Cognition, Emotional States and Health-Related Quality of Life in Awake Craniotomy for Glioma: A Case Series

Abstract

Awake craniotomy is an effective procedure for optimizing the onco-functional balance of resections in glioma. However, limited data exists on the cognition, emotional states, and health-related quality of life (HRQoL) of patients with glioma who undergo awake craniotomy. This study aims to describe (1) peri-operative cognitive function and emotional states in a multi-lingual Asian population, (2) associations between peri-operative cognitive function and follow-up HRQoL, and (3) associations between pre-operative emotional states and follow-up HRQoL. This is a case series of 14 adult glioma patients who underwent awake craniotomy in Singapore. Cognition was assessed with the Montreal Cognitive Assessment and the Repeatable Battery for the Assessment of Neuropsychological Status, emotional states with the Depression, Anxiety and Stress Scale-21 Items, and HRQoL using the EuroQol-5D-5L, the EORTC QLQ-C30, and the EORTC QLQ-BN20. Patients with better pre-operative cognitive scores on all domains reported better HRQoL. Better post-operative immediate memory and language scores were associated with better HRQoL. Moderate pre-operative depression scores and mild and moderate pre-operative stress scores were associated with poorer HRQoL compared to scores within the normal range. Mild pre-operative anxiety scores were associated with better HRQoL compared to scores within the normal range. This descriptive case series showed that patients with higher pre-operative cognitive scores reported better follow-up HRQoL, while patients who reported more pre-operative depressive and stress symptomatology reported worse follow-up HRQoL. Future analytical studies may help to draw conclusions about whether peri-operative cognition and emotional states predict HRQoL on follow up.