Filling the Gap: brief neuropsychological assessment protocol in glioma patients undergoing awake surgeries

doi:10.21203/rs.3.rs-3408603/v1

Download PDF

Case Report

Filling the Gap: brief neuropsychological assessment protocol in glioma patients undergoing awake surgeries

https://doi.org/10.21203/rs.3.rs-3408603/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Purpose: To evaluate the feasibility of applying a concise cognitive assessment protocol - Ohy-Maldaun Fast Track Cognitive Test (OMFTCT) and to compare it with the Boston Naming Test (BNT). This study aims to address the demand for a streamlined neurocognitive assessment in clinical practice.

Methods: This is a prospective longitudinal observational clinical study conducted on a cohort of 50 glioma patients eligible for awake craniotomies. The proposed protocol assesses multiple cognitive domains, including language, short-term verbal and visual memories, working memory, praxis, executive functions, and calculation ability. The protocol comprises ten different subtests, with a maximum score of 50 points and was applied at three time points: preoperative, immediate postoperative period and 30 days after surgery.

Results: Among the initial 50 patients enrolled, 36 underwent assessment at all three designated time points. The mean age of patients was 45.3 years, with an average of 15 years of education. Predominant tumor types included Glioblastoma, IDH-wt (44.1%), and diffuse astrocytoma, IDH-mutant (41.2%). Tumors were mainly located in the left temporal lobe (27.8%), followed by the left frontal lobe (25%). The full test had an average completion time of 23 minutes. Findings revealed a moderate correlation (r=0.6) and statistical significance (p=0.02) between the OMFTCT protocol and the BNT short version, with the proposed protocol also detecting additional deficits in visual memory.

Conclusion: OMFTCT provided preoperative and postoperative assessment of different cognitive domains, enabling precise planning of intraoperative cognitive testing. Additionally, immediate diagnosis of neurocognitive deficits played a crucial role in optimizing patient care.

neuropsychological assessment

awake craniotomy

glioma

language mapping

maximal safe resection

Diffuse gliomas are the most common primary malignant brain tumor in adults[1]. Recent studies have provided strong evidence that extent of tumor resection, as well as postsurgical tumor volumes, are associated with further progression and overall survival in diffuse gliomas patients[2–4]. Currently, the concept of resection changed from arbitrary categories into the new model of maximal and safely achievable volumetric resection, in a delicate balance between achieving maximal tumor resection and inducing new deficits.

Since the original description of awake craniotomy by Horsley, this technique have been used for different indications with the overarching goal of enhancing safety[5]. The use of the awake intraoperative mapping is valuable for increasing the extent of resection while preventing postoperative neurological deficits, and has been associated with improved neurological, functional, cognitive, radiological and survival outcomes in both low-grade and high-grade glioma patients [6–12]

Suitable patient selection and perioperative neuropsychological assessment are essential to ensure intra- and postoperative success with awake mapping. In this context, preoperative neuropsychological evaluation is of paramount importance to identify the more subtle deficits, as approximately 50% of diffuse glioma patients exhibit neurocognitive impairments before surgery, what have been linked to negative impacts on both quality of live and survival rate [13, 14].

There is a lack of a concise neurocognitive test in the literature to evaluate the primary cognitive domains affected in neurooncological patients. The Boston Naming Test (BNT), considered the gold standard by many authors, is either incomplete in its short version or overly extensive in its full version[15]. Therefore, the primary aim of this work is to assess the feasibility of employing a brief cognitive assessment protocol – Ohy-Maldaun Fast Track Cognitive Test (OMFTCT), and compare it to the BNT, which is widely regarded as the gold standard. This aims to address the need for a streamlined neurocognitive assessment in clinical practice.

This is a prospective longitudinal observational clinical study conducted on a cohort of 50 patients eligible for awake craniotomies for brain tumors, who were followed by a specialized neuro-oncology team at Sírio-Libanês Hospital in Sao Paulo, Brazil, from September 2019 to June 2022.

