Clinical Scorecard: Chronology of Cognitive Performance in Glioma Patients Undergoing Awake Brain Tumor Resection

At a Glance

Key Highlights

• Awake brain tumor surgery is safe, feasible, and associated with fewer neurological deficits and shorter hospital stays compared to general anesthesia.
• Cognitive functioning is generally preserved postoperatively in most domains except for transient psychomotor speed decline.
• A detailed timeline of cognitive function immediately after surgery is lacking; this study assesses cognitive performance pre-, intra-, and postoperatively using a concise cognitive screener.

Guideline-Based Recommendations

Diagnosis

• Use neuropsychological screening preoperatively to establish baseline cognitive function.
• Assess tumor location, especially in eloquent brain areas, to determine suitability for awake surgery.

Management

• Perform awake brain tumor resection with intraoperative cortical and subcortical electrostimulation to preserve neurological and cognitive functions.
• Utilize a concise cognitive screener assessing object naming, reading, attention span, working memory, inhibition, switching, and visuoperception at multiple time points.

Monitoring & Follow-up

• Conduct cognitive assessments preoperatively, intraoperatively if feasible, and postoperatively at days and months after surgery to monitor cognitive trajectory.
• Monitor for transient postoperative cognitive deterioration due to fatigue or brain swelling.

Risks

• Potential temporary postoperative cognitive decline, particularly in psychomotor speed, due to surgical effects.
• Risk of neurological deficits minimized by awake surgery and intraoperative mapping.

Patient & Prescribing Data

37 adult glioma patients undergoing awake brain tumor surgery

Majority maintained cognitive function postoperatively; cognitive screener feasible and useful for tracking cognitive changes over time.

Clinical Best Practices

• Select patients with good language command and ability to complete cognitive assessments for awake surgery.
• Incorporate intraoperative cognitive testing when patient condition and logistics allow to guide resection.
• Use multiple parallel versions of cognitive screener to reduce learning effects across repeated assessments.
• Provide psychoeducation to patients regarding expected cognitive course post-surgery to support wellbeing.

References

• Van Kessel et al. study on cognitive functioning post awake surgery
• Snodgrass Naming Task
• Delis-Kaplan Executive Function System (DKEFS) Colour-Word Interference Test
• Cortical Vision Screening Test (CORVIST) and Visual Object and Space Perception Battery (VOSP)