title: Prospective analysis of neuropsychological deficits following resection of benign skull base meningiomas.
abstract: OBJECTIVE Resection of skull base tumors is challenging. The introduction of alternative treatment options, such as radiotherapy, has sparked discussion regarding outcome in terms of quality of life and neuropsychological deficits. So far, however, no prospective data are available on this topic. METHODS A total of 58 patients with skull base meningiomas who underwent surgery for the first time were enrolled in this prospective single-center trial. The average age of the patients was 56.4 ± 12.5 years. Seventy-nine percent of the tumors were located within the anterior skull base. Neurological examinations and neuropsychological testing were performed at 3 time points: 1 day prior to surgery (T1), 3-5 months after surgery (T2), and 9-12 months after surgery (T3). The average follow-up duration was 13.8 months. Neuropsychological assessment consisted of quality of life, depression and anxiety, verbal learning and memory, cognitive speed, attention and concentration, figural memory, and visual-motor speed. RESULTS Following surgery, 23% of patients showed transient neurological deficits and 12% showed permanent new neurological deficits with varying grades of manifestation. Postoperative quality of life, however, remained stable and was slightly improved at follow-up examinations at T3 (60.6 ± 21.5 vs 63.6 ± 24.1 points), and there was no observed effect on anxiety and depression. Long-term verbal memory, working memory, and executive functioning were slightly affected within the first months following surgery and appeared to be the most vulnerable to impairment by the tumor or the resection but were stable or improved in the majority of patients at long-term follow-up examinations after 1 year. CONCLUSIONS This report describes the first prospective study of neuropsychological outcomes following resection of skull base meningiomas and, as such, contributes to a better understanding of postoperative impairment in these patients. Despite deterioration in a minority of patients on subscales of the measures used, the majority demonstrated stable or improved outcome at follow-up assessments.
authors.forename: Klaus
authors.initials: K
authors.lastname: Zweckberger
authors.forename: Eveline
authors.initials: E
authors.lastname: Hallek
authors.forename: Lidia
authors.initials: L
authors.lastname: Vogt
authors.forename: Henrik
authors.initials: H
authors.lastname: Giese
authors.forename: Uta
authors.initials: U
authors.lastname: Schick
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Unterberg
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition / Q000502:physiology; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D008570:Memory, Short-Term / Q000502:physiology; D008579:Meningioma / Q000523:psychology / Q000601:surgery*; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: EORTC = European Organization for Research and Treatment of Cancer; FM = figural memory; FSRT = fractionated stereotactic radiotherapy; GTR = gross-total resection; HAD-S = Hospital Anxiety and Depression Scale; HAWIE-R = Hamburger Wechsler Intelligence Test for Adults–Revised; IMRT = intensity-modulated radiotherapy; STR = subtotal resection; TMT-B = Trail Making Test, version B; VLMT = Verbal Learning and Memory Test; WMS-R = Wechsler Memory Scale, revised version; neurocognitive functioning; neuropsychological assessment; oncology; quality of life; resection; skull base meningioma