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Effects of surgery on neurocognitive function in patients with glioma: a meta-analysis of immediate post-operative and long-term follow-up neurocognitive outcomes

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Abstract

Purpose

This study aims to identify the neuropsychological tests commonly used for assessment in each neurocognitive domain, and quantify the post-operative changes in neurocognitive function in the immediate post-operation and follow-up.

Methods

With the use of the PubMed, a comprehensive search of the English literature was performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. There were 1021 publications identified for screening. Standardized mean differences (SMD) in neuropsychological task performance were calculated both for immediate post-operation (up to 1 week) and follow-up (up to 6 months).

Results

Out of 12 studies which met the inclusion criteria, 11 studies were analyzed in this meta-analysis, with a total of 313 patients (age range 18–82, 50% males) with intracranial gliomas (45% high-grade, 55% low-grade). Complex attention, language and executive function were the most frequently tested neurocognitive domains. Surgery had a positive impact in the domains of complex attention, language, learning and memory tasks in the immediate post-operative period and sustained improvement at follow-up. In contrast, surgery was found to negatively impact performance for executive function in the immediate post-operative period with sustained decline in performance in the long term.

Conclusions

This meta-analysis suggests that surgery for glioma confers a benefit for the domains of complex attention, language, learning and memory, while negatively affecting executive function, in the periods immediately after surgery and at 6 months follow-up. In addition, awake surgery seemed to confer a beneficial effect on neurocognitive functions. Future research should attempt to standardize a battery of neuropsychological tests for patients undergoing surgical resection for glioma, perhaps with a particular focus on executive function.

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Funding

This research is supported by Singapore Ministry of Health’s National Medical Research Council under its Translational and Clinical Research Flagship Programme - Tier 1 (Project No: NMRC/TCR/016-NNI/2016).

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Justin Choon Hwee Ng & Ting Yao Ang

  2. Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore

    Angela An Qi See, Lysia Yan Rong Tan, Beng Ti Ang & Nicolas Kon Kam King

  3. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore

    Angela An Qi See, Beng Ti Ang & Nicolas Kon Kam King

  4. Duke-NUS Medical School, Singapore, Singapore

    Beng Ti Ang & Nicolas Kon Kam King

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  1. Justin Choon Hwee Ng
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  2. Angela An Qi See
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Correspondence to Nicolas Kon Kam King.

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Ng, J.C.H., See, A.A.Q., Ang, T.Y. et al. Effects of surgery on neurocognitive function in patients with glioma: a meta-analysis of immediate post-operative and long-term follow-up neurocognitive outcomes. J Neurooncol 141, 167–182 (2019). https://doi.org/10.1007/s11060-018-03023-9

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