Sample eligibility was based on the following inclusion criteria: adults aged 18 years or older, undergoing awake surgery, with a highly suspicious neuroimaging of unifocal glioma, located in an eloquent or near-eloquent region. The exclusion criteria included: prior cognitive disturbance, temporo-spatial disorientation, prolonged hospitalization in the preoperative period (more than 15 days), seizure within the last 24 hours prior to surgery, and failure to complete the assessments and follow-up of the study.

Conception of the OMFTCT protocol

The OMFTCT cognitive protocol was methodologically developed in the following steps: 1) identification of demands related to assessing cognitive functions during the evaluation process of patients undergoing awake surgery; 2) review of the literature addressing the instruments used in the context of cognitive assessment for patients undergoing awake craniotomies; 3) multidisciplinary team discussion and conception of the protocol; 4) selection of images according to a validated protocol tailored to Brazilian native speakers[16]; 5) selection of tests that can be replicated intraoperatively; 6) analysis of the applicability of the instrument, taking into consideration patient flow and the available time for the assessment; 7) Establishment of the routine and procedures of the cognitive protocol.

The proposed protocol was applied at three time points: preoperative (T1), immediate postoperative period (T2) and 30 days after surgery (T3). It assesses multiple cognitive domains, including language, short-term verbal and visual memories, working memory, praxis, executive functions, and calculation ability. Table 1 shows the cognitive domains assessed in each subtest of the OMFTCT protocol.

A video tutorial on how to apply the OMFTCT protocol was created by a specialized neurophysiologist and shared with all team members to ensure the consistent application of the steps in all patients, thereby minimizing potential biases.

Table 1

Cognitive domains assessed in each subtest of the OMFTCT protocol.
Subtest	Cognitive domain
Object naming	Language, working memory (dual task)
Verbal memory	Short-term verbal memory
Semantic	Language, working memory (dual task)
Calculation	Logical mathematical intelligence
Writing	Praxis, language
Visual memory	Short-term visual memory
Reading	Language
Syntax	Language
Drawing	Praxis
Spelling	Working memory

OMFTCT subtests

The protocol comprises ten different subtests, with a maximum score of 50 points (Supplementary Material – full version of the test).

Naming: five images from both living and non-living categories, including animals, objects, and food, are presented. The first three images should be named individually, while the last two should be named in combination with a dual task: alternately opening and closing the hands. Correction and scoring: the patient must respond within 20 seconds. If the patient provides a correct answer after the allotted time, it should be noted as qualitative data, but not scored.

Verbal memory: sequences of phrases, words, letters and numbers are dictated, and the patient is required to repeat them immediately after hearing them. Correction and scoring: To receive a score for this item, the dictated sequence must be repeated without any alterations to its elements.

Semantics: in this subtest, both verbal and non-verbal semantics are employed. The patient is required to identify the correct combination of three images (Pyramids and Palm Trees Test), identify the object's utility, what material it is made of, and the shape of a specific figure. Correction and scoring: in this subtest, if the patient correctly points to the answer but is unable to provide the name (for the first three items), it should be scored as correct, and the difficulty of naming should be recorded as qualitative data.

Calculation: the patient is presented with mathematical operations and abstract-logical reasoning problems, and they are required to mentally solve them. Calculations must be performed mentally, and the use of paper, pen, or a calculator is not allowed.

Writing: this subtest is divided into two separate stages: the first stage involves the patient copying two words and one sentence, while the second one entails the patient being dictated another word and sentence to write on the same answer sheet. Correction and scoring: the patient must write the words and sentences correctly. Errors such as changing, omitting, or adding letters are not scored, and incorrect accentuation. Incorrect accentuation and punctuation are not considered errors.

Visual memory: A picture A is presented to the patient to memorize for 15 seconds. After memorization, a picture B is presented, which contains the same images as picture A but with additional distracting images. The patient is then required to identify and verbalize which images were originally presented in Picture A. Correction and scoring: The patient must correctly identify and name all the images that appear in Picture A.

