Late neurocognitive sequelae in patients with WHO grade I meningioma

Dijkstra, Monica; Nieuwenhuizen, D. van; Stalpers, Lukas J.A.; Wumkes, M.; Waagemans, Martin L; Vandertop, W. Peter; Heimans, Jan J.; Leenstra, Sieger; Dirven, Clemens M.F.; Reijneveld, J.C.; Klein, Martin

doi:10.1136/jnnp.2007.138925

Cited by 94 publications

(93 citation statements)

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“…1,2,13 Regarding postoperative neurocognitive outcomes, the literature suggests that about 40% of patients experience cognitive or emotional problems following surgery. 26 Patients with meningioma show significant long-term impairments in executive functioning; 6 those with skull base meningiomas perform lower on cognitive testing than those with convexity meningiomas, and those with leftsided meningiomas show more verbal memory deficits than those with right-sided meningiomas. 28 In general, neurocognitive deficits have been documented preoperatively in patients with meningiomas, suggesting that the tumor itself can cause neuropsychological disturbances.…”

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confidence: 99%

Effects of intracranial meningioma location, size, and surgery on neurocognitive functions: a 3-year prospective study

Liouta

Koutsarnakis

Liakos

et al. 2016

JNS

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MeningioMas constitute approximately 15%-20% of all intracranial neoplasms and are often associated with favorable clinical prognosis because of their benign histology. Because of the high survival rates associated with meningiomas, patients with meningiomas can expect increased functional capacity compared with patients harboring other brain tumors. Parameters such as the rate of survival, tumor recurrence, and progression, 8 as well as the quality of life 3,17 of these patients, have traditionally been used to assess outcomes after intracranial meningioma surgery. According to recommendations from current outcomes research programs, neuropsychological-cognitive parameters also need to be incorporated to comprehensively evaluate surgical outcomes.Although meningiomas are extraaxial tumors, cognitive decline may arise due to perilesional edema and mass obJective Current recommendations stress the need for cognitive parameters to be integrated in the evaluation of outcomes for intracranial meningioma surgery. The aim of this prospective study was to examine neurocognitive function in meningioma patients pre- and postoperatively. methods Patients with skull base (anterior and middle fossa) and convexity (anterior and posterior) meningiomas (n = 54) underwent neuropsychological examination prior to and 1 year after surgery. A control group (n = 52) of healthy volunteers matched for age, sex, and education underwent the same examination. Assessments included executive, memory, and motor functions with standardized testing. Patients with convexity meningiomas were clinically assessed for parietal association cortex functions. results All patients performed significantly worse (p < 0.05) in most neurocognitive domains than controls. The skull base group showed more disturbances in memory than the convexity group (p < 0.05). The anterior convexity group showed more deficits in executive function than the posterior convexity group, which presented with parietal association cortex deficits. Verbal deficits were more pronounced in the left hemisphere than in the right hemisphere. Patients with a large tumor (> 4 cm) had more severe neurocognitive deficits than those with a small tumor (< 4 cm). Postoperatively, patients showed no deterioration in neurocognitive function. Instead, significant improvement (p < 0.05) was observed in some executive, motor, and parietal association cortex functions. coNclusioNs According to the authors' findings, intracranial meningiomas may cause neurocognitive deficits in patients. Surgery does not cause a deterioration in cognitive function; instead, it may lead to improvements in some functions. Permanent neuropsychological postoperative deficits should be interpreted as tumor-induced rather than due to surgery.

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confidence: 99%

Effects of intracranial meningioma location, size, and surgery on neurocognitive functions: a 3-year prospective study

Liouta

Koutsarnakis

Liakos

et al. 2016

JNS

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“…6 Recent onderzochten we denkstoornissen en kwaliteit van leven bij 89 patiënten met een meningeoom, gemiddeld 3,5 jaar na chirurgie alleen of na chirurgie met radiotherapie. 28 Vergeleken met de (normale) controlegroep was de cognitie van beide groepen patiënten fors verminderd, maar tussen de patiëntengroepen onderling was geen ver- Voorts vonden we dat zowel de denkstoornissen als de verminderde kwaliteit van leven gedeeltelijk samenhingen met het gebruik van anti-epileptica en niet met het hebben van epileptische insulten (ondanks anti-epileptica). 28 Bij het voorschrijven van anti-epileptica moet de arts derhalve bedacht zijn op de bijwerkingen op het denkvermogen, moet eerder gedacht worden aan middelen die wellicht minder geestvernauwend zijn en is het niet steeds wenselijk om te streven naar een volledige vrijheid van epileptische insulten.…”

