Article
Neuropsychological outcome after awake surgery of brain tumours in the language-dominant hemisphere
Neuropsychologisches Outcome nach Wach-Operationen von Hirntumoren in der sprachdominanten Hemisphäre
Search Medline for
Authors
Published: | June 4, 2021 |
---|
Outline
Text
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.