gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Neuropsychological outcome after awake surgery of brain tumours in the language-dominant hemisphere

Neuropsychologisches Outcome nach Wach-Operationen von Hirntumoren in der sprachdominanten Hemisphäre

Meeting Abstract

  • presenting/speaker Marion Behrens - University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Deutschland
  • Irina Lortz - University Hospital Frankfurt, Department of Neurosurgery, Frankfurt am Main, Deutschland
  • Nadine Conradi - University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Deutschland
  • Christian Kell - University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Deutschland
  • Volker Seifert - University Hospital Frankfurt, Department of Neurosurgery, Frankfurt am Main, Deutschland
  • Helmuth Steinmetz - University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Deutschland
  • Marie-Thérèse Forster - University Hospital Frankfurt, Department of Neurosurgery, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV136

doi: 10.3205/21dgnc128, urn:nbn:de:0183-21dgnc1283

Published: June 4, 2021

© 2021 Behrens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objective: Preserving patients’ cognitive performance during surgical therapy is of special importance for their future participation and professional ability. Therefore, we aimed at evaluating the neuropsychological outcome in patients after awake brain tumour surgery in language-relevant areas.

Methods: In 27 patients with gliomas in language-relevant areas of the left dominant hemisphere comprehensive neuropsychological assessment was performed before (T0) awake surgery as well as ≤9 months (T1) and >9 months (T2) thereafter. A neuropsychological test battery evaluating attention, verbal fluency, verbal memory, working memory, executive functions, and mood disturbances was applied. Differences in pre- and postsurgical cognitive performance were analysed by paired samples t-tests, and Cochran tests.

Results: At T1, impairments in all cognitive domains were noted, with significant deteriorations in verbal fluency (t0vs1=-2.824, p=0.010), and working memory (t0vs1=-2.668, p=0.014). At T2, all cognitive functions, particularly verbal fluency (t1vs2=5.200, p<0.001) and verbal memory (t1vs2=3.407, p=0.004) had recovered. Defining a z-score <-1.5 as an objectified deficit, we found significant changes in deficit rates for verbal fluency (Cochran’s Q=9.333, p=0.009) with a pronounced increase to T1 and a subsequent return almost to the preoperative level (T0: 7.7%, T1: 36.4%, T2: 10.5%), for executive functions (Q=6.000, p=0.049) with also higher values for T1 (T0: 14.8%, T1: 34.8%, T2: 5.0%), but also a decrease in the rate of mood impairments (Q=7.000, p=0.030; T0: 66.7%, T1: 34.8%, T2: 35.0%). In summary, at T2, 5% of patients still had deficits in attention, working memory and executive functions, 10.5% deficits in verbal fluency, 20% disorders of verbal memory, and 35% still showed impaired mood.

Conclusion: Our results indicate that the cognitive status of patients with tumours in language-relevant areas initially worsened significantly after awake surgery. These deficits consistently recovered after the subsequent months, but a relevant number of patients with persistent impairments remained (especially in language-related functions and mood). Therefore, caution is advised regarding the assumption of full recovery of cognitive performance after awake surgery, in order to identify individual needs for neuropsychological rehabilitation and psychotherapeutic support in this subset of patients.