ArticleBrain topography2026
Subcortical and Cerebellar Compensation for Motor Control in Medial Frontal Glioblastoma: A Task-Based Connectivity Study.
Article in Brain topography, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Patients with medial frontal gliomas often retain motor function despite tumor infiltration of canonical planning hubs, a paradox suggesting unmapped compensatory networks. We used task-based connectivity analysis to reveal demand-dependent reorganization invisible to standard mapping, aiming to identify distributed systems critical for surgical preservation. Twenty-five WHO Grade IV left medial frontal glioma patients and 25 controls performed visually-paced finger-tapping (2 Hz) during 3 T fMRI. Generalized psychophysiological interaction (gPPI) analysis mapped task-modulated connectivity within sensorimotor, subcortical, cerebellar, and frontoparietal networks. Brain-behavior correlations assessed functional relevance. Canonical sensorimotor coupling and Putamen-Thalamus integration were silenced in patients. Contrary to traditional plasticity models predicting contralesional recruitment, compensation operated through unexpected pathways: Caudate-dominated subcortical connectivity (F = 42.42, p-FDR < 0.05) emerged exclusively in patients, correlating with motor accuracy (ρ = 0.44, p = 0.028); anterior cerebellar feedback circuits (Lobules III/VIII) were recruited; and enhanced frontoparietal engagement indicated cognitive supervision of movement. Patients who exhibited this canonical reorganization pattern, comprising 68% of the cohort, significantly outperformed those who did not (p = 0.014). Preservation of visual network connectivity supported externally-guided timing as a compensatory scaffold. Medial frontal gliomas induce a shift from automatic to cognitively-supervised motor control, mediated by a Caudate-cerebellar-frontoparietal axis that acquires functional significance specifically under task demand. These compensatory networks undetectable at rest represent critical surgical targets. Approximately one-third of patients did not engage this reorganization and showed corresponding performance deficits, suggesting the value of individualized preoperative connectivity mapping. This represents one of the first task-based gPPI evidence demonstrating Caudate-dominated subcortical compensation specifically replacing canonical Putamen-Thalamus motor circuits in WHO Grade IV medial frontal gliomas.
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