QOL-41. FEASIBILITY OF PREOPERATIVE NEUROPSYCHOLOGICAL EVALUATION IN PEDIATRIC BRAIN TUMOR PATIENTS: IS IT POSSIBLE TO ASSESS BEFORE SURGERY?

Abstract

Abstract BACKGROUND We aim to evaluate the feasibility of pre-surgical neuropsychological assessment in pediatric brain tumor patients and to examine the impact of various factors on cognitive changes during follow-up. METHODS Between 2021 and 2023, we analyzed the timing of pre-surgery neuropsychological evaluations, completion rates, referral sources, non-referral rates, as well as general cognitive ability, executive and socioemotional functioning in relation to clinical variables. RESULTS There were 11 preoperative evaluations (mean referral time=2.45 days) and 12 postoperative but pre-oncologic evaluations, reflecting the timing of referrals (M=13.92 days). Referrals came mainly from oncology (17 patients) and rehabilitation (6 patients) teams. Ten patients lacked preoperative or pretreatment neuropsychological referral, 7 discontinued follow-up, and 7 died. 10 patients showed full cooperation, 4 families didn’t complete questionnaires, 3 assessments were adapted due to clinical conditions, 1 patient did not cooperate and 7 were developmental assessments. Six patients’ IQ or Development Quotient (DQ) was below normal at preoperative assessment, despite a group mean of z=0.22. Only three patients had a developmental delay diagnosed at time of presurgery evaluation, 2 of whom had comorbid AED. The remaining patients had no previous diagnosis. At post-treatment evaluation, 15 patients experienced a significant decline in IQ/DQ (t=5.157; p=0.000) and worsened in executive functioning (t=-2.462; p=0.042), while 8 patients improved IQ/DQ scores (t=3.672; p=0.008) with no significant changes in executive (t=1.462; p=0.203) or socioemotional (t=-0.218; p=0.836) functioning. CONCLUSIONS Early neuropsychological assessment is paramount in pediatric patients with a brain tumor. However, it is not always feasible and presents significant challenges: requiring adaptation to the patient’s clinical status, coordination across departments, and managing the family’s emotional response to potential diagnoses. Incorporating preoperative neuropsychological assessment into care protocols is essential to analyze premorbid cognitive and behavioral functioning and to improve patient management and guide targeted interventions.