Reading: The patient is instructed to read a set of 5 sentences, commonly referred to as "tongue twisters", to evaluate their reading ability and logical reasoning. Correction and scoring: the patient is expected to read all items correctly.

Syntax: The patient is presented with items related to word formation, grammar, and vocabulary. Correction and scoring: the patient is required to provide exact answers to all the items.

Drawing: The patient is instructed to spontaneously draw three geometric shapes described verbally and copy two other shapes presented graphically. Correction and scoring: the patient must draw all items with the correct number of sides and angles in order to receive a score."

Spelling: The patient is required to spell five words, with the first three in regular order and the last two in reverse order. Correction and scoring: the patient must provide the exact answer for all items without writing the words on paper in order to receive a score.

Data Collection

Patient data was collected by an OMFTCT-trained tester, who could be one of the following team members: the neurosurgeons, neurosurgery residents, neurosurgical oncology fellows or the neuropsychologist. All of them were involved with patient care and qualified for test application. The tests were applied using a screen presented to the patient and the results were filled into an identification form, which included the patient ́s data like age, sex, educational level, occupation, laterality of the lesion, cognitive, emotional, and clinical symptoms, tumor characteristics and date of diagnosis.

The OMFTCT protocol was applied at three different moments: preoperative (up to one week before surgery), immediate postoperative (up to 48 hours after surgery), and late postoperative (30 days after surgery). The BNT (short version)[15] was applied only at the third moment, for comparison and complementary analyses. To eliminate the learning bias of the test, the same subtests were applied, but with different items.

The initial testing was conducted either in person at a clinic or following hospital admission. In certain instances, remote evaluations were carried out, particularly during the third stage of the protocol, when patients were located in different states of the country and opted for participation via videoconference. Videoconference evaluations were conducted using the Zoom app, allowing for screen sharing with the patient. The subtests of Writing and Drawing were performed on paper, as requested by the tester. After completing the task, the paper was photographed and sent for scoring evaluation and further assessment.

This study was performed with the principles of the Declaration of Helsinki. The research was approved by the Research Ethics Committee of the Sirio-Libanes Hospital (number 1134). All patients signed the Informed Consent Form.

Statistical analysis

The descriptive analysis of the collected data included variables such as age, sex, education in years, tumor type and location, histological grade, and preoperative cognitive, emotional and clinical symptoms. The data were tested for the nature of the sampling distribution (parametric or nonparametric) using the K-S Distance (Kolmogorov-Smirnov) test. For comparison with the BNT and the different domains evaluated in the OMFTCT, the percentage of correct responses was normalized relative to the total number of possible correct responses for each domain. In this case, the Mann-Whitney test followed by Dunns post-hoc test was employed. To compare the visual domain with the BNT, the paired Mann-Whitney test was used. Correlation analysis was conducted using Spearman's test. All statistical analyses were performed using GraphPad Prism 9, and statistical significance was considered when p < 0.05.

Sample characteristics

Out of the 50 patients initially recruited, 36 underwent evaluation at all three distinct time points. However, 14 patients did not complete the entire protocol due to their unwillingness to participate in the final evaluation after 30 days. Table 2 presents demographic and preoperative data for the patients who completed the research protocol (n = 36). The mean age of the patients was 45.3 years, and the average years of education were 15. The sample consisted of an equal distribution of 50% male and 50% female patients. The most common tumor types were Glioblastoma, IDH-wt (44.1%) and diffuse astrocytoma, IDH-mutant (41.2%). Regarding tumor location, the majority were located in the left temporal lobe (27.8%), followed by left frontal lobe (25%). Clinical, cognitive, and emotional symptoms were recorded. Among the clinical symptoms, seizure (22.2%) and headache (16.7%) were the most frequently observed, although the majority of the patients (36.1%) were asymptomatic. In terms of cognitive symptoms, memory deficit were the most frequently reported (38.9%). Lastly, the majority of patients (88.9%) had no preoperative emotional complaints.