Section: Late Gevolgenunclassified

“…28 Vergeleken met de (normale) controlegroep was de cognitie van beide groepen patiënten fors verminderd, maar tussen de patiëntengroepen onderling was geen ver- Voorts vonden we dat zowel de denkstoornissen als de verminderde kwaliteit van leven gedeeltelijk samenhingen met het gebruik van anti-epileptica en niet met het hebben van epileptische insulten (ondanks anti-epileptica). 28 Bij het voorschrijven van anti-epileptica moet de arts derhalve bedacht zijn op de bijwerkingen op het denkvermogen, moet eerder gedacht worden aan middelen die wellicht minder geestvernauwend zijn en is het niet steeds wenselijk om te streven naar een volledige vrijheid van epileptische insulten. 29,30 Stoornissen in denken en stemmingen worden tegenwoordig beter herkend bij patiën-ten met een hersentumor, maar een effectieve behandeling ontbreekt nog.…”

Section: Late Gevolgenunclassified

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Stalpers¹,

Furth²

2008

BIJB

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SamenvattingIeder jaar wordt in Nederland bij zeven-à achthonderd patiënten een goedaardige tumor van het centraal zenuwstelsel vastgesteld. Het aantal langdurige overlevers is een veelvoud daarvan. Ondanks de goede genezingskansen houden veel patiënten (15-50%) blijvend neurologische en psychosociale beperkingen ten gevolge van de aandoening en/of de behandeling. Naast neurologische uitval en epilepsie komen chronische denkstoornissen, stemmingsstoornissen en moeheid veel voor; deze worden soms pas laat ontdekt. Ook het gebruik van anti-epileptica op zichzelf is een risicofactor voor cognitieve achteruitgang en verminderde kwaliteit van leven. Radiotherapie is een belangrijke risicofactor voor mentale achterstand bij kinderen met een hersentumor; bij volwassenen is de cognitieve schade door neurochirurgie en bestraling minder opvallend dan de schade door de tumor. InleidingGoedaardige tumoren van het centraal zenuwstelsel worden histologisch gekenmerkt door een scherp begrensde groei binnen de schedel en het ruggenmergkanaal. Per definitie metastaseren ze niet, maar door lokale druk op hersenen en zenuwen kunnen ze wel aanleiding geven tot neurologische uitval en prikkeling (pijn, epilepsie). De meeste patiënten kunnen worden genezen met neurochirurgie en radiotherapie, maar veel patiënten houden langdurig neurologische, cognitieve en hormonale restverschijnselen. Deze langetermijnproblemen worden pas de laatste jaren onderkend. Er kunnen verschillende redenen zijn waarom de aandacht voor goedaardige tumoren en hun gevolgen zo gering is: . de diagnose 'benigne hersentumor' is een vergaarbak van histologisch zeer verschil-

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“…However, adult patients with a low-grade glioma or meningioma who had been irradiated showed no additional detrimental effect by irradiation over damage by the tumor and by neurosurgery [9]. Shukitt-Hale et al [10] found that cranial irradiation was associated with reduced performance in tasks assessing spatial learning and memory, which could at least partly be due to a lack of GH [11].…”

Section: Introductionmentioning

confidence: 98%

Reduced growth hormone secretion after cranial irradiation contributes to neurocognitive dysfunction

Quik

Valk

Drent

et al. 2012

Growth Hormone & IGF Research

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a b s t r a c tThe objective of this study was to investigate the relation between growth hormone (GH) and attentional electro-cortical responses to task-relevant stimuli (N2b), target detections, speed of responding, P300 latencies, and performance on neuropsychological tests in 19 patients who received external beam radiation therapy for brain tumors in adulthood. In addition, we studied the association between IGF-I and activation of the motor cortex responses (lateralized readiness potential, LRP). Brain function was assessed using event-related potentials (ERPs) during a go/no go selective-attention task, including N2b, P300 and selective motor preparation as reflected in the LRP. Correlations were calculated between peak GH levels after a standardized growth hormone-releasing hormone (GHRH)-arginine test, plasma IGF-I, and cognitive functions. We separately studied four patients who were diagnosed with GHD according to the GHRH-arginine test. Performance on WAIS digit span backward and the Rey-Osterrieth complex figure test correlated positively with GH peak. GHD patients performed worse than non-GHD patients on Stroop interference, trail making B/A attentional shifting and Rey-Osterrieth complex figure test. At trend-level significance, trails A performance was better in patients with lower GH levels and higher radiation doses, and GHD participants detected fewer targets in the go/no go selective attention task. N2b was not significantly altered by GH status. Furthermore, plasma IGF-I was positively correlated with the sum of digit span forward and backward. No relations with P300 were observed. In this study only 21% (4/19) of the patients who received fractionated radiotherapy for a non-endocrine brain tumor were diagnosed with GHD. GHD in these patients was associated with impaired interference control, attentional shifting, and visual long-term memory. The results for interference control and attentional shifting suggest an additional effect of the radiation history.

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Late neurocognitive sequelae in patients with WHO grade I meningioma

Abstract: ABSTRACT

Cited by 94 publications

References 27 publications

Effects of intracranial meningioma location, size, and surgery on neurocognitive functions: a 3-year prospective study

Effects of intracranial meningioma location, size, and surgery on neurocognitive functions: a 3-year prospective study

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Reduced growth hormone secretion after cranial irradiation contributes to neurocognitive dysfunction

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