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Long-term evaluation of cognition after glioma surgery in eloquent areas

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Abstract

Preservation of cognition is an important outcome measure in eloquent area glioma surgery. Glioma patients may have pre-operative deficits in one or more cognitive domains which could deteriorate post-operatively. It is assumed that these impairments recover within 3 months; some studies however, still detected cognitive decline. Longer follow-up is necessary to elucidate the conclusive effects of surgery. 45 patients with gliomas (low- and high-grade, but without contrast enhancement at diagnosis) in eloquent areas were assessed pre-operatively, 3 months and 1 year post-operatively with a neuropsychological test-protocol. Patients’ performance was compared to normal population and between test-moments. Univariate analyses were performed between cognitive change and tumor-characteristics (localization, grade, volume, extent of resection [EOR]) and treatment-related factors (radio-/chemotherapy). Pre- and post-operatively, impairments were found in all cognitive domains; language, memory, attention and executive functions (p < 0.05). Post-operatively, permanent improvement was observed on a memory test (verbal recall: t = −1.931, p = 0.034), whereas deterioration was found on a language test (category fluency: t = 2.517, p = 0.030). Between 3 months and 1 year, patients improved on 2 language tests (naming: t = −2.781, p = 0.026 and letter fluency: t = −1.975, p = 0.047). There was no influence of tumor- or treatment-related factors on cognitive change. The findings underline the importance of cognitive testing at longer term post-operatively, as cognitive recovery took longer than 3 months, especially within the language domain. However, this longitudinal follow-up study showed that glioma surgery is possible without major long-term damage of cognitive functions. Tumor characteristics and EOR are no additional risk factors for cognitive outcome.

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Acknowledgments

The authors thank the European Low Grade Glioma Network for elaborate discussion on this work at the 2013 Annual ELLGN meeting in Ghent, Belgium.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Dr. Molewaterplein 50, Room EE220, 3015 GE, Rotterdam, The Netherlands

    Djaina Satoer, Evy Visch-Brink, Clemens Dirven & Arnaud Vincent

  2. Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands

    Marion Smits

  3. Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands

    Alfred Kloet

  4. Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands

    Caspar Looman

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  1. Djaina Satoer
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Correspondence to Djaina Satoer.

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Satoer, D., Visch-Brink, E., Smits, M. et al. Long-term evaluation of cognition after glioma surgery in eloquent areas. J Neurooncol 116, 153–160 (2014). https://doi.org/10.1007/s11060-013-1275-3

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