{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T21:42:08Z","timestamp":1789422128620,"version":"build-2803163510"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2018,8,22]],"date-time":"2018-08-22T00:00:00Z","timestamp":1534896000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Neurosurgical management of brain tumors has entered a paradigm of supramarginal resections that demands thorough understanding of peritumoral functional effects. Historically, the effects of tumors have been believed to be local, and long-range effects have not been considered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To test the hypothesis that tumors affect the brain globally, producing long-range gradients in cortical function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Resting-state functional magnetic resonance imaging (fMRI) data were acquired from 11 participants with glioblastoma and split into discovery and validation datasets in a single-center prospective cohort study. Fractal complexity was computed with a wavelet-based estimator of the Hurst exponent. Distance-related effects of the tumors were tested with a tumor mask-dilation technique and parcellation of the underlying Hurst maps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Fractal complexity demonstrates a penumbra of suppression in the peritumoral region. At a global level, as distance from the tumor increases, this initial suppression is balanced by a subsequent overactivity before finally normalizing. These effects were best fit by a quadratic model and were consistent across different network construction pipelines. The Hurst exponent was correlated with graph theory measures of centrality including network robustness, but graph theory measures did not demonstrate distance-dependent effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>This work provides evidence supporting the theory that focal brain tumors produce long-range gradients in function. Consequently, the effects of focal lesions need to be interpreted in terms of the global changes on functional complexity and network architecture rather than purely in terms of functional localization. Determining whether peritumoral changes represent potential plasticity may facilitate extended resection of tumors without functional cost.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyy378","type":"journal-article","created":{"date-parts":[[2018,7,20]],"date-time":"2018-07-20T00:11:36Z","timestamp":1532045496000},"page":"1201-1213","source":"Crossref","is-referenced-by-count":56,"title":["Global Effects of Focal Brain Tumors on Functional Complexity and Network Robustness: A Prospective Cohort Study"],"prefix":"10.1227","volume":"84","author":[{"given":"Michael G","family":"Hart","sequence":"first","affiliation":[{"name":"Brain Mapping Unit, Department of Psychiatry, Sir William Hardy Building, University of Cambridge, Cambridge, United Kingdom"},{"name":"Academic Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Romero-Garcia","sequence":"additional","affiliation":[{"name":"Brain Mapping Unit, Department of Psychiatry, Sir William Hardy Building, University of Cambridge, Cambridge, United Kingdom"},{"name":"Academic Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J","family":"Price","sequence":"additional","affiliation":[{"name":"Academic Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Suckling","sequence":"additional","affiliation":[{"name":"Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,6]]},"reference":[{"issue":"7","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1007\/s00330-006-0561-2","article-title":"Predicting patterns of glioma recurrence using diffusion tensor imaging","volume":"17","author":"Price","year":"2007","journal-title":"Eur Radiol"},{"issue":"10)","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1136\/jnnp.2003.028480","article-title":"Discrepancy between lesion distributions on methionine PET and MR images in patients with glioblastoma multiforme: insight from a PET and MR fusion study","volume":"75","author":"Miwa","year":"2004","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"Spec No 2","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"S159","DOI":"10.1259\/bjr\/26838774","article-title":"Imaging biomarkers of brain tumour margin and tumour invasion","volume":"84","author":"Price","year":"2011","journal-title":"Br J Radiol"},{"issue":"3","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"568","DOI":"10.3171\/jns.2002.97.3.0568","article-title":"Diffusion-tensor imaging of white matter tracts in patients with cerebral neoplasm","volume":"97","author":"Witwer","year":"2002","journal-title":"J Neurosurg"},{"issue":"5","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S1470-2045(06)70665-9","article-title":"Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial","volume":"7","author":"Stummer","year":"2006","journal-title":"Lancet