor

Shun Yao; Einat Liebenthal; Parikshit Juvekar; Adomas Bunevicius; Matthew Vera; Laura Rigolo; Alexandra J Golby; Yanmei Tie

doi:10.3389/fnins.2020.00004

Sex Effect on Presurgical Language Mapping in Patients With a Brain Tumor

Front Neurosci. 2020 Jan 24:14:4. doi: 10.3389/fnins.2020.00004. eCollection 2020.

Authors

Shun Yao^{1

2

3}, Einat Liebenthal^{4

5}, Parikshit Juvekar¹, Adomas Bunevicius¹, Matthew Vera¹, Laura Rigolo¹, Alexandra J Golby^{1

6}, Yanmei Tie¹

Affiliations

¹ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
² Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
³ Wuhan School of Clinical Medicine, Southern Medical University, Wuhan, China.
⁴ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
⁵ Institute for Technology in Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, United States.
⁶ Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.

Abstract

Differences between males and females in brain development and in the organization and hemispheric lateralization of brain functions have been described, including in language. Sex differences in language organization may have important implications for language mapping performed to assess, and minimize neurosurgical risk to, language function. This study examined the effect of sex on the activation and functional connectivity of the brain, measured with presurgical functional magnetic resonance imaging (fMRI) language mapping in patients with a brain tumor. We carried out a retrospective analysis of data from neurosurgical patients treated at our institution who met the criteria of pathological diagnosis (malignant brain tumor), tumor location (left hemisphere), and fMRI paradigms [sentence completion (SC); antonym generation (AG); and resting-state fMRI (rs-fMRI)]. Forty-seven patients (22 females, mean age = 56.0 years) were included in the study. Across the SC and AG tasks, females relative to males showed greater activation in limited areas, including the left inferior frontal gyrus classically associated with language. In contrast, males relative to females showed greater activation in extended areas beyond the classic language network, including the supplementary motor area (SMA) and precentral gyrus. The rs-fMRI functional connectivity of the left SMA in the females was stronger with inferior temporal pole (TP) areas, and in the males with several midline areas. The findings are overall consistent with theories of greater reliance on specialized language areas in females relative to males, and generalized brain areas in males relative to females, for language function. Importantly, the findings suggest that sex could affect fMRI language mapping. Thus, considering sex as a variable in presurgical language mapping merits further investigation.

Keywords: brain tumor; functional MRI (fMRI); functional connectivity; language processing; presurgical language mapping; sex effect; supplementary motor area (SMA).

Abstract

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