脳腫瘍手術後の周術期神経心理学的評価による神経認知機能の動的変化の解明

Research has shown that patients with primary brain tumours have baseline neurocognitive deficits.

In the present study, we sought to explore the impact of surgical intervention as it is not adequately understood.

Patients with intra-axial tumours undergoing surgery were perioperatively evaluated using a comprehensive neuropsychological battery on domains of Attention and Executive Function, memory, Language, Visuomotor Speed and Visuospatial ability. Assessments were done at baseline and post-operatively around 1 month after the surgery before starting any adjuvant treatment (n = 66).

Excluding memory, all domains showed an increased number of patients with severe deficits post-operatively, though the percentage of patients with overall severe deficits decreased. Memory domain was thought to have the most improvement while visuomotor speed had the highest worsening. Patients who underwent craniotomies under general anaesthesia had significant worsening in the memory domain and had an overall trend for worsening across all domains post-op in comparison to those who underwent awake craniotomies. Visuomotor speed was affected by subtotal resection. Tumour lateralisation to the right influenced performance in the visuospatial domain.

There is significant neurocognitive dysfunction in patients with PBTs in the perioperative period with many dynamic changes in the post-operative performance as compared to the baseline. Awake craniotomy can mitigate some of this decline. Detailed cognitive assessments serially performed over the course of treatment is essential to unearth the evolving changes in neurocognition and customise interventions.