Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas...

The main goal in Awake monitoring with intraoperative electrical mapping is maintain the quality of life (QOL) by maximizing the extent of resection (EOR) while sparing critical neural structures. And what about neurocognitive outcomes?

In the paper "Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas: A longitudinal, within-patient design study”, 157 patients with DLGG were longitudinally evaluated before and 3 months after surgery with neuropsychological assessments.

Eighty-seven patients (55.4%) had preoperative cognitive impairments. Eighty-six percent of patients exhibited no postoperative cognitive decline, and among them, 10% exhibited cognitive improvement despite a mean EOR of 92.3% -+7.8%. The 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.

- This is the largest, homogeneous, and consecutive series of DLGG with systematic neuropsychological assessment to date;

-The present study supports the idea that awake surgery with cognitive mapping is a safe and effective therapeutic approach in newly diagnosed DLGG patients.

-Surprisingly, a greater EOR did not correlate with cognitive deficits but instead with improvement in certain tasks (eg. memory encoding). These results may be due to better control of mass effect and/or seizure control in the early postoperative setting. The challenge in addressing the “onco-functional balance” may be accomplished with an awake mapping surgery, which will optimize extent of surgical resection while sparing critical neural structures.

-DLGG are most commonly found in young adults following onset of seizures but who otherwise enjoy an active, normal life. As such, preserving QOL of an otherwise healthy and active patient is of utmost importance.

Maíra Cristina Velho is a neurological surgeon from Nossa Senhora das Graças Hospital and 2nd treasurer of SNOLA.

Article link: https://doi.org/10.1093/neuonc/noab275