Neurosurgery 99:140–148, 2026
This study evaluates how resections of language-associated white matter tracts (WMTs) predict persistent postoperative language deficits (PLDs) in 68 glioma patients using tractography, intraoperative mapping, and outcome assessments. Results show WMT resection strongly predicts PLDs with high negative predictive value but modest positive predictive value, and temporal/parietal segments carry the greatest risk.
Anatomic clustering localized high-risk resections to the temporoparietal junction and middle temporal lobe, while frontal operculum and orbitofrontal tracts were often resectable without lasting deficits. Anatomically stratifying tracts (parietal/temporal) improved positive predictive value, supporting tractography-informed surgical planning alongside intraoperative mapping.
Goal Identify predictors of permanent postoperative language deficits (PLDs) in language-eloquent glioma surgery by analyzing which language-associated white matter tract (WMT) segments are resected.
Cohort & approach Retrospective analysis of consecutive adults undergoing awake craniotomy with intraoperative language mapping; WMT tractography reconstructed 6 language-related tracts and parcellated by anatomic location; outcomes based on formal language testing pre-op vs 1–3 months post-op (with clinical follow-up to 6 months for persistence).
Overall predictive signal Any WMT resection strongly increased odds of PLDs (odds ratio 16.0, P = .0115) with high NPV 97.4% but low PPV 29.6%.
Anatomic vulnerability Resections associated with PLDs clustered in the temporoparietal junction (TPJ) and middle temporal lobe (MTL), while resections without PLDs were more diffuse and concentrated in frontal/anterior regions.
Resectability by region Frontal tract segments showed near-complete resectability (PPV = 0 across reported frontal segments), whereas parietal/temporal segments had higher PPVs (eg, parietal AF 0.4, temporal AF 1, temporal IFOF 0.5, temporal ILF 0.5).
Stratified model Focusing only on parietal and temporal tract segment resections improved prediction of PLDs (odds ratio 29.4, P < .001) and increased PPV to 50% (NPV 96.7%).
Resection volume The volume of tract resected did not differ by functional outcome (U = 84.0, P = .70), suggesting location/segment matters more than amount.
Clinical implication WMT resections in orbitofrontal, anterior temporal, and frontal operculum regions were often tolerated, while parietal/temporal WMT injuries substantially increased PLD risk.
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