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 ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Autonomous Province of Trento, Italy: Project: NeuSurPlan and integrated approach to neurosurgery planning based on multimodal data to S.S. and J.J. Italian Ministry of Education, University and Research: Dipartimento di Eccellenza project 2018-2022 to F.S. Lucarelli Irion Foundation, Rovereto, Italy, who supported F.S. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval for this study was obtained by the Ethical Committee of the Azienda Provinciale per i Servizi Sanitari (APSS, Neusurplan project, authorization ID A734). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes