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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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The find-the-symbol test to detect and monitor deficits of visual attention and executive functions in brain tumour patients

Der Finde-das-Symbol Test zur klinischen Verlaufsdiagnostik von visueller Aufmerksamkeit und Exekutivfunktionen von Hirntumorpatienten

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  • presenting/speaker Catharina Schröter - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland
  • Anna M. Wagner - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland
  • Kimberley Rodrian - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland
  • Sophia Kochs - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland
  • Anne K. Rehme - Universitätsklinikum Köln, Department of Neurology, Köln, Deutschland
  • Charlotte Nettekoven - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland
  • Ricardo Louçäo - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland
  • Dorothee Wiewrodt - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Mario Löhr - Universitätsklinikum Würzburg, Klinik und Poliklinik für Neurochirurgie, Würzburg, Deutschland
  • Christine Jungk - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Roland Goldbrunner - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland
  • NOA-19 Study Group - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland; Universitätsklinikum Köln, Department of Neurology, Köln, Deutschland; Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland; Universitätsklinikum Würzburg, Klinik und Poliklinik für Neurochirurgie, Würzburg, Deutschland; Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland; Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland; Donau-Isar-Hospital Deggendorf, Department of Neurosurgery, Deggendorf, Deutschland; Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland; Universitätsklinikum Schleswig-Holstein, Klinik für Neurochirurgie, Lübeck, Deutschland; Hospital Chemnitz GmbH, Department of Neurosurgery, Chemnitz, Deutschland; HELIOS Hospital Schwerin, Department of Neurosurgery, Schwerin, Deutschland; Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland; Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg i. Br., Deutschland; Universitätsklinikum Tübingen, Departments of Neurology and Neurosurgery, Tübringen, Deutschland
  • Carolin Weiß-Lucas - Universitätsklinikum Köln, Center for Neurosurgery, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV249

doi: 10.3205/22dgnc241, urn:nbn:de:0183-22dgnc2418

Published: May 25, 2022

© 2022 Schröter 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: The Find The Symbol test (FST) was recently proposed to detect neglect, as well as other deficits of visual attention and executive functions, and was designed to offer repeated testings in the clinical follow-up of brain tumour patients, using slightly modified versions to avoid learning effects (parallel versions). We now set out to investigate (1) the test parallel-test reliability and (2) the clinical validity of the FST, as well as (3) the anatomical lesion locations correlating to poor FST performance.

Methods: First, 20 patients (cohort A; 50% males; median age 62 yrs) with right-hemispheric intracerebral lesions were tested at a single time point with five parallel FST versions in pseudo-randomized sequence to analyse parallel-test reliability (Cronbach’s Alpha in R 3.6.3). Secondly, 232 glioblastoma patients (cohort B; 64% males; median age 63 yrs) were tested prior to first tumour surgery. The influence of the factors age, educational level, gender, and parallel test version on FST performance were tested by analysis of variance (ANOVA). The FST laterality indices were normalized to percentile ranks, and were correlated to the clinical neglect diagnosis. The tumour volumes were segmented in the preoperative CE-T1 MRIs to generate volumes of interest. A mass univariate voxel based lesion symptom mapping (VLSM, Brunner Munzel) was performed to correlate the functional deficits to anatomical lesion locations. Symptom-correlated brain regions were determined by intersecting the VLSM results to a standard brain atlas.

Results: The internal consistency of the five parallel FST versions was good (Cronbach’s alpha=0.82; confidence interval: 0.70 – 0.93; cohort A). Accordingly, ANOVA showed no significant influence of parallel test version, age, gender, or educational level on the test scores (cohort B). Clinical diagnosis of neglect correlated negatively with FST percentile ranks (p=0.02). VLSM showed an association of poor FST performance (i.e., low percentile ranks) with the right-hemispheric temporo-parietal junction (supramarginal gyrus, superior temporal gyrus > postcentral gyrus), and the neigbouring segment of the perisylvian pathways (arcuate fascicle).

Conclusion: The FST, coming with 5 well-comparable parallel versions standardized for glioblastoma patients, offers a simple diagnostic tool to detect deficits in spatial attention such as neglect. It seems particularly useful for testing and monitoring patients with lesions of the right temporo-parietal junction.