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67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

Neuropsychological performance before and after awake surgery: Evaluation of comprehensive intraoperative testing

Meeting Abstract

  • Bernd-Otto Hütter - Neurochirurgische Klinik, Universitätsklinikum Essen, Germany
  • Karsten H. Wrede - Neurochirurgische Klinik, Universitätsklinikum Essen, Germany
  • Nicolai El Hindy - Neurochirurgische Klinik, Universitätsklinikum Essen, Germany
  • Philipp Dammann - Neurochirurgische Klinik, Universitätsklinikum Essen, Germany
  • Oliver Müller - Neurochirurgische Klinik, Universitätsklinikum Essen, Germany
  • Ulrich Sure - Neurochirurgische Klinik, Universitätsklinikum Essen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.03.07

doi: 10.3205/16dgnc014, urn:nbn:de:0183-16dgnc0144

Veröffentlicht: 8. Juni 2016

© 2016 Hütter et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Awake craniotomy allows safe removal of lesions in or adjacent to eloquent brain areas and minimizes neurological deficits for the patient. However, the factual functional safety of this surgical procedure is unknown. Therefore, we applied extended neuropsychological testing during surgery and evaluated its effectiveness by a comprehensive cognitive exam prior and after surgery.

Method: As of yet, a consecutive series of 18 patients aged between 22 and 62 years was investigated prospectively. Six patients were operated upon a low-grade glioma, 5 had a glioblastoma, 4 higher-grade glioma (WHO III), 2 beared a cavernoma and one presented with a meningioma. In 16 patients the lesion was located in the dominant hemisphere in or adjacent to language-relevant areas. Cognitive capacity was assessed by means of a comprehensive neuropsychological testing battery including tests for language, short- and long-term memory and different aspects of attention. Follow-up testing was performed 4-9 months after the operation.

Results: One patient was lost for follow-up and had therefore to be excluded from the neuropsychological analysis. The neurological result 4-9 months after surgery was rated as good (GOS=I) in 15 (83%) patients. At the time of follow-up, no patient had tumor progress or recurrence. 13 patients presented with signs of aphasia preoperatively, 11 of them remained stable at the follow-up exam while one patient improved substantially. In only one patient the aphasia present before surgery worsened postoperatively. Only one patient developed a new aphasia not present before surgery. Pre- and postoperative neuropsychological performance showed no significant differences in the test mean scores. According to the statistical single-case analysis 2 patients substantially worsened neuropsychologically beyond language function after surgery while 14 remained stable and one single patient improved cognitively.

Conclusions: According to the present results awake craniotomy in combination with extensive neuropsychological testing can be regarded as a safe procedure for the surgical treatment of lesions in or adjacent to eloquent brain areas. Regarding the small sample size, larger prospective studies are needed to confirm and expand the present findings.