Oncol"},{"issue":"4","key":"bib6-20231011","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s00259-010-1690-z","article-title":"Comparison of 18F-FET PET and 5-ALA fluorescence in cerebral gliomas","volume":"38","author":"Floeth","year":"2011","journal-title":"Eur J Nucl Med Mol Imag"},{"issue":"6","key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1227\/NEU.0b013e31828c3974","article-title":"Prognostic value of residual fluorescent tissue in glioblastoma patients after gross total resection in 5-aminolevulinic acid-guided surgery","volume":"72","author":"Aldave","year":"2013","journal-title":"Neurosurgery"},{"issue":"1","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"234","DOI":"10.3171\/2016.1.JNS152153","article-title":"Extent of resection of peritumoral diffusion tensor imaging-detected abnormality as a predictor of survival in adult glioblastoma patients","volume":"126","author":"Yan","year":"2017","journal-title":"J Neurosurg"},{"issue":"4","key":"bib9-20231011","doi-asserted-by":"crossref","first-page":"977","DOI":"10.3171\/2015.5.JNS142087","article-title":"The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection?","volume":"124","author":"Li","year":"2016","journal-title":"J Neurosurg"},{"issue":"1","key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s11060-012-0798-3","article-title":"Prospective cohort study of radiotherapy with concomitant and adjuvant temozolomide chemotherapy for glioblastoma patients with no or minimal residual enhancing tumor load after surgery","volume":"108","author":"Stummer","year":"2012","journal-title":"J Neurooncol"},{"key":"bib13-20231011","author":"Penfield","year":"1950","journal-title":"The Cerebral Cortex of Man"},{"issue":"9","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.tics.2014.04.003","article-title":"Scale-free brain activity: past, present, and future","volume":"18","author":"He","year":"2014","journal-title":"Trends Cogn Sci"},{"issue":"6735","key":"bib15-20231011","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1038\/20924","article-title":"Multifractality in human heartbeat dynamics","volume":"399","author":"Ivanov","year":"1999","journal-title":"Nature"},{"issue":"Supplement 1","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"2466","DOI":"10.1073\/pnas.012579499","article-title":"Fractal dynamics in physiology: alterations with disease and aging","volume":"99","author":"Goldberger","year":"2002","journal-title":"Proc Natl Acad Sci"},{"issue":"2","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jneumeth.2008.06.037","article-title":"Endogenous multifractal brain dynamics are modulated by age, cholinergic blockade and cognitive performance","volume":"174","author":"Suckling","year":"2008","journal-title":"J Neurosci Methods"},{"issue":"7","key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1002\/hbm.20593","article-title":"Monofractal and multifractal dynamics of low frequency endogenous brain oscillations in functional MRI","volume":"29","author":"Wink","year":"2008","journal-title":"Hum Brain Mapp"},{"issue":"1","key":"bib19-20231011","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.neuroimage.2004.10.044","article-title":"Fractional Gaussian noise, functional MRI and Alzheimer's disease","volume":"25","author":"Maxim","year":"2005","journal-title":"Neuroimage"},{"issue":"3","key":"bib20-20231011","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1063\/1.1395631","article-title":"From 1\/f noise to multifractal cascades in heartbeat dynamics","volume":"11","author":"Ivanov","year":"2001","journal-title":"Chaos"},{"issue":"6","key":"bib21-20231011","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.3171\/2015.4.JNS142683","article-title":"Graph theory analysis of complex brain networks: new concepts in brain mapping applied to neurosurgery","volume":"124","author":"Hart","year":"2016","journal-title":"J Neurosurg"},{"issue":"5","key":"bib22-20231011","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1080\/02688697.2016.1208809","article-title":"Connectome analysis for pre-operative brain mapping in neurosurgery","volume":"30","author":"Hart","year":"2016","journal-title":"Br J Neurosurg"},{"issue":"6","key":"bib23-20231011","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s00401-016-1545-1","article-title":"The 2016 world health organization classification of tumors of the central nervous system: A summary","volume":"131","author":"Louis","year":"2016","journal-title":"Acta Neuropathol"},{"issue":"11","key":"bib24-20231011","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1200\/JCO.2009.26.3541","article-title":"Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group","volume":"28","author":"Wen","year":"2010","journal-title":"J Clin Oncol"},{"key":"bib25-20231011","doi-asserted-by":"crossref","DOI":"10.54294\/uvnhin","article-title":"Advanced normalization tools: V1. 