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Published on: May 3, 2019
Cognitive and Behavioral Outcome of Pediatric Low-Grade Central Nervous System Tumors Treated Only with Surgery: A
Matilde Taddei1, Silvia Esposito1, Gianluca Marucci2
1Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy.
Insights
Surgery for pediatric low-grade central nervous system (CNS) tumors can impact cognitive and behavioral outcomes. Early intervention and regular assessments are crucial for optimal patient functioning.
Area of Science:
- Pediatric Neuro-oncology
- Neuropsychology
- Neurosurgery
Background:
- Low-grade central nervous system (CNS) tumors are a significant concern in pediatric oncology.
- Surgical intervention is a primary treatment modality for these tumors.
- Understanding the long-term cognitive and behavioral effects of surgery is essential for comprehensive patient care.
Purpose of the Study:
- To describe the cognitive and behavioral outcomes in children with low-grade CNS tumors treated solely with surgery.
- To identify factors influencing these outcomes.
- To establish recommendations for clinical practice.
Main Methods:
- Retrospective analysis of medical records from 2000-2020.
- Inclusion of 38 pediatric patients with low-grade CNS tumors.
- Exclusion of patients with specific neurological conditions or genetic predispositions.
Main Results:
- Patients generally presented with normal cognitive and behavioral functioning, but with specific weaknesses in verbal working memory and processing speed.
- Cognitive and behavioral outcomes were associated with pre-treatment variables (age at onset, tumor histology, location, seizures), surgical timing, and seizure control.
- Younger age at onset indicated higher vulnerability to cognitive deficits, while older age/longer follow-up increased risk for behavioral disturbances.
Conclusions:
- Timely surgical treatment is vital for overall patient outcomes and daily functioning.
- Preoperative and regular, long-term postsurgical cognitive and behavioral assessments should be integrated into standard clinical care.
- Early detection and management of cognitive and behavioral changes are critical for improving quality of life.
Background:
The present mono-institutional report aimed to describe the cognitive and behavioral outcomes of low-grade central nervous system (CNS) tumors in a cohort of children treated exclusively with surgical intervention.
Methods:
Medical records from 2000-2020 were retrospectively analyzed. We included 38 children (mean age at first evaluation 8 years and 3 months, 16 females) who had undergone presurgical cognitive-behavioral evaluation and/or at least 6 months follow-up. Exclusion criteria were a history of traumatic brain injury, stroke, cerebral palsy or cancer-predisposing syndromes.
Results:
The sample presented cognitive abilities and behavioral functioning in the normal range, with weaknesses in verbal working memory and processing speed. The obtained results suggest that cognitive and behavioral functioning is related to pre-treatment variables (younger age at symptoms' onset, glioneuronal histological type, cortical location with preoperative seizures), timing of surgery and seizure control after surgery, and is stable when controlling for a preoperative cognitive and behavioral baseline. Younger age at onset is confirmed as a particular vulnerability in determining cognitive sequelae, and children at older ages or at longer postsurgical follow-up are at higher risk for developing behavioral disturbances.
Conclusions:
Timely treatment is an important factor influencing the global outcome and daily functioning of the patients. Preoperative and regular postsurgical cognitive and behavioral assessment, also several years after surgery, should be included in standard clinical practices.
