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Cognition and resective surgery for diffuse infiltrative glioma: an overview.

Klein M, Duffau H, De Witt Hamer PC - J. Neurooncol. (2012)

Bottom Line: Compared to classical oncological outcome measures such as time to progression and survival, the importance of cognitive functioning in patients with diffuse infiltrative brain tumors has only recently been recognized.Our understanding of the effects of brain surgery on cognition, for instance, is largely based on studies in surgical patients with refractory epilepsy, with only a limited number of studies in surgical patients with gliomas.The impact of other factors affecting cognition in glioma patients such as direct tumor effects, radiotherapy and chemotherapy, and medical treatment, including anti-epileptic drugs and steroids, have been studied more extensively.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. m.klein@vumc.nl

ABSTRACT
Compared to classical oncological outcome measures such as time to progression and survival, the importance of cognitive functioning in patients with diffuse infiltrative brain tumors has only recently been recognized. Apart from the relatively low incidence and the invariably fatal outcome of gliomas, the general assumption that cognitive assessment is time-consuming and burdensome contributes to this notion. Our understanding of the effects of brain surgery on cognition, for instance, is largely based on studies in surgical patients with refractory epilepsy, with only a limited number of studies in surgical patients with gliomas. The impact of other factors affecting cognition in glioma patients such as direct tumor effects, radiotherapy and chemotherapy, and medical treatment, including anti-epileptic drugs and steroids, have been studied more extensively. The purpose of this paper is to provide an overview of cognition in patients with diffuse infiltrative gliomas and the impact of resective surgery as well as other tumor and treatment-related factors.

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Rapid transformation from a WHO grade II oligodendroglioma at the time of surgery into an anaplastic oligodendroglioma at 22 months
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Related In: Results  -  Collection


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Fig1: Rapid transformation from a WHO grade II oligodendroglioma at the time of surgery into an anaplastic oligodendroglioma at 22 months

Mentions: A 36-year old female presented with several elementary seizures in the 3 months preceding presentation, characterized by foul smell followed by inattention and dysphasia. Otherwise she suffered from fatigue for 10 years which was diagnosed as ‘chronic fatigue syndrome’. She was married, had one child and worked as an administrative employee in an international organization. She had a normal neurological examination and was right-handed. The first MRI showed a T2/FLAIR hyperintense lesion of 50 ml anterior in the left insula with no enhancement after gadolinium suggesting a low-grade glioma (Fig. 1a). She started on carbamazepine 200 mg bid. Information was provided on resective surgery with its presumed beneficial impact on time to progression and survival, the acceptable low risk of permanent neurological deficits when using brain mapping under local anesthesia, and the unknown risk of cognitive decline, as well as alternative treatment options consisting of a biopsy and radiotherapy or chemotherapy and radiological follow-up with delayed treatment. She was highly motivated to undergo resective surgery with language mapping. A baseline assessment for language and neuropsychological examination was obtained showing a score on the Boston naming test in the lower normal range.


Cognition and resective surgery for diffuse infiltrative glioma: an overview.

Klein M, Duffau H, De Witt Hamer PC - J. Neurooncol. (2012)

Rapid transformation from a WHO grade II oligodendroglioma at the time of surgery into an anaplastic oligodendroglioma at 22 months
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3351615&req=5

Fig1: Rapid transformation from a WHO grade II oligodendroglioma at the time of surgery into an anaplastic oligodendroglioma at 22 months
Mentions: A 36-year old female presented with several elementary seizures in the 3 months preceding presentation, characterized by foul smell followed by inattention and dysphasia. Otherwise she suffered from fatigue for 10 years which was diagnosed as ‘chronic fatigue syndrome’. She was married, had one child and worked as an administrative employee in an international organization. She had a normal neurological examination and was right-handed. The first MRI showed a T2/FLAIR hyperintense lesion of 50 ml anterior in the left insula with no enhancement after gadolinium suggesting a low-grade glioma (Fig. 1a). She started on carbamazepine 200 mg bid. Information was provided on resective surgery with its presumed beneficial impact on time to progression and survival, the acceptable low risk of permanent neurological deficits when using brain mapping under local anesthesia, and the unknown risk of cognitive decline, as well as alternative treatment options consisting of a biopsy and radiotherapy or chemotherapy and radiological follow-up with delayed treatment. She was highly motivated to undergo resective surgery with language mapping. A baseline assessment for language and neuropsychological examination was obtained showing a score on the Boston naming test in the lower normal range.

Bottom Line: Compared to classical oncological outcome measures such as time to progression and survival, the importance of cognitive functioning in patients with diffuse infiltrative brain tumors has only recently been recognized.Our understanding of the effects of brain surgery on cognition, for instance, is largely based on studies in surgical patients with refractory epilepsy, with only a limited number of studies in surgical patients with gliomas.The impact of other factors affecting cognition in glioma patients such as direct tumor effects, radiotherapy and chemotherapy, and medical treatment, including anti-epileptic drugs and steroids, have been studied more extensively.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. m.klein@vumc.nl

ABSTRACT
Compared to classical oncological outcome measures such as time to progression and survival, the importance of cognitive functioning in patients with diffuse infiltrative brain tumors has only recently been recognized. Apart from the relatively low incidence and the invariably fatal outcome of gliomas, the general assumption that cognitive assessment is time-consuming and burdensome contributes to this notion. Our understanding of the effects of brain surgery on cognition, for instance, is largely based on studies in surgical patients with refractory epilepsy, with only a limited number of studies in surgical patients with gliomas. The impact of other factors affecting cognition in glioma patients such as direct tumor effects, radiotherapy and chemotherapy, and medical treatment, including anti-epileptic drugs and steroids, have been studied more extensively. The purpose of this paper is to provide an overview of cognition in patients with diffuse infiltrative gliomas and the impact of resective surgery as well as other tumor and treatment-related factors.

Show MeSH
Related in: MedlinePlus