0","author":"Avants","year":"2009","journal-title":"Insight J"},{"key":"bib26-20231011","doi-asserted-by":"crossref","article-title":"The ANTs cortical thickness processing pipeline","author":"Tustison","DOI":"10.1117\/12.2007128"},{"issue":"2","key":"bib27-20231011","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.neuroimage.2008.12.016","article-title":"Registration based cortical thickness measurement","volume":"45","author":"Das","year":"2009","journal-title":"Neuroimage"},{"issue":"3","key":"bib28-20231011","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1006\/cbmr.1996.0014","article-title":"AFNI: software for analysis and visualization of functional magnetic resonance neuroimages","volume":"29","author":"Cox","year":"1996","journal-title":"Comput Biomed Res"},{"issue":"40","key":"bib29-20231011","doi-asserted-by":"crossref","first-page":"16187","DOI":"10.1073\/pnas.1301725110","article-title":"Integrated strategy for improving functional connectivity mapping using multiecho fMRI","volume":"110","author":"Kundu","year":"2013","journal-title":"Proc Natl Acad Sci"},{"issue":"5","key":"bib30-20231011","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1191\/0962280203sm339ra","article-title":"Wavelets and statistical analysis of functional magnetic resonance images of the human brain","volume":"12","author":"Bullmore","year":"2003","journal-title":"Stat Methods Med Res"},{"issue":"4","key":"bib31-20231011","doi-asserted-by":"crossref","first-page":"3522","DOI":"10.1016\/j.neuroimage.2011.10.086","article-title":"Effects of network resolution on topological properties of human neocortex","volume":"59","author":"Romero-Garcia","year":"2012","journal-title":"Neuroimage"},{"issue":"3","key":"bib32-20231011","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.neuroimage.2009.12.027","article-title":"Whole-brain anatomical networks: does the choice of nodes matter?","volume":"50","author":"Zalesky","year":"2010","journal-title":"Neuroimage"},{"issue":"3","key":"bib33-20231011","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/0378-8733(78)90021-7","article-title":"Centrality in social networks conceptual clarification","volume":"1","author":"Freeman","year":"1978","journal-title":"Soc. Netw"},{"issue":"7028","key":"bib34-20231011","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1038\/nature03288","article-title":"Functional cartography of complex metabolic networks","volume":"433","author":"Guimera","year":"2005","journal-title":"Nature"},{"issue":"3","key":"bib35-20231011","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.neuroimage.2009.10.003","article-title":"Complex network measures of brain connectivity: uses and interpretations","volume":"52","author":"Rubinov","year":"2010","journal-title":"Neuroimage"},{"issue":"6","key":"bib36-20231011","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1109\/TAC.1974.1100705","article-title":"A new look at the statistical model identification","volume":"19","author":"Akaike","year":"1974","journal-title":"IEEE Trans Automat Contr"},{"issue":"4","key":"bib37-20231011","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s10334-013-0420-5","article-title":"A preliminary study on the effects of acute ethanol ingestion on default mode network and temporal fractal properties of the brain","volume":"27","author":"Weber","year":"2014","journal-title":"Magn Reson Mater Phy"},{"issue":"Pt 1","key":"bib38-20231011","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1093\/brain\/awn293","article-title":"Childhood brain insult: can age at insult help us predict outcome?","volume":"132","author":"Anderson","year":"2009","journal-title":"Brain"},{"issue":"8","key":"bib39-20231011","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.cortex.2009.10.008","article-title":"Margaret Kennard (1899-1975): Not a \u201cPrinciple\u201d of brain plasticity but a founding mother of developmental neuropsychology","volume":"46","author":"Dennis","year":"2010","journal-title":"Cortex"},{"issue":"2","key":"bib40-20231011","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s11060-012-0811-x","article-title":"Cognition and resective surgery for diffuse infiltrative glioma: an overview","volume":"108","author":"Klein","year":"2012","journal-title":"J Neurooncol"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00006123-201906000-00005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:44:24Z","timestamp":1786121064000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00006123-201906000-00005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,22]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyy378","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,22]]}}}