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Plasticity of cognitive functions before and after awake brain tumor surgery

Djaina Satoer1, 2, 3*, Elke De Witte4, Roelien Bastiaanse2, Arnaud Vincent1, Peter Mariën4, 5 and Evy Visch-Brink1
  • 1 Erasmus MC University Medical Center, Department of Neurosurgery, Netherlands
  • 2 University of Groningen, Center for Language and Cognition Groningen (CLCG), Netherlands
  • 3 University of Groningen, Groninger Center of Expertise for Language and Communication Disorders, Netherlands
  • 4 Free University of Brussels, Department of Clinical and Experimental Neurolinguistics, Center for Linguistics, Belgium
  • 5 ZNA Middelheim, Department of Neurology and Memory Clinic, Belgium

Introduction: Deficits in cognition, i.e. language memory, attentional and executive functions are common in patients with primary brain tumors in eloquent areas (Papagno et al., 2011; Santini et al., 2012; Satoer et al., 2012). Tumor resection may aggravate these deficits, which can recover 1 year postoperatively (Satoer et al., 2014). This finding was based on group analyses, however in clinical practice individual variety is common. Pre- and postoperative neural plasticity mechanisms play an important role in brain tumor patients; substantial support is provided for a hodotopic (i.e. dynamic) approach of functional organization as opposed to a topological viewpoint (i.e. static) (Duffau, 2014). Aim: To describe the influence of plasticity on cognitive functions by means of pre- and postoperative profiles of patients with a similar brain tumor localization. Methods: We present 4 right-handed cases (P1, P2, P3, P4) originating from 2 outcome studies (De Witte et al., 2015; Satoer et al., 2014) with brain tumors in the same language areas (P1, P2: temporoparietal; P3, P4: insula) and operated awake. Language, memory, attentional and executive functions were formally examined pre- (all cases) and postoperatively (P3, P4: 3 and 12 months). Results: P1 and P2 showed opposite preoperative cognitive profiles. P1 obtained normal cognitive results and P2 had clinically significant impairments in all cognitive domains, (language, memory, attentional and executive deficits) (z-score ≥-1.50). P3 and P4 also demonstrate opposite preoperative profiles. P4 obtained intact cognitive results, whereas P3 was impaired in memory and executive functions (z-score ≥-1.50). Intraoperatively, in both P3 and P4 positive language sites were found (left inferior frontal gyrus and left parietal lobe). At 3 months postoperatively, P3 presented language deficits followed by recovery at 12 months, whereas P4 appeared to have recovered at 3 months postoperatively from the observed premorbid impairments in memory and executive functioning (z-score <-1.50). Pathological examination revealed a slow growing brain tumor (low-grade) in P1 and P3 and a fast growing brain tumor (high-grade) in P2 and P4. Conclusion: In patients with similar brain tumor localizations, we found distinct cognitive profiles, possibly affected by different neural plasticity processes. Preoperatively, a favorable plasticity effect on cognition was found in P1 (temporoparietal area), potentially affected by tumor grade. Preserved cognitive functions was possibly facilitated by the slow growth rate of a low-grade tumor allowing functional reorganization (Mandonnet et al., 2003). However, P2 with a brain tumor in the same area showed preoperative deficits in several domains (language, memory and attention/executive functions). A faster growth rate of a high-grade tumor could have more aggressively affected cognition. In P3 and P4 with the same localization (insula), we found a different effect on the cognitive recovery process; at short term (3 months), improvement of the preoperatively observed cognitive impairments in a low-grade tumor P3, whereas a more gradual functional reorganization was found in language (3-12 months) in P4, a high-grade tumor, contrasting Habets et al., 2014; Talacchi, Santini, Savazzi, & Gerosa, 2010. Hence, extensive pre- and postoperative neuropsychological investigation is of fundamental importance due to neural plasticity.

References

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Satoer, D., Vork, J., Visch-Brink, E., Smits, M., Dirven, C., & Vincent, A. (2012). Cognitive functioning early after surgery of gliomas in eloquent areas. J Neurosurg, 117(5), 831-8.
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Keywords: brain tumor patients, awake surgery, cognitive functions, neurolinguistics, neural plasticity

Conference: Academy of Aphasia 53rd Annual Meeting, Tucson, United States, 18 Oct - 20 Oct, 2015.

Presentation Type: platform paper

Topic: Not student first author

Citation: Satoer D, De Witte E, Bastiaanse R, Vincent A, Mariën P and Visch-Brink E (2015). Plasticity of cognitive functions before and after awake brain tumor surgery. Front. Psychol. Conference Abstract: Academy of Aphasia 53rd Annual Meeting. doi: 10.3389/conf.fpsyg.2015.65.00067

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Received: 23 Apr 2015; Published Online: 24 Sep 2015.

* Correspondence: Dr. Djaina Satoer, Erasmus MC University Medical Center, Department of Neurosurgery, Rotterdam, 3015 CN, Netherlands, d.satoer@erasmusmc.nl