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Brain Surgery Associated With Cognitive Improvement: Presented at AANS

By Norra MacReady

SAN FRANCISCO, C.A. -- April 27, 2006 -- Surgical resection may improve cognitive function in people with brain tumors, according to findings from a poster presented here at the annual meeting of the American Association of Neurological Surgeons (AANS).

According to the National Brain Tumor Foundation, more than 190,000 people are diagnosed with a brain tumor in the United States each year. The tumors often produce a rapid decline in thinking, speech, memory, and other cognitive functions that may rival Alzheimer's disease in severity. The speed and degree of impairment depend on the tumor's size, location and growth rate.

These effects are especially poignant given the poor prognosis for many of these patients. Their life expectancy may be a little as 6 to 12 months, and the cognitive effects may curtail their ability to spend their remaining days with their loved ones.

Surgery is the treatment of choice in most cases, but it is thought to exacerbate cognitive decline.

To determine the effect of surgical resection on these patients, Elana Farace, PhD, associate professor of neurosurgery and health evaluation sciences, Pennsylvania State University, University Park, Charlottesville, Pennsylvania, United States, and colleagues evaluated 25 patients with primary brain tumors who underwent surgical resection.

Study subjects had a variety of tumor types, such as craniopharyngioma, meningioma, central neurocytoma, colloidal cyst, and gliomas that ranged in severity from grade I to IV. The median age at diagnosis was 39 years.

Patients underwent a standard neuropsychological evaluation before surgery and at 6 weeks post-surgery. The evaluation measured a broad range of domains, including attention, memory, executive function, visual and verbal memory, psychomotor speed, and depression. The scores were adjusted for patient demographics, using test norms where available.

At the postoperative evaluation, 84% of patients had improved in at least 1 domain by at least 1 standard deviation, while 36% of the cohort had deteriorated. The percentages overlap because some patients improved in one domain and declined in another, the authors explained. Memory was the domain most likely to show improvement.

Surgery is associated with a variety of risks and complications, like hemorrhage or damage to the surrounding brain tissue, which could worsen neurocognitive function. On the other hand, as these findings demonstrate, it may also improve function, the investigators wrote in their poster.

Possible salutary mechanisms include resolution of mass effect, relief of intracranial pressure, or an effect of debulking. More research is needed to understand completely the cognitive effects of brain tumor resection, they wrote.


[Presentation title: Neurocognitive Improvement Following Surgical Resection in Patients with Primary Brain Tumors. Poster 1437]

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