title: Long-term evaluation of cognition after glioma surgery in eloquent areas.
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.
authors.affiliation: Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Dr. Molewaterplein 50, Room EE220, 3015 GE, Rotterdam, The Netherlands, d.satoer@i.cloud.com.
authors.forename: Djaina
authors.initials: D
authors.lastname: Satoer
authors.forename: Evy
authors.initials: E
authors.lastname: Visch-Brink
authors.forename: Marion
authors.initials: M
authors.lastname: Smits
authors.forename: Alfred
authors.initials: A
authors.lastname: Kloet
authors.forename: Caspar
authors.initials: C
authors.lastname: Looman
authors.forename: Clemens
authors.initials: C
authors.lastname: Dirven
authors.forename: Arnaud
authors.initials: A
authors.lastname: Vincent
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D005910:Glioma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult