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Cognitive Functions in Repeated Glioma Surgery.

Gabriele Capo1, Miran Skrap1, Ilaria Guarracino2

  • 1Department of Neurosurgery, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, 33100 Udine, Italy.

Cancers
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Summary

Repeated surgery for recurrent low-grade gliomas (LGG) in eloquent brain areas is feasible. Neuropsychological testing revealed no significant short-term cognitive decline 4 months post-operation.

Keywords:
awake surgerydiffuse low surgeryneurocognitionneuropsychological assessment

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Area of Science:

  • Neuro-oncology
  • Neurosurgery
  • Cognitive Neuroscience

Background:

  • Low-grade gliomas (LGG) are slow-growing brain tumors that often recur and may undergo malignant transformation.
  • Re-operation for recurrent LGG in eloquent brain areas is often avoided due to concerns about neurological and cognitive deficits, yet evidence is limited.
  • Comprehensive neuropsychological assessment is crucial for evaluating the impact of surgical interventions on cognitive function.

Purpose of the Study:

  • To evaluate the cognitive outcomes following a second surgery for recurrent gliomas in eloquent brain regions.
  • To determine if re-operation leads to significant short-term neurological and cognitive deficits.
  • To provide evidence-based insights into the safety and efficacy of repeat glioma surgery.

Main Methods:

  • Retrospective analysis of 40 patients with recurrent gliomas in eloquent left hemisphere areas.
  • Comprehensive pre- (T3) and post-surgical (T4) neuropsychological assessments conducted 4 months after the second surgery.
  • Longitudinal cognitive outcome comparison in 17 patients across four time points (T1-T4), including before the first surgery and at various post-operative intervals.

Main Results:

  • No significant difference was observed in the number of patients scoring within the normal cognitive range between pre- (T3) and post-surgery (T4) assessments.
  • Patient performance levels showed no significant changes between T3 and T4.
  • Longitudinal analysis (T1-T4) revealed no significant decline in the number of patients within the normal cognitive range, with only phonological fluency showing a significant change in performance level.

Conclusions:

  • Repeated glioma surgery in eloquent brain areas can be performed without causing major short-term damage to cognitive functions.
  • Neuropsychological assessments do not support the assumption of significant cognitive deficits after repeat surgery for recurrent LGG.
  • This study suggests that re-operation is a viable option for recurrent gliomas in eloquent areas, with acceptable short-term cognitive outcomes.