Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France.
Neuro Oncol. 2022 May 4;24(5):781-793. doi: 10.1093/neuonc/noab275.
Awake surgery with intraoperative electrical mapping emerged as a gold-standard approach in newly diagnosed diffuse low-grade glioma (DLGG) to optimize the extent of resection (EOR) while sparing critical brain structures. However, no study has assessed to what extent cognitive recovery occurs following awake mapping-guided neurosurgery in a large, longitudinal, and homogeneous series of DLGG.
A longitudinal study on the cognitive status of 157 DLGG patients was performed. Neuropsychological assessments were done before and three months after awake mapping-based surgery. Z-scores and variations of Z-scores were computed to determine the number of patients with cognitive deficit(s) or decline. Clinical, surgical, and histopathological variables were studied to investigate factors contributing to neurocognitive outcomes.
Eighty-seven patients (55.4%) had preoperative cognitive impairments. Statistical analysis between the preoperative (baseline) and postoperative assessments demonstrated a significant difference in three domains (Executive, Psychomotor Speed and Attention, Verbal Episodic Memory). Eighty-six percent of patients exhibited no postoperative cognitive decline, and among them, 10% exhibited cognitive improvement. The mean EOR was 92.3%±7.8%. The EOR, postoperative volume, and tumor lateralization had a significant association with cognitive decline. No patients demonstrated permanent postoperative neurologic deficits, but 5.8% did not resume their preoperative professional activities. The 5-year survival rate was 82.2%.
This is the largest series ever reported with systematic longitudinal neuropsychological assessment. 86% of patients demonstrated no cognitive decline despite large resections and only 5.8% did not return to work. This work supports the practice of awake surgery with cognitive mapping as safe and effective in DLGG patients.
术中电描记术引导的清醒手术已成为新诊断的弥漫性低级别胶质瘤（DLGG）的金标准方法，可优化切除范围（EOR），同时保留关键的脑结构。然而，尚无研究评估在大型、纵向和同质的 DLGG 系列中，清醒映射引导神经外科手术后认知恢复的程度。
对 157 例 DLGG 患者的认知状态进行了一项纵向研究。在清醒映射引导手术前和术后 3 个月进行神经心理学评估。计算 Z 分数和 Z 分数的变化，以确定有认知缺陷或下降的患者数量。研究了临床、手术和组织病理学变量，以调查影响神经认知结果的因素。
87 例患者（55.4%）术前存在认知障碍。术前（基线）和术后评估之间的统计分析显示，在三个领域（执行、精神运动速度和注意力、言语情节记忆）存在显著差异。86%的患者无术后认知下降，其中 10%表现出认知改善。平均 EOR 为 92.3%±7.8%。EOR、术后体积和肿瘤侧化与认知下降有显著关联。无患者出现永久性术后神经功能缺损，但 5.8%未恢复术前的职业活动。5 年生存率为 82.2%。
这是迄今为止报告的最大系列，具有系统的纵向神经心理学评估。尽管进行了大切除，但 86%的患者无认知下降，只有 5.8%的患者无法恢复工作。这项工作支持在 DLGG 患者中进行清醒手术和认知映射的安全性和有效性。
