Neuropsychological assessments before and after awake surgery for incidental low-grade gliomas

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  • 1 Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier;
  • 2 Department of Speech–Language Pathology, University of Montpellier;
  • 3 INSERM U1191, Team “Plasticity of Central Nervous System, Human Stem Cells, and Glial Tumors,” Institute of Functional Genomics, Montpellier; and
  • 4 Department of Neurosurgery, Poitiers University Hospital, Poitiers, France
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OBJECTIVE

Early surgery in presumed asymptomatic patients with incidental low-grade glioma (ILGG) has been suggested to improve maximal resection rates and overall survival. However, no study has reported on the impact of such preventive treatment on cognitive functioning. The aim of this study was to investigate neuropsychological outcomes in patients with ILGG who underwent preventive surgery.

METHODS

This was a retrospective analysis of a consecutive series of patients with ILGG who underwent awake surgery and who had presurgical and 3-month postsurgical neuropsychological assessments. Data were normalized into z-scores and regrouped by cognitive domains. Clinicoradiological data, histomolecular profile, and differences in z-scores (Δz-scores) were analyzed.

RESULTS

Forty-seven patients were included (mean age 39.2 ± 11.3 years). Twenty-eight patients (59.6%) underwent supratotal or total resections. All patients were still alive after a mean follow-up of 33.0 ± 30.8 months. Forty-one patients (87.2%) had stable (n = 34, 72.3%) or improved (Δz-score > 1; n = 7, 14.9%) neurocognitive outcomes after surgery. Six patients (12.8%) presented a slight impairment (Δz-score < −1) in at least one cognitive domain. The mean presurgical and postsurgical z-scores were comparable except in the psychomotor speed and attention domain. A significant correlation between presurgical executive functioning and tumor volume was reported, whereas the extent of resection and histomolecular profile did not impact neuropsychological outcomes.

CONCLUSIONS

Early surgical treatment in presumed asymptomatic patients with ILGG was associated with stable or improved neuropsychological outcomes in 87.2% of patients at 3 months, with only mild cognitive decline observed in 6 patients. In return, supratotal or total resections were achieved in most patients, and all patients were still alive at the end of the follow-up.

ABBREVIATIONS AED = antiepileptic drug; EOR = extent of resection; ILGG = incidental LGG; LGG = low-grade glioma; RL-RI16 = Rappel libre et Rappel indicé à 16 items; ROCF = Rey-Osterrieth complex figure; TCF = Taylor complex figure; TMT = Trail-Making Test; WAIS-IV = Wechsler Adult Intelligence Scale–Fourth Edition.

Supplementary Materials

    • Supplemental Table 1 (PDF 470 KB)

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Contributor Notes

Correspondence Sam Ng: Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France. s-ng@chu-montpellier.fr.

INCLUDE WHEN CITING Published online December 4, 2020; DOI: 10.3171/2020.7.JNS201507.

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

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