108 Chapter 5 study investigating neuro-anatomical correlates of neglect in a low-grade glioma population found an association between the medial frontal cortex and neglect, which has not yet been documented in stroke lesion studies.27 This underlines the added value of using different populations in lesion-deficit inferences. Nevertheless, the stroke population remains the predominant research population in LSM studies, while it is still unclear whether etiology-specific biases limit the generalizability of these results. Therefore, we directly compare LSM for memory and language functions from two populations, a tumor versus a stroke population. We expect that both populations will independently show function-specific neural correlates for memory and language functions, as described in previous literature. The aim of this study is to investigate if brain areas where both stroke and tumor populations have adequate coverage, show topographical overlap in lesion-symptom associations. For this study, data from two different studies were combined: a single-center retrospective study in a cohort of treatment-naïve diffuse glioma patients8,28 and a multi-center prospective cohort study in patients with ischemic stroke.29,30 With a state-of-the-art machine learning-based, multivariate voxel-wise approach, we produced lesion-symptom maps for memory and verbal fluency tasks for both populations separately. METHODS Patient recruitment The University Medical Center Utrecht (UMCU) institutional ethical review board approved both studies in accordance with the Declaration of Helsinki.31 Detailed in- and exclusion criteria are provided in the Supplementary Materials. Tumor patients The data from the tumor patients was gathered as part of a single-center retrospective study in a cohort of adult treatment-naïve diffuse glioma patients (WHO grade II-IV according to WHO2016 classification32) who underwent awake brain surgery between January 2010 and July 2019 at the UMCU. As the data of this cohort was previously gathered as part of routine clinical care and was anonymized, informed consent was not required, in agreement with Dutch law. Preoperative neurocognitive assessment and preoperative MRI were part of routine clinical care in preparation for awake craniotomy and used for the current study. Patients who underwent craniotomy under full anesthesia could not be included for the current study, as elaborate preoperative neurocognitive assessment is not part of routine clinical care.
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