Abstract
Patients with a diffuse glioma may experience cognitive decline or improvement upon resective surgery. To examine the impact of glioma location, cognitive alteration after glioma surgery was quantified and related to voxel‐based resection probability maps. A total of 59 consecutive patients (range 18–67 years of age) who had resective surgery between 2006 and 2011 for a supratentorial nonenhancing diffuse glioma (grade I–III, WHO 2007) were included in this observational cohort study. Standardized neuropsychological examination and MRI were obtained before and after surgery. Intraoperative stimulation mapping guided resections towards neurological functions (language, sensorimotor function, and visual fields). Maps of resected regions were constructed in standard space. These resection cavity maps were compared between patients with and without new cognitive deficits (z‐score difference >1.5 SD between baseline and one year after resection), using a voxel‐wise randomization test and calculation of false discovery rates. Brain regions significantly associated with cognitive decline were classified in standard cortical and subcortical anatomy. Cognitive improvement in any domain occurred in 10 (17%) patients, cognitive decline in any domain in 25 (42%), and decline in more than one domain in 10 (17%). The most frequently affected subdomains were attention in 10 (17%) patients and information processing speed in 9 (15%). Resection regions associated with decline in more than one domain were predominantly located in the right hemisphere. For attention decline, no specific region could be identified. For decline in information speed, several regions were found, including the frontal pole and the corpus callosum. Cognitive decline after resective surgery of diffuse glioma is prevalent, in particular, in patients with a tumor located in the right hemisphere without cognitive function mapping.
Highlights
The main findings of this study are that (a) cognitive alterations after resective surgery of diffuse glioma are rather prevalent with 17% of patients declining in more than one domain and 10% improved in at least one domain, (b) attention and information processing speed are the most frequently declined cognitive domains, and (c) the brain regions most vulnerable for cognitive decline after surgery are located in the right hemisphere
Few studies have reported on cognitive alteration after glioma resection based on pre- and postoperative neuropsychological examination (Dallabona et al, 2017; Habets et al, 2014; Mandonnet et al, 2015; Noll et al, 2015; Racine, Li, Molinaro, Butowski, & Berger, 2015; Satoer et al, 2014; Talacchi et al, 2011; Wu et al, 2011)
These studies have included mainly patients with WHO grade IV glioblastoma, in whom tumor mass-effect on the brain and subsequent surgical relief of compression is likely different from removal of tumor-infiltrated brain regions in patients with lower grade gliomas
Summary
Standard care for diffuse glioma of grade WHO I–III includes resective surgery, followed by radio- and/or chemotherapy, depending on tumor grade, subtype, and molecular markers, either adjuvant or delayed at recurrence. Patients were included, who (a) were over 17 years of age, (b) were diagnosed with a supratentorial glioma of grade I–II, or III with focal anaplasia—WHO 2007, (c) had a resection between 1/1/2006 and 31/12/2011, (d) had no prior radiotherapy to avoid MRI signal misinterpretation, (e) had pre- and postoperative cognitive assessment in seven cognitive domains, (f) had a pre- and postoperative MRI available, and (g) had stable disease between surgery and postoperative assessment. Patients with another neurological or psychiatric disorder or with insufficient Dutch language skills were excluded, as this could have interfered with cognitive assessment.
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