Spatial Attentional Functioning in Adult Brain Tumor Patients
Toorn, R. van den
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Background. Cognitive functioning is at risk in patients with gliomas because of the infiltration of healthy surrounding brain tissue. Cognitive changes can be related to direct tumor effects, treatment effects including surgery, radiotherapy, chemotherapy, antiepileptic medication, and corticosteroids, and ultimately, tumor progression. Objective. We determined the impact of resective surgery on cognitive functioning by comparing pre- and postoperative neuropsychological outcome specifically focusing on attentional functioning (as measured by the Stroop Color Word Test (SCWT)). Methods. 24 adult patients (10 females, median age: 40, range: 20-64) with supratentorial gliomas (WHO II: 17, WHO III: 3 and WHO IV: 4) underwent neurosurgery of which 17 in eloquent brain regions using intraoperative brain mapping. Neuropsychological examination was administered approximately one week before surgery and 9 months thereafter. Outcome was analyzed at the group and individual level. Several predictive factors for potential cognitive deterioration were explored. Results. Deterioration following surgery in reading speed (performance on Card 1, SCWT) was observed at group level. The effect of predictive factors and individual analyses showed that more extensive resections (i.e. >80%) and tumors located in language eloquent areas yielded clinically relevant deterioration in reading speed. Conclusion. Deterioration in reading speed was found clinically relevant in the predictive dichotomies Extent of Resection (EOR) and language eloquent area. In these patients, both tumor location and location of surgical intervention suggest involvement of the superior longitudinal fasciculus (SLF II). Extra attention should be sought in this particular region during resective brain surgery along with further research in order to map spatial attention in a more accurate way.