Liguoro Ilaria, Pilotto Chiara, Tuniz Francesco, Toniutti Maristella, Cogo Paola, Zilli Tiziana
Division of Pediatrics, University Hospital of Udine, Piazzale Santa Maria Della Misericordia, 15, 33100, Udine, Italy.
Neurosurgery Unit, Department of Neurosciences, University of Udine, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
Childs Nerv Syst. 2025 Feb 1;41(1):97. doi: 10.1007/s00381-025-06751-2.
This study was aimed at evaluating cognitive functioning in children with brain tumors before and after surgery and at the end of all adjunctive treatments.
All newly diagnosed children with primary brain tumor were prospectively assessed. Neurocognitive evaluations were performed before surgery (T0), within 7-10 days from surgery (T1) and 18-24 months after the end of all treatments (T2). Language, memory, attention, executive functions, visual-constructional, and sensorimotor skills were evaluated at T0, T1, and T2, whereas intelligent quotient (IQ) was explored at T0 and T2.
Twenty-five patients (M:F = 15:10, mean age 10.9 ± 3.4 years) were enrolled between January 2019 and December 2022. At baseline, patients showed major deficits in narrative memory (6.6 ± 3.7, p < 0.001) and visuo-spatial memory (copy design tasks: general 6.8 ± 3.9, p < 0.001; specific 6.2 ± 3.3, p < 0.001; and motor 5.2 ± 3.2, p < 0.001). In the post-surgery phase (T1), significant deficits remained in narrative memory (6.2 ± 3.3, p < 0.001) and visual-motor coordination (copy design tasks: specific 5.9 ± 3.0, p < 0.001; motor 4.8 ± 4.3 p < 0.001), while attention and visual-constructional abilities significantly improved (p = 0.04 and p = 0.001 respectively). Nine out of 25 patients (36%) reached the T2 evaluation: persistency of deficits in the area of visuo-spatial processing and a possible decline in median IQ values in comparison to T0 evaluation (93 vs 100, p = 0.05) were shown.
Children with brain tumors may present several neuropsychological impairments since diagnosis. Surgery may have a positive impact in relation to the recovery of some cognitive functions. However, cognitive decline may worsen over time. Baseline and periodic neurocognitive evaluations should be encouraged to indicate targets for cognitive monitoring, to early detect functional difficulties.
本研究旨在评估脑肿瘤患儿手术前后以及所有辅助治疗结束时的认知功能。
对所有新诊断的原发性脑肿瘤患儿进行前瞻性评估。在手术前（T0）、手术后7 - 10天内（T1）以及所有治疗结束后18 - 24个月（T2）进行神经认知评估。在T0、T1和T2评估语言、记忆、注意力、执行功能、视觉构建和感觉运动技能，而在T0和T2评估智商（IQ）。
2019年1月至2022年12月期间纳入了25例患者（男∶女 = 15∶10，平均年龄10.9±3.4岁）。基线时，患者在叙事记忆（6.6±3.7，p < 0.001）和视觉空间记忆方面表现出严重缺陷（复制设计任务：总体6.8±3.9，p < 0.001；特定6.2±3.3，p < 0.001；运动5.2±3.2，p < 0.001）。在术后阶段（T1），叙事记忆（6.2±3.3，p < 0.001）和视觉运动协调方面仍存在显著缺陷（复制设计任务：特定5.9±3.0，p < 0.001；运动4.8±4.3，p < 0.001），而注意力和视觉构建能力显著改善（分别为p = 0.04和p = 0.001）。25例患者中有9例（36%）完成了T2评估：结果显示视觉空间处理领域的缺陷持续存在，与T0评估相比，智商中位数可能下降（93对100，p = 0.05）。
脑肿瘤患儿自诊断以来可能存在多种神经心理损伤。手术可能对某些认知功能的恢复有积极影响。然而，认知功能衰退可能会随着时间恶化。应鼓励进行基线和定期神经认知评估，以确定认知监测目标，早期发现功能障碍。
