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Neuropsychological impairment in primary malignant brain tumor patients with awake craniotomy: a hospital-based registration study

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Abstract

Purpose

Neuroplasticity is an ability to maintain neural circuit function when facing damages. It is one of the reasons that making brain tumors notorious. Therefore, we evaluated the characteristics of patients with primary brain tumors, compared neuropsychological deficits between patients who had awake craniotomy with left- or right-sided tumors, and analyzed the association between white matter tracts and neuropsychological deficits in patients with right-sided tumors.

Methods

Using the registration dataset of Chang Gung Memory Hospital between 2014 and 2020, this study included a total of 698 adult patients who received craniotomy for primary brain tumors (538 of conventional craniotomy; 160 of awake craniotomy). Neuropsychological assessments were arranged in patients as preoperative evaluation for awake craniotomies.

Results

A lower proportion of right-sided tumors was noted in patient who had awake craniotomy than those who had conventional craniotomy (33.8% and 51.5%, p < 0.001). In awake craniotomy, 88.7% of patients with left-sided tumors and 77.8% of patients with right-sided tumors had neuropsychological impairment. Patients with left-sided tumors had worse preoperative performance compared to those with right-sided tumors in global function (36.2% and 8.0%, p < 0.001), language domain (57.6% and 22.2%, p < 0.001), and attention (36.0% and 18.5%, p = 0.02). Furthermore, in those with right-sided low-grade gliomas, patients involving pathway of superior longitudinal fasciculus (SLF) I had a higher risk of deficits than those without involvement in verbal memory (p = 0.001, Odd ratio = 11.2, 95% CI = 1.8 ~ 71.4) and visual memory (p = 0.048, Odd ratio = 10.5, 95% CI = 1.0 ~ 111).

Conclusion

In awake craniotomy, patients with left-sided brain tumors had worse cognitive function than those with right-sided tumors in terms of global function, language, and attention. 77% of patients with right-sided tumors had neuropsychological impairment. Therefore, a comprehensive neuropsychological evaluation and awake craniotomy are necessary for patients with brain tumors.

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Acknowledgements

This study is based in part on data from the Chang Gung Research Database provided by Chang Gung Memorial Hospital. The interpretation and conclusions contained herein do not represent the position of Chang Gung Memorial Hospital.

Funding

This study was supported by the Chang Gung Medical Foundation, Taiwan (grant numbers CMRPG3L1341), as well as by the Ministry of Science and Technology, Executive Yuan, Taiwan (grant numbers 109-2629-B-182 A-001, 110-2314-B-182 A-070, 111-2314-B-182 A-134-MY2). All authors report no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan, Taiwan

    Yah-Yuan Wu, Yi-Chuan Chu, Chun-Chang Yeh, Wei-Chia Chen & Yi-Chun Chen

  2. Dementia Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Yah-Yuan Wu, Yi-Chuan Chu, Chun-Chang Yeh, Wei-Chia Chen & Yi-Chun Chen

  3. Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

    Ko-Ting Chen & Kuo-Chen Wei

  4. Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    Ko-Ting Chen, Pin-Yuan Chen & Kuo-Chen Wei

  5. School of Medicine, Chang Gung University, Taoyuan, Taiwan

    Ko-Ting Chen, Pin-Yuan Chen & Kuo-Chen Wei

  6. Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan

    Pin-Yuan Chen

  7. Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan

    Wei-Han Chang

  8. School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan

    Wei-Han Chang

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  1. Yah-Yuan Wu
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Y-CC, C-CY, W-CC, K-CW, and W-HC. Analysis was performed by Y-YW, Y-CC, K-TC, and Y-PC. The first draft of the manuscript was written by Y-YW and Y-CC, and all authors commented on previous versions of the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Yi-Chun Chen.

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Wu, YY., Chen, KT., Chu, YC. et al. Neuropsychological impairment in primary malignant brain tumor patients with awake craniotomy: a hospital-based registration study. J Neurooncol 164, 483–491 (2023). https://doi.org/10.1007/s11060-023-04431-2

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