Predicting attention deficits and functional recovery after glioma resection through functional executive networks: insights from dynamic properties

Background Postoperative short-term attentional and executive dysfunctions are common after brain tumor resection, significantly impacting patients’ quality of life and functional recovery. The current study investigated whether presurgical functional dynamics of key brain networks supporting executive functioning could predict postoperative neuropsychological outcomes. Methods Twenty-two patients with gliomas underwent longitudinal resting-state fMRI scans (before and three-months after surgery), along with neuropsychological assessments (before, one-week and three-months after surgery). Co-activation patterns analysis (CAPs) characterized the functional dynamic properties of executive networks, including the Fronto-parietal (FPN) and Dorsal Attention networks (DAN). Temporal network properties were examined for stability, integration, and centrality over timepoints. Partial least squares analyses and linear models explored associations between network dynamics and cognitive functioning. Results Immediate post-surgical attentional deficits were linked to pre-surgical FPN properties revealing associated dynamic patterns of network activation. Pre-surgical FPN temporal properties predicted not only immediate appearance or persistence of post-resection deficits, but also the longitudinal progression of attentional performance otherwise neglected. However, regardless of the severity of attentional deficit, at three months post-surgery, temporal properties and neuropsychological profiles did not significantly differ from the pre-surgical ones, indicating recovery to baseline beyond treatment strategies. Conclusions Our study demonstrates that presurgical dynamic properties of intrinsic executive networks alone can predict short-term postoperative neuropsychological outcomes, highlighting the clinical utility of temporal functional connectivity. These findings emphasize the potential for using intrinsic brain activity dynamics as predictive markers for postoperative recovery and planning tailored rehabilitation interventions for cognitive deficits. Key messages What is already known on this topic: Attentive deficits are common in short-term post-glioma neurosurgery, yet their anticipation remains a challenge. What this study adds: Integrating presurgical intrinsic fMRI dynamic connectivity properties within executive networks with pre-surgical attention scores enables the prediction of the severity of attentive deficits post-surgery. How this study might affect research, practice or policy: The proposed prognostic framework has the potential to significantly impact patient outcome in neuro oncological treatments by informing the planning of tailored interventions, both at the level of pre-treatment and for post-treatment rehabilitation planning.