Abstract
Low-grade gliomas (LGG) are slow-growing brain tumors infiltrating the central nervous system which tend to recur, often with malignant degeneration after primary treatment. Re-operations are not always recommended due to an assumed higher risk of neurological and cognitive deficits. However, this assumption is relatively ungrounded due to a lack of extensive neuropsychological testing. We retrospectively examined a series of 40 patients with recurrent glioma in eloquent areas of the left hemisphere, who all completed comprehensive pre- (T3) and post-surgical (T4) neuropsychological assessments after a second surgery (4-month follow up). The lesions were most frequent in the left insular cortex and the inferior frontal gyrus. Among this series, in 17 patients the cognitive outcomes were compared before the first surgery (T1), 4 months after the first surgery (T2), and at T3 and T4. There was no significant difference either in the number of patients scoring within the normal range between T3 and T4, or in their level of performance. Further addressing the T1–T4 evolution, there was no significant difference in the number of patients scoring within the normal range. As to their level of performance, the only significant change was in phonological fluency. This longitudinal follow-up study showed that repeated glioma surgery is possible without major damage to cognitive functions in the short-term period (4 months) after surgery.
Highlights
Low-grade gliomas (LGG) are a heterogeneous group of primary brain tumors that often arise in young, otherwise healthy, patients, often located close to or infiltrating eloquent brain areas
We further addressed the neuropsychological pattern for the subgroup (N = 17) of patients who were tested pre- and post- first and second surgery (T1–T4)
By analyzing the neuropsychological data from 40 patients after second surgery, we considered two different measures: the number of patients scoring within the normal range, namely we tested for changes in the number of patients scoring normally after the second surgery, with respect to the cut-offs, and, as a second measure of the patients’ levels of performance, we tested for changes in their accuracy
Summary
Low-grade gliomas (LGG) are a heterogeneous group of primary brain tumors that often arise in young, otherwise healthy, patients, often located close to or infiltrating eloquent brain areas. In the case of these tumors, survival is associated with maximal extent of resection (EOR) [1,2,3,4,5,6,7,8,9], though this may affect neurological and cognitive functions, and patient quality of life (QoL). Management is based on histology, molecular profile, tumor location, and patient characteristics. To combine maximal resection with a reduced risk of clinical and neuropsychological impairment, mapping with awake craniotomies and neuropsychological testing has become an almost mandatory stage in therapeutic management in supratentorial locations. Several clinicians are reluctant to re-operate on LGG patients, preferring new cycles of chemotherapy and/or radiotherapy, their major concern
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