Spatial neglect in parietal glioma patients: what do we know? a systematic review

Spatial neglect-a multifaceted neuropsychological (NP) syndrome-has been studied extensively after stroke. Yet its prevalence, trajectory, and anatomical underpinnings in parietal glioma remain poorly defined. We performed a systematic literature review to synthesize current evidence on neglect in this population, highlighting its temporal course, the white-matter networks implicated, and the NP assessment.

A systematic literature search was conducted following PRISMA guidelines, using keywords related to parietal gliomas and visuospatial deficits. Eligible studies included adult patients with parietal gliomas assessed with NP assessment.

Only nine heterogeneous studies met inclusion criteria. Overall, across 86 parietal glioma cases, neglect was documented in 12% pre-operatively and in 23% post-operatively. Long-term follow-up (reported for just five patients) suggested an 80% recovery rate. Most cases recovered within five days, indicating that neglect may be transient or under-detected. Low-grade gliomas (LGGs) were associated with a lower risk then high-grade gliomas (HGGs), despite the limited sample size. Diffusion-tensor imaging (DTI) and direct electrical stimulation (DES) consistently implicated the second branch of the superior longitudinal fasciculus (SLF II), while pointing to a broader fronto-parietal network involved in both onset and recovery. Comprehensive NP batteries proved critical for delineating neglect occurrence and evolution, and co-existing visuospatial or global cognitive deficits.

Neglect frequency rises after resection of parietal gliomas, though current evidence is limited by small, heterogeneous samples. While most patients recover within three months, these findings rely on low-quality data often limited to single-task assessments. Multimodal evaluation via DTI, DES, and comprehensive NP batteries is essential for tracking recovery. Larger, prospective studies are needed to clarify the network dynamics that govern neglect emergence and resolution, and to refine evidence-based management strategies.