Neuropsychological functioning after surgery in children treated for brain tumor.
OBJECTIVE
To describe the neuropsychological functioning of children treated with surgery only for localized brain tumors in Dana-Farber Cancer Institute Protocol 92-077. Subsequent reports will describe the neuropsychological functioning of children treated with surgery and stereotactic radiation therapy on Dana-Farber Cancer Institute 92-077.


METHODS
The intellectual functioning of 106 patients was evaluated within 3 months after surgery. An in-depth assessment of the neuropsychological functioning, including an impairment index, was conducted for a subset of 77 school-age children (6-16 yr old) across six functional domains. Descriptive statistics were generated; binomial distribution analyses were performed to assess whether the proportion of individuals with impaired performance on each measure exceeded normative expectations. The impairment index assessed whether poor performance was attributable to a few children or reflected the performance of the cohort as a whole.


RESULTS
Although the Full Scale IQ was within normative expectations, the Verbal IQ was higher than the Performance IQ with 45% of individuals showing a significant discrepancy (P < 0.01) between these scales. There was an increased prevalence of poor performance for measures of motor output, verbal memory, and visuospatial organization. The distribution of the impairment index indicated moderate impairment across the school-age cohort rather than severe impairment in a few patients.


CONCLUSIONS
The results document a moderate level of neuropsychological morbidity among children with brain tumors before stereotactic radiation therapy, presumably referable to the tumor itself and the surgery. The extent to which stereotactic radiation therapy may increase this burden will be assessed in follow-up studies evaluating the longitudinal neuropsychological data.
Carpentieri
Sarah C
SC
Division of Psychology, Department of Psychiatry, Children's Hospital, Boston, MA, USA. sarah.carpentieri@carpenburymed.com
Waber
Deborah P
DP
Pomeroy
Scott L
SL
Scott
R Michael
RM
Goumnerova
Liliana C
LC
Kieran
Mark W
MW
Billett
Amy L
AL
Tarbell
Nancy J
NJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001254:Astrocytoma / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D001932:Brain Neoplasms / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D004806:Ependymoma / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology*; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology*; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D020339:Optic Nerve Glioma / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D011183:Postoperative Complications; D012720:Severity of Illness Index; D013997:Time Factors