Changes in Cognitive Functioning After Surgical Resection of Language-related, Eloquent-area, High-grade Gliomas Under Awake Craniotomy.

Abstract

BACKGROUND:

Dominant-hemisphere tumors, especially gliomas, as infiltrative tumors, frequently affect cognitive functioning. Establishing a balance between extensive resection, which is proven to result in longer survival, and less extensive resection, in order to maintain more cognitive abilities, is challenging.

OBJECTIVE:

To evaluate changes in cognitive functioning before and after surgical resection of language-related, eloquent-area, high-grade gliomas under awake craniotomy.

METHOD:

We provided individuals with newly diagnosed high-grade gliomas of the language-related eloquent areas with the same standard of care, including surgical resection of the glioma using intraoperative sensory-motor and cognitive mapping under awake craniotomy, and the same protocol for chemoradiotherapy. Cognitive functioning was assessed using Addenbrooke's Cognitive Examination-Revised (ACE-R) at four time points (preoperatively, early after surgery, and 3 and 6 months postoperatively).

RESULTS:

The preoperative evaluation revealed a range of cognitive impairments in 70.7% of the individuals, affecting all of the cognitive subdomains (mostly attention and visuospatial abilities). Overall cognitive functioning (ie, ACE-R score) dropped by 13.5% (P = 0.169) early postoperatively. At the 3-month evaluation, an average of 15.3% (P = 0.182) recovery in cognitive functioning was observed (mostly in verbal fluency: 39.1%). This recovery improved further, reaching 29% (P < 0.001) at the 6-month evaluation. The greatest improvement occurred in verbal fluency: 68.8%, P = 0.001.

CONCLUSION:

Extensive resection of eloquent-area gliomas with the aid of modern neuroimaging and neuromonitoring techniques under awake craniotomy is possible without significant long-term cognitive sequela.

• Authors: Kasra Hendi, Mohamad Rahmani, Amirhossein Larijani, Hamideh Ajam Zibadi, Samira Raminfard, Reza Shariat Moharari, Venelin Gerganov, Maysam Alimohamadi
• Journal: Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology (Cogn Behav Neurol) Vol. 35 Issue 2 Pg. 130-139 (06 01 2022) ISSN: 1543-3641 [Electronic] United States
• PMID: 35486526 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Brain Mapping
• Brain Neoplasms (surgery)
• Cognition
• Craniotomy (methods)
• Glioma (pathology, surgery)
• Humans
• Language
• Wakefulness