Long-term evaluation of cognition after glioma surgery in eloquent areas
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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.
KeywordsCognition Brain tumor surgery Glioma Eloquent area Longitudinal follow-up
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.
- 10.Bello L, Gallucci M, Fava M, Carrabba G, Giussani C, Acerbi F, Baratta P, Songa V, Conte V, Branca V, Stocchetti N, Papagno C, Gaini SM (2007) Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery 60(1):67–80 discussion 80–62PubMedCrossRefGoogle Scholar
- 14.Le Rhun E, Delbeuck X, Devos P, Pasquier F, Dubois F (2009) Cognitive disorders and adult grade II and III gliomas: analysis of a series of 15 patients (Troubles cognitifs dans les gliomes de grade II et III de l’adulte : a propos d’une serie de 15 patients). Neurochirurgie 55(3):303–308. doi: 10.1016/j.neuchi.2008.08.111 PubMedCrossRefGoogle Scholar
- 17.Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376PubMedCrossRefGoogle Scholar
- 19.Graetz S, De Blesser P, Willmes K (1991) Akense Afasie Test, Dutch edn. Swets and Zeitlinger, LisseGoogle Scholar
- 20.Kaplan E, Goodglass H, Weintraub S (2001) Boston naming test. Lippincott, Williams and Wilkins, Philadelphia, TokyoGoogle Scholar
- 21.Luteijn F, Barelds DPF (2004) Groninger Intelligentie Test II (GIT II). Pearson, AmsterdamGoogle Scholar
- 24.Lezak MD (2004) Neuropsychological Assessment. Oxford University Press, New YorkGoogle Scholar
- 25.Verhage F (1964) Intelligentie en leeftijd: Onderzoek bij Nederlanders van 12 tot 77 jaar Van Gorkum, AssenGoogle Scholar
- 27.Gehring K, Sitskoorn MM, Gundy CM, Sikkes SA, Klein M, Postma TJ, van den Bent MJ, Beute GN, Enting RH, Kappelle AC, Boogerd W, Veninga T, Twijnstra A, Boerman DH, Taphoorn MJ, Aaronson NK (2009) Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. J Clin Oncol 27(22):3712–3722. doi: 10.1200/JCO.2008.20.5765 PubMedCrossRefGoogle Scholar
- 30.Weintraub S, Rogalski E, Shaw E, Sawlani S, Rademaker A, Wieneke C, Mesulam MM (2013) Verbal and nonverbal memory in primary progressive aphasia: the Three Words-Three Shapes Test. Behav Neurol 26:67–76Google Scholar
- 31.Gruber O, Goschke T (2004) Executive control emerging from dynamic interactions between brain systems mediating language, working memory and attentional processes. Acta Psychol (Amst) 115:105–121Google Scholar
- 38.Costello A, Shallice T, Gullan R, Beaney R (2004) The early effects of radiotherapy on intellectual and cognitive functioning in patients with frontal brain tumours: the use of a new neuropsychological methodology. J Neurooncol 67(3):351–359Google Scholar
- 39.Satoer D, Vincent A, Smits M, Dirven C, Visch-Brink E (2013) Spontaneous speech of patients with gliomas in eloquent areas before and early after surgery. Acta Neurochir 155:685–692Google Scholar
- 42.Klein M, Heimans JJ, Aaronson NK, van der Ploeg HM, Grit J, Muller M, Postma TJ, Mooij JJ, Boerman RH, Beute GN, Ossenkoppele GJ, van Imhoff GW, Dekker AW, Jolles J, Slotman BJ, Struikmans H, Taphoorn MJ (2002) Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study. Lancet 360(9343):1361–1368PubMedCrossRefGoogle Scholar