The average application time for the full test was 23 minutes, with the minimum time being 14 minutes and the maximum, 35 minutes.

Table 2

Preoperative data.
Variable	Mean	Median
Age (years)	45.3	41.0
Educational level (years)	15.5	16.0
	n	%
Tumor type (WHO Classification 5th ed.)
Astrocytoma, IDH-mutant	14	41.2
Astrocytoma, IDH-mutant (grade II)	9	64.3
Astrocytoma, IDH-mutant (grade III)	1	7.1
Astrocytoma, IDH-mutant (grade IV)	2	14.3
Glioblastoma, IDH-wildtype	15	44.1
MGMT promoter methylation	5	33.3
Oligodendroglioma, IDH-mutant, 1p19q codel	5	14.7
Tumor site
Right frontal lobe	1	2.8
Left frontal lobe	9	25.0
Left fronto-temporal	1	2.8
Insula	4	11.1
Left occipital lobe	1	2.8
Left parietal lobe	8	22.2
Right temporal lobe	2	5.6
Left temporal lobe	10	27.8
Signs and symptoms
Auditory deficit	1	2.8
Hyposmia	1	2.8
Headaches	6	16.7
Seizure	8	22.2
Motor deficit	3	8.3
Sensory deficit	1	2.8
Nausea/vomiting	2	5.6
Asymptomatic	13	36.1
Preoperative cognitive deficits
Language	9	25.0
Memory	14	38.9
Executive function	3	8.3
Praxis	3	8.3
Attention	5	13.9
Asymptomatic	15	41.7
Emotional symptoms
Anxiedy	2	5.6
Irritability	2	5.6
Asymptomatic	32	88.9

Comparison between OMFTCT and BNT

The OMFTCT protocol was compared to the gold standard BNT short version to determine whether the OMFTCT could yield equivalent scores to the BNT short version. They were both applied to patients at the 30th day-follow up. The findings indicate that the OMFTCT protocol exhibits a moderate correlation (r = 0.6) and is statistically significant (p = 0.02) when compared to the BNT short version. As shown in Fig. 1, patients who exhibit low scores on OMFTCT also had low scores on BNT. However, the results appear to be worse for OMFTCT because it includes different cognitive domains besides naming. When analyzing only the naming domain of OMFTCT alongside BNT, we also observed an association.

Evaluation of the different domains of cognitive tasks proposed by the OMFTCT protocol

Figure 2 compares the cognitive domains tested by OMFTCT and the BNT short version. OMFTCT includes ten domains, while the BNT short version focuses solely on naming ability. Patients demonstrated equivalent performance in both tests, except for visual memory (Fig. 3). OMFTCT was able to identify visual memory impairment in 20 patients, which was the most frequent deficit. Among these patients, 17 had lesions in the left hemisphere, located in the temporal lobe (9 patients), frontal lobe (5 patients), and parietal lobe (3 patients). Relying solely on the BNT would inadvertently neglect the detection of significant cognitive decline in individuals manifesting visual memory impairments.

*** p < 0.0001 when compared to the Boston. Kruskal-Wallis followed by Dunns post-hoc test.

*** p < 0.0001 when compared to the BNT. Mann-Whitney test.

Table 3 shows the cognitive scores at three different time points during the patient's evaluation. In the initial assessment before surgery, the median score was 41 out of 50 total points. However, a significant portion of the sample (75th percentile) achieved scores higher than 47, indicating a high level of cognitive performance among these patients.

