Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review

Clinical outcomes after surgery for intracranial meningiomas might be overvalued as cognitive dimensions and quality of life are probably underreported. This review aims to summarize the current state of cognitive screening and treatment-related outcomes after meningioma surgery. We present a systematic review (Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P) 2015-based) of cognitive outcomes after intracranial meningioma surgery. A total of 1572 patients (range 9-261) with a mean age of 58.4 years (range 23-87), and predominantly female (n = 1084, 68.9%) were identified. Mean follow-up time after treatment was 0.86 ± 0.3 years. Neuropsychological assessment was very heterogeneous, but five dimensions of cognition were described: memory (19/22); attention (18/22); executive functions (17/22); language (11/22); flexibility (11/22 studies). Cognitive abilities were impaired in 18 studies (81.8%), but only 1 showed deterioration in all dimensions simultaneously. Memory was the most affected. with significant post-therapy impairment in 9 studies (40.9%). Postoperatively, only 4 studies (18.2%) showed improvement in at least one dimension. Meningioma patients had significantly lower cognitive scores when compared to healthy subjects. Surgery and radiotherapy for meningiomas were associated with cognitive impairment, probably followed by a partial recovery. Cognition is poorly defined, and the assessment tools employed lack standardization. Cognitive impairment is probably underreported in meningioma patients.