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脑功能区胶质瘤术后认知功能的长期评估

Long-term evaluation of cognition after glioma surgery in eloquent areas.

机构信息

Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Dr. Molewaterplein 50, Room EE220, 3015 GE, Rotterdam, The Netherlands,

出版信息

J Neurooncol. 2014 Jan;116(1):153-60. doi: 10.1007/s11060-013-1275-3. Epub 2013 Oct 31.


DOI:10.1007/s11060-013-1275-3
PMID:24173681
Abstract

Preservation of cognition is an important outcome measure in eloquent area glioma surgery. Glioma patients may have pre-operative deficits in one or more cognitive domains which could deteriorate post-operatively. It is assumed that these impairments recover within 3 months; some studies however, still detected cognitive decline. Longer follow-up is necessary to elucidate the conclusive effects of surgery. 45 patients with gliomas (low- and high-grade, but without contrast enhancement at diagnosis) in eloquent areas were assessed pre-operatively, 3 months and 1 year post-operatively with a neuropsychological test-protocol. Patients' performance was compared to normal population and between test-moments. Univariate analyses were performed between cognitive change and tumor-characteristics (localization, grade, volume, extent of resection [EOR]) and treatment-related factors (radio-/chemotherapy). Pre- and post-operatively, impairments were found in all cognitive domains; language, memory, attention and executive functions (p < 0.05). Post-operatively, permanent improvement was observed on a memory test (verbal recall: t = -1.931, p = 0.034), whereas deterioration was found on a language test (category fluency: t = 2.517, p = 0.030). Between 3 months and 1 year, patients improved on 2 language tests (naming: t = -2.781, p = 0.026 and letter fluency: t = -1.975, p = 0.047). There was no influence of tumor- or treatment-related factors on cognitive change. The findings underline the importance of cognitive testing at longer term post-operatively, as cognitive recovery took longer than 3 months, especially within the language domain. However, this longitudinal follow-up study showed that glioma surgery is possible without major long-term damage of cognitive functions. Tumor characteristics and EOR are no additional risk factors for cognitive outcome.

摘要

保留认知能力是语言区脑胶质瘤手术的重要结果测量指标。胶质瘤患者可能在术前就存在一个或多个认知领域的缺陷,这些缺陷可能在术后恶化。人们认为这些损伤会在 3 个月内恢复;然而,一些研究仍然发现认知能力下降。需要更长时间的随访来阐明手术的最终效果。45 名位于语言区的胶质瘤患者(低级别和高级别,但在诊断时无对比增强)在术前、术后 3 个月和 1 年时接受神经心理学测试方案评估。将患者的表现与正常人群和不同测试时间进行比较。对认知变化与肿瘤特征(定位、分级、体积、切除范围 [EOR])和治疗相关因素(放疗/化疗)之间进行了单变量分析。术前和术后,所有认知领域都出现了损伤;语言、记忆、注意力和执行功能(p<0.05)。术后,在一项记忆测试(词语回忆:t=-1.931,p=0.034)中观察到永久性改善,而在一项语言测试(类别流畅性:t=2.517,p=0.030)中观察到恶化。在 3 个月至 1 年期间,患者在两项语言测试(命名:t=-2.781,p=0.026 和字母流畅性:t=-1.975,p=0.047)中有所改善。肿瘤或治疗相关因素对认知变化没有影响。这些发现强调了在术后较长时间内进行认知测试的重要性,因为认知恢复需要超过 3 个月的时间,尤其是在语言领域。然而,这项纵向随访研究表明,胶质瘤手术在不造成认知功能重大长期损害的情况下是可行的。肿瘤特征和 EOR 不是认知结果的附加危险因素。

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[6]
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[7]
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[9]
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本文引用的文献

[1]
Spontaneous speech of patients with gliomas in eloquent areas before and early after surgery.

Acta Neurochir (Wien). 2013-2-26

[2]
Cognitive functioning early after surgery of gliomas in eloquent areas.

J Neurosurg. 2012-8-31

[3]
Verbal and nonverbal memory in primary progressive aphasia: the Three Words-Three Shapes Test.

Behav Neurol. 2013

[4]
Recent surgical management of gliomas.

Adv Exp Med Biol. 2012

[5]
Speech and language therapy for aphasia following stroke.

Cochrane Database Syst Rev. 2012-5-16

[6]
Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis.

J Clin Oncol. 2012-4-23

[7]
Changes in neurocognitive functioning and quality of life in adult patients with brain tumors treated with radiotherapy.

J Neurooncol. 2012-2-18

[8]
Cognitive outcome after awake surgery for tumors in language areas.

J Neurooncol. 2012-2-21

[9]
Low-grade gliomas in adults.

J Neurosurg. 2011-11

[10]
Awake surgery in low-grade gliomas harboring eloquent areas: 3-year mean follow-up.

Neurol Sci. 2011-4-13

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