Table 3

Cognitive scores during patients’ evaluation
Moment	Mean	Standard deviation	Median	Min	Max	75th percentile	25th percentile
Preoperative (T1)	41.1	8.5	43.0	17.0	50.0	40.0	47.0
Immediate postoperative (T2)	41.8	8.3	44.0	8.0	50.0	39.5	46.8
Late postoperative (T3)	41.6	8.5	44.0	8.0	50.0	39.0	46.3

OMFTCT related to tumor location

Figure 4 shows a graphic representation of the average OMFTCT scores in the preoperative period, categorized by tumor location. Among the most commonly impaired lobes, object naming and semantics were mostly affected in patients with insular tumors, while verbal and visual memory were predominantly affected in patients with temporal lesions. Interestingly, patients with right temporal lesions (2 patients) exhibited notably low average scores.

As preservation of neurocognitive function plays a crucial role in quality of life, it has become a primary goal in surgical approaches for glioma patients. Additionally, accurate assessment of neurocognitive function enhances intraoperative mapping and the safety of the procedure. Perioperative neurocognitive assessment is fundamental for evaluating the preservation of the functional margins and improving the learning curve of the entire team involved in patient management.

Neurocognitive deficits are common among individuals diagnosed with glioma, due to the adjuvant treatment and the slow growth of the tumor[17]. Most frequently, executive functions (higher-level cognitive processes responsible for planning, organizing and problem-solving) and memory are involved[18]. Hence, it is essential to diagnose previous cognitive deficits in order to correctly select patients to undergo awake craniotomy. The patient should hold skills for effective expression and communication, be able to perform the requested task and report any discomfort he may experience. Additionally, it is desirable that he maintains memory capabilities to retain instructions during surgery, and preserved visual abilities, particularly to perform tasks involving object naming and semantic[19]. Therefore, a straightforward preoperative neurophysiologic assessment is fundamental to evaluate these cognitive domains before awake surgery and track the results postoperatively.

The severity and type of neuropsychological impairment play a crucial role in determining the quality of life for individuals with glial tumors. Correct interpretation of intraoperative mapping relies on understanding the patient’s previous cognitive deficits. Acquiring precise information about a person's neuropsychological condition is essential for designing appropriate rehabilitation and supportive care plans[20, 21]. While not assessed in the current study, this protocol can be readily employed for ongoing patient follow-up during the treatment of glial neoplasia, allowing for the evaluation of phenomena such as chemobrain and the effects of radiotherapy. Neuropsychological functioning has been shown to have implications for prognosis and tumor recurrence, and it may even be more sensitive than imaging techniques in predicting early tumor recurrence[22, 23].

While choosing the neuropsychological assessment, an important practical consideration in both research and clinical settings is the trade-off between specificity and brevity[20, 24, 25]. Given that individuals with brain tumors often experience fatigue and psychological distress, administering a lengthy test battery not only burdens the individual but also risks compromising the validity of the test results[20]. Hence, it is crucial to strike a balance between specificity and brevity in neuropsychological testing to ensure the generation of valid and meaningful information[20]. The OMFTCT can be fully applied within a maximum of 35 minutes and has been routinely conducted at the patient's bedside, both one day before the surgical procedure and on the day of discharge from the hospital. Furthermore, qualitative analysis has shown consistent results across different testers. These attributes render the test highly adaptable and inclusive, facilitating preoperative cognitive assessments even in facilities lacking specialized neuropsychologists.

Naming ability plays a pivotal role in surgical protocols due to its association with various language areas distributed across different brain lobes and tracts. Consequently, OMFTCT incorporates naming tasks, while the BNT short version is exclusively focused on object naming. Therefore, OMFTCT was designed to encompass additional cognitive domains typically assessed in comprehensive neuropsychological evaluations. We've adapted these assessments to reduce administration time and minimize patient fatigue. Conducting a more extensive preoperative diagnosis enables safer and more comprehensive intraoperative testing. In our practice, we adhere to a rule that any function not assessed previously should not be included in the surgical mapping, as it could lead to false-positive mappings. Nevertheless, functions that go untested are susceptible to potential damage during tumor resection.

