Artikel
Longitudinal, multimodal, multicentre analysis of CNS-changes associated with resection of low-grade glioma – a feasibility study
Longitudinale, multimodale, multizentrische Erfassung von ZNS-Änderungen assoziiert mit der Resektion von Low-grade Gliomen: eine Machbarkeitsstudie
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Low-grade gliomas (LGG) typically develop in younger patients at ages of 30 to 40 years and are frequently associated with cognitive deficits present already at the initial state of disease. Early maximal resection is considered the gold standard therapy, but there is lack of knowledge on how resection interferes with cognition and how cognitive deficits depend on tumor type, tumor sub-/cortical location and affection of functional neural networks. Therefore, we assessed the possible changes in brain function caused by resection of LGG by multiple methods.
Methods: In this multi-center prospective analysis, we included patients in whom LGG was suspected from MRI and who received maximal tumor resection. Patients underwent neurocognitive testing pre- and shortly postoperatively. In addition, they received a preoperative 18F-FET-PET scan, as well as pre- and postoperative resting state functional MRI (rs-fMRI) and diffusion-weighted MRI (DWI). Depending on the final diagnosis, further adjuvant treatment was initiated postoperatively. Follow-up exams are planned including cognitive testing and standard MRI every 6 months, as well as 18F-FET-PET, DWI and rs-fMRI every 12 months.
Results: In this feasibility phase, we included 10 consecutive patients who underwent resection in our neurosurgery department. Compared to preoperative screening, mild cognitive impairment was slightly more frequent after resection (t-sample test, p=0.039). One patient's cognitive scores improved postoperatively, and one patient achieved full scores in both assessments. In the preoperative resting-state MRI scans, the main structure of the principle resting-state networks was preserved. Postoperatively, the intra-network connectivity of the somato-motor and ventral attentional networks was significantly reduced (p=0.028, p=0.007, Wilcoxon matched pairs test).
Conclusion: The presented data confirm the feasibility of the planned study design. We could demonstrate alterations in both cognitive functioning and resting-state fMRI in patients pre- and postoperatively. The results emphasize the importance of neurocognitive assessment in LGG patients, and give a first insight in possible effects of surgery on functional networks of the brain. However, more knowledge of the specific anatomical functions of these networks and the consequences of their affection by therapy and tumor progression is clearly needed. Follow-up data is pending, and we are planning to examine a bigger cohort focusing especially on these issues.