Friedman Melissa A, Meyers Christina A, Sawaya Raymond
The Brain and Spine Center, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Neurosurgery. 2003 Apr;52(4):791-8; discussion 798. doi: 10.1227/01.neu.0000053367.94965.6b.
This study assessed the neuropsychological outcome of patients after surgical treatment for third ventricle brain tumors. Neuropsychological consequences of surgical intervention can have a major impact on patients' quality of life and therefore have important implications for treatment planning.
A retrospective analysis of 33 patients' neuropsychological data was performed. All patients received a comprehensive neuropsychological evaluation after treatment for a primary brain tumor in the third ventricular region. Twenty-six patients underwent surgery, 14 via the transcallosal approach and 12 via a subfrontal, left transcortical, right pterional, or infratentorial supracerebellar approach. Seven patients were not treated by surgical intervention.
There was a significantly elevated frequency of cognitive impairment relative to normative values in memory, executive functioning, and fine manual speed and dexterity. There were no differences in mean neuropsychological scores between patients who underwent surgery and those who did not. There were no differences in mean performance on the basis of surgical approach, tumor infiltration, or history of cranial irradiation. Repeated measures data available for two patients revealed memory impairment before and after surgery, and one patient experienced major improvement after surgery on a measure of mental flexibility and problem solving.
Patients with third ventricle tumors are at risk for developing impairments in memory, executive function, and fine manual speed and dexterity, which are domains associated with frontal subcortical functions. In the current study, different types of treatment were not associated with differential cognitive sequelae, and surgical intervention did not account for cognitive deficits.
本研究评估了第三脑室脑肿瘤患者手术治疗后的神经心理学结果。手术干预的神经心理学后果会对患者的生活质量产生重大影响，因此对治疗规划具有重要意义。
对33例患者的神经心理学数据进行回顾性分析。所有患者在第三脑室区域原发性脑肿瘤治疗后均接受了全面的神经心理学评估。26例患者接受了手术，14例通过经胼胝体入路，12例通过额下、左侧经皮质、右侧翼点或幕下小脑上入路。7例患者未接受手术干预。
与正常标准值相比，记忆、执行功能以及精细手部速度和灵活性方面的认知障碍发生率显著升高。接受手术的患者与未接受手术的患者之间平均神经心理学评分无差异。根据手术入路、肿瘤浸润或颅脑放疗史，平均表现也无差异。两名患者的重复测量数据显示手术前后存在记忆障碍，一名患者在心理灵活性和问题解决能力的测量上术后有显著改善。
第三脑室肿瘤患者有发生记忆、执行功能以及精细手部速度和灵活性障碍的风险，这些方面与额叶皮质下功能相关。在本研究中，不同类型的治疗与不同的认知后遗症无关，手术干预也不能解释认知缺陷。