OMFTCT demonstrated a moderate correlation (r = 0.6) with statistical significance (p = 0.02) when compared to the gold standard BNT short version, aligning with deficits identified by low scores on the BNT short version. Furthermore, OMFTCT effectively identified visual deficits. The inclusion of various cognitive tasks in the primary assessment allows the detection of impairments that the patient, as well as their closest relatives and friends, may not be aware of. Due to the slow growth of tumors and neuroplasticity, subtle changes in cognitive abilities can go unnoticed. Identifying these changes is imperative for planning an appropriate intraoperative protocol.

The optimization of the intraoperative language protocol is crucial because awake testing typically lasts 1.5 to 2 hours, during which the patient may become distressed and fatigued. Therefore, the protocol should prioritize testing the most likely functions in the vicinity of the manipulated brain area. The choice of tests is determined by the surgeon's orientation and requirements, as well as clinical presentation, OMFTCT scores, and anatomical planning. However, there is a lack of literature data suggesting the optimal score that would ensure safe intraoperative testing. Mitchel Berger has suggested that a 25% error rate is acceptable for safe intraoperative testing[26, 27]. In our practice, we typically aim for scores in the range of 3 to 5.

In developing the protocol, our primary concern was to incorporate tests that had already been applied and validated in comprehensive neuropsychological assessment processes. However, we aimed to adapt these tasks to reduce the application time. Our goal was to prioritize an appropriate assessment duration that would minimize patient fatigue while still covering multiple cognitive domains. We also sought to include a sensitive measure, as suggested by Giovagnoli[28], to evaluate the overall cognitive abilities of these patients. Then, we proposed a practical and comprehensive test that can be easily administered within an average time of 23 minutes.

Among the cognitive symptoms observed in the preoperative period, memory deficit was the most common, affecting 38.9% of the sample. In terms of emotional complaints, the majority of patients (88.9%) did not exhibit mood alterations, except for 11.2%, who experienced irritability and anxiety. It is worth noting that these emotional symptoms were primarily attributed to the surgical context rather than being a direct result of the disease itself.

In general, glioma patients undergoing treatment are likely to experience medium to long-term deficits in memory and attention domains. The OMFTCT protocol correlates with BNT but also identifies visual memory deficits that are not assessed in the last one. The main findings indicate that visual memory impairment is the most prominent cognitive domain affected. Among the 36 evaluated patients, 20 exhibited visual memory deficits, with most of these lesions located in the left hemisphere.

A slight decline in performance was observed during the second evaluation period (48 hours after surgery) due to intraoperative manipulation, we further recovery. After a 30-day post-surgery period, the patients underwent the third application of the protocol. This timeframe is justified by the average duration in which patients are typically referred for adjuvant treatment, allowing the team to assess the patient's overall condition, including the emotional-cognitive component, before radiotherapy and/or chemotherapy.

Out of the 50 patients who completed the OMFTCT protocol, 14 were excluded from the study due to failure to complete the final stage of the evaluation. It is worth noting potential biases associated with this issue. We believe that patients who perform better in assessments and cognitive rehabilitation tend to have a better prognosis, which may lead to reduced therapeutic adherence. Therefore, it is crucial to emphasize the importance of completing all stages of the evaluation protocol to ensure a more comprehensive and individualized therapeutic strategy for these patients. Despite of being excluded, we correlated the T1 score with tumor location (Fig. 4).

The OMFTCT protocol offers a significant clinical advantage, as it does not necessitate the presence of a specialized neuropsychologist. It is easy and can be administered at the patient's bedside. However, it remains essential to have a neuropsychologist with expertise in cognitive assessment within the team. Their role includes the qualitative analysis of results, supervision of test administration to ensure consistency and standardization, and team training.Furthermore, the neuropsychologist can assess and address any emotional issues related to the illness, establishing a strong rapport with the patient that enhances adherence to cognitive rehabilitation. Another protocol advantage is its intraoperative replicability across all subtests.

One limitation of the study was the small sample size. However, the primary objective was to demonstrate the feasibility of a new fast-track protocol. Future studies with larger, more diverse populations, including patients with lower levels of education, may yield more comprehensive data.

