Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore.
J Neurooncol. 2019 Jan;141(1):167-182. doi: 10.1007/s11060-018-03023-9. Epub 2018 Nov 16.
This study aims to identify the neuropsychological tests commonly used for assessment in each neurocognitive domain, and quantify the post-operative changes in neurocognitive function in the immediate post-operation and follow-up.
With the use of the PubMed, a comprehensive search of the English literature was performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. There were 1021 publications identified for screening. Standardized mean differences (SMD) in neuropsychological task performance were calculated both for immediate post-operation (up to 1 week) and follow-up (up to 6 months).
Out of 12 studies which met the inclusion criteria, 11 studies were analyzed in this meta-analysis, with a total of 313 patients (age range 18-82, 50% males) with intracranial gliomas (45% high-grade, 55% low-grade). Complex attention, language and executive function were the most frequently tested neurocognitive domains. Surgery had a positive impact in the domains of complex attention, language, learning and memory tasks in the immediate post-operative period and sustained improvement at follow-up. In contrast, surgery was found to negatively impact performance for executive function in the immediate post-operative period with sustained decline in performance in the long term.
This meta-analysis suggests that surgery for glioma confers a benefit for the domains of complex attention, language, learning and memory, while negatively affecting executive function, in the periods immediately after surgery and at 6 months follow-up. In addition, awake surgery seemed to confer a beneficial effect on neurocognitive functions. Future research should attempt to standardize a battery of neuropsychological tests for patients undergoing surgical resection for glioma, perhaps with a particular focus on executive function.
本研究旨在确定用于评估每个神经认知领域的神经心理学测试，并量化术后即刻和随访期间神经认知功能的变化。
使用 PubMed 数据库，按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南对英文文献进行全面检索。共筛选出 1021 篇文献。计算了神经心理学任务表现的标准化均数差（SMD），包括术后即刻（1 周内）和随访（6 个月内）。
在符合纳入标准的 12 项研究中，有 11 项研究纳入了本次荟萃分析，共有 313 例颅内胶质瘤患者（年龄 18-82 岁，50%为男性）纳入分析，其中 45%为高级别胶质瘤，55%为低级别胶质瘤。复杂注意力、语言和执行功能是最常测试的神经认知领域。手术对术后即刻的复杂注意力、语言、学习和记忆任务有积极影响，并在随访期间持续改善。相比之下，手术在术后即刻对执行功能产生负面影响，长期表现持续下降。
本荟萃分析表明，手术治疗胶质瘤可改善复杂注意力、语言、学习和记忆等领域的认知功能，但对术后即刻和 6 个月随访时的执行功能有负面影响。此外，唤醒手术似乎对神经认知功能有有益的影响。未来的研究应尝试为接受手术切除治疗胶质瘤的患者标准化一套神经心理学测试，可能特别关注执行功能。
