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Background  The human brain has an extraordinary ability to functionally change or reorganize its structure in response to disease. The aim of this study is to assess the structural and functional plasticity of contralesional medial temporal lobe (MTL) in patients with unilateral MTL glioma.    Methods  Sixty-eight patients with unilateral MTL glioma (left MTL glioma,  n  = 33; right MTL glioma,  n  = 35) and 40 healthy controls were recruited and scanned with 3D T1 MRI and rest-fMRI. We explored the structure of the contralesional MTL using voxel-based morphometry (VBM) and assessed the memory networks of the contralesional hemisphere using resting-state functional connectivity (rs-FC). The association between FC and cognitive function was assessed with partial correlation analysis.    Results  Compared with healthy controls, both patient groups exhibited (1) a large cluster of voxels with gray matter (GM) volume decrease in the contralesional MTL using region of interest (ROI)-based VBM analysis (cluster level  p  < 0.05, FDR corrected); and (2) decreased intrahemispheric FC between the posterior hippocampus (pHPC) and posterior cingulate cortex (PCC) ( p  < 0.01, Bonferroni corrected). Intrahemispheric FC between the pHPC and PCC was positively correlated with cognitive function in both patient groups.    Conclusion  Using multi-modality brain imaging tools, we found structural and functional changes in the contralesional MTL in patients with unilateral MTL glioma. These findings suggest that the contralesional cortex may have decompensation of structure and function in patients with unilateral glioma, except for compensatory structural and functional adaptations. Our study provides additional insight into the neuroanatomical and functional network changes in the contralesional cortex in patients with glioma.

Structural and Functional Alterations in the Contralesional Medial Temporal Lobe in Glioma Patients