In conclusion, the OMFTCT provided preoperative and postoperative assessments of various cognitive domains, enabling the effective planning of intraoperative cognitive testing. Moreover, immediate diagnosis of neurocognitive deficits played a crucial role in guiding patient care and rehabilitiation. The OMFTCT protocol demonstrated its representativeness and statistical significance when compared to the widely used BNT test for assessing similar patient populations.

Ostrom QT, Price M, Neff C, et al (2022) CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015-2019. Neuro Oncol 24:v1–v95. https://doi.org/10.1093/neuonc/noac202
Molinaro AM, Hervey-Jumper S, Morshed RA, et al (2020) Association of Maximal Extent of Resection of Contrast-Enhanced and Non-Contrast-Enhanced Tumor with Survival Within Molecular Subgroups of Patients with Newly Diagnosed Glioblastoma. JAMA Oncol 6:495–503. https://doi.org/10.1001/jamaoncol.2019.6143
Brown TJ, Brennan MC, Li M, et al (2016) Association of the extent of resection with survival in glioblastoma a systematic review and meta-Analysis. JAMA Oncol 2:1460–1469. https://doi.org/10.1001/jamaoncol.2016.1373
Wijnenga MMJ, French PJ, Dubbink HJ, et al (2018) The impact of surgery in molecularly defined low-grade glioma: An integrated clinical, radiological, and molecular analysis. Neuro Oncol 20:103–112. https://doi.org/10.1093/neuonc/nox176
Horsley V (1887) Remarks on Ten consecutive cases of operations upon the brain and cranial cavity to illustrate the details and safety of the method employed (what a table). Br Med J 1:863–865. https://doi.org/10.1136/bmj.1.1373.863
De Witt Hamer PC, Robles SG, Zwinderman AH, et al (2012) Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol Off J Am Soc Clin Oncol 30:2559–2565. https://doi.org/10.1200/JCO.2011.38.4818
Sanai N, Mirzadeh Z, Berger MS (2008) Functional outcome after language mapping for glioma resection. N Engl J Med 358:18–27. https://doi.org/10.1056/NEJMoa067819
Hervey-Jumper SL, Li J, Lau D, et al (2015) Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg 123:325–339. https://doi.org/10.3171/2014.10.JNS141520
Bu L-H, Zhang J, Lu J-F, Wu J-S (2021) Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review. Neurosurg Rev 44:1997–2011. https://doi.org/10.1007/s10143-020-01418-9
Fukui A, Muragaki Y, Saito T, et al (2022) Impact of awake mapping on overall survival and extent of resection in patients with adult diffuse gliomas within or near eloquent areas: a retrospective propensity score-matched analysis of awake craniotomy vs. general anesthesia. Acta Neurochir (Wien) 164:395–404. https://doi.org/10.1007/s00701-021-04999-6
Motomura K, Chalise L, Ohka F, et al (2021) Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping. J Neurooncol 153:361–372. https://doi.org/10.1007/s11060-021-03776-w
Gerritsen JKW, Zwarthoed RH, Kilgallon JL, et al (2022) Effect of awake craniotomy in glioblastoma in eloquent areas (GLIOMAP): a propensity score-matched analysis of an international, multicentre, cohort study. Lancet Oncol 23:802–817. https://doi.org/10.1016/S1470-2045(22)00213-3
Aaronson NK, Taphoorn MJB, Heimans JJ, et al (2011) Compromised health-related quality of life in patients with low-grade glioma. J Clin Oncol 29:4430–4435. https://doi.org/10.1200/JCO.2011.35.5750
Schei S, Solheim O, Salvesen Ø, et al (2022) Pretreatment patient-reported cognitive function in patients with diffuse glioma. Acta Neurochir (Wien) 164:703–711. https://doi.org/10.1007/s00701-022-05126-9
