Improvement in cognitive function after surgery for low-grade glioma

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Cognition is a key component in health-related quality of life (HRQoL) and is currently incorporated as a major parameter of outcome assessment in patients treated for brain tumors. The effect of surgery on cognition and HRQoL remains debatable. The authors investigated the impact of resection of low-grade gliomas (LGGs) on cognition and the correlation with various histopathological markers.


A retrospective analysis of patients with LGG who underwent craniotomy for tumor resection at a single institution between 2010 and 2014 was conducted. Of 192 who underwent resective surgery for LGG during this period, 49 had complete pre- and postoperative neurocognitive evaluations and were included in the analysis. These patients completed a full battery of neurocognitive tests (memory, language, attention and working memory, visuomotor organization, and executive functions) pre- and postoperatively. Tumor and surgical characteristics were analyzed, including volumetric measurements and histopathological markers (IDH, p53, GFAP).


Postoperatively, significant improvement was found in memory and executive functions. A subgroup analysis of patients with dominant-side tumors, most of whom underwent intraoperative awake mapping, revealed significant improvement in the same domains. Patients whose tumors were on the nondominant side displayed significant improvement only in memory functions. Positive staining for p53 testing was associated with improved language function and greater extent of resection in dominant-side tumors. GFAP positivity was associated with improved memory in patients whose tumors were on the nondominant side. No correlation was found between cognitive outcome and preoperative tumor volume, residual volume, extent of resection, or IDH1 status.


Resection of LGG significantly improves memory and executive function and thus is likely to improve functional outcome in addition to providing oncological benefit. GFAP and pP53 positivity could possibly be associated with improved cognitive outcome. These data support early, aggressive, surgical treatment of LGG.

ABBREVIATIONS EOR = extent of tumor resection; fMRI = functional MRI; FWE = family-wise error; HRQoL = health-related quality of life; LGG = low-grade glioma.

Article Information

Correspondence Zvi Ram: Tel Aviv Medical Center, Tel Aviv, Israel.

INCLUDE WHEN CITING Published online March 23, 2018; DOI: 10.3171/2017.9.JNS17658.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



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    Representation of tumor locations. Tumors are grouped according to their anatomical location and are presented on a generic brain (fsaverage5) surface representation imported from FreeSurfer ( LH = left hemisphere; RH = right hemisphere.

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    Preoperative (light gray) and postoperative (dark gray) mean cognitive scores in LGG patients. A: Mixed cohort of patients with tumors in the dominant and nondominant side. B: Patients with dominant-side tumors. C: Patients with tumors in the nondominant side. D: Patients with tumors in the left frontal lobe. The expected population average score is 0 for each test. *p < 0.05.





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