Mack WJ, Freed DM, Williams BW, Henderson VW (1992) Boston Naming Test: shortened versions for use in Alzheimer’s disease. J Gerontol 47:P154-8. https://doi.org/10.1093/geronj/47.3.p154
Verst SM, de Castro I, Scappini-Junior W, et al (2021) Methodology for creating and validating object naming and semantic tests used by Verst-Maldaun Language Assessment during awake craniotomies. Clin Neurol Neurosurg 202:106485. https://doi.org/10.1016/j.clineuro.2021.106485
van Kessel E, Baumfalk AE, van Zandvoort MJE, et al (2017) Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment. J Neurooncol 134:9–18. https://doi.org/10.1007/s11060-017-2503-z
Van Kessel E, Emons MAC, Wajer IH, et al (2019) Tumor-related neurocognitive dysfunction in patients with diffuse glioma: A retrospective cohort study prior to antitumor treatment. Neuro-Oncology Pract 6:463–472. https://doi.org/10.1093/nop/npz008
Szelényi A, Bello L, Duffau H, et al (2010) Intraoperative electrical stimulation in awake craniotomy: Methodological aspects of current practice. Neurosurg Focus 28:1–8. https://doi.org/10.3171/2009.12.FOCUS09237
Dwan TM, Ownsworth T, Chambers S, et al (2015) Neuropsychological assessment of individuals with brain tumor: Comparison of approaches used in the classification of impairment. Front Oncol 5:1–8. https://doi.org/10.3389/fonc.2015.00056
Ownsworth T, Hawkes A, Steginga S, et al (2009) A biopsychosocial perspective on adjustment and quality of life following brain tumor: a systematic evaluation of the literature. Disabil Rehabil 31:1038–1055. https://doi.org/10.1080/09638280802509538
Armstrong CL, Goldstein B, Shera D, et al (2003) The predictive value of longitudinal neuropsychologic assessment in the early detection of brain tumor recurrence. Cancer 97:649–656. https://doi.org/10.1002/cncr.11099
Meyers CA, Hess KR (2003) Multifaceted end points in brain tumor clinical trials: cognitive deterioration precedes MRI progression. Neuro Oncol 5:89–95. https://doi.org/10.1093/neuonc/5.2.89
Lageman SK, Cerhan JH, Locke DEC, et al (2010) Comparing neuropsychological tasks to optimize brief cognitive batteries for brain tumor clinical trials. J Neurooncol 96:271–276. https://doi.org/10.1007/s11060-009-9960-y
Wefel JS, Vardy J, Ahles T, Schagen SB (2011) International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 12:703–708. https://doi.org/10.1016/S1470-2045(10)70294-1
Al-Adli NN, Young JS, Sibih YE, Berger MS (2023) Technical Aspects of Motor and Language Mapping in Glioma Patients. Cancers (Basel) 15:1–17. https://doi.org/10.3390/cancers15072173
Gogos AJ, Young JS, Morshed RA, et al (2020) Awake glioma surgery: technical evolution and nuances. J Neurooncol 147:515–524. https://doi.org/10.1007/s11060-020-03482-z
Giovagnoli AR (2012) Investigation of cognitive impairments in people with brain tumors. J Neurooncol 108:277–283. https://doi.org/10.1007/s11060-012-0815-6
Hedden T, Schultz AP, Rieckmann A, et al (2016) Multiple Brain Markers are Linked to Age-Related Variation in Cognition. Cereb Cortex 26:1388–1400. https://doi.org/10.1093/cercor/bhu238

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Filling the Gap: brief neuropsychological assessment protocol in glioma patients undergoing awake surgeries

Status:

Version 1

Abstract

Figures

Introduction

Methods

Conception of the OMFTCT protocol

OMFTCT subtests

Data Collection

Statistical analysis

Results

Sample characteristics

Comparison between OMFTCT and BNT

Evaluation of the different domains of cognitive tasks proposed by the OMFTCT protocol

OMFTCT related to tumor location

Discussion

References

Additional Declarations

Supplementary Files

Status:

Version 1