Long-term Impact of Cognitive Deficits and Epilepsy on Quality of Life in Patients With Low-Grade Meningiomas

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

doi:10.1227/neu.0b013e318212badb

Cited by 93 publications

(106 citation statements)

References 32 publications

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“…4 With regard to tumor laterality, patients with left-sided meningiomas had decreased verbal fluency and recall for verbal material compared with patients with right-sided meningiomas. This finding supports the well-established notion that the left hemisphere is dominant for language function 15 and is in agreement with previous studies reporting verbal deficits in patients with left-hemisphere benign, 28 low-grade, 9 and high-grade malignancy 12 tumors. Regarding the superoinferior axis, patients with skull base meningiomas had more deficits in memory components and long-term verbal and nonverbal memory than those with convexity meningiomas.…”

Section: Discussionsupporting

confidence: 93%

“…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. Furthermore, a number of studies have suggested that patients with surgically treated meningiomas present postoperatively with cognitive declines.…”

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confidence: 99%

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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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Section: Discussionsupporting

confidence: 93%

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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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“…1,3–6,8,9,11,12,18–22,25,26,28–30,35–38,40,41,43,48,51–53,55,59,60, 62–64,68–70 All investigations were retrospective observational case series, and no prospective controlled trials were identified.…”

Section: Resultsmentioning

confidence: 99%

Seizures in supratentorial meningioma: a systematic review and meta-analysis

Englot¹,

Magill²,

Han³

et al. 2016

JNS

127

109

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Object Meningioma is the most common benign intracranial tumor, and patients with supratentorial meningioma frequently suffer from seizures. The rates and predictors of seizures in patients with meningioma have been significantly under-studied, even in comparison with other brain tumor types. Improved strategies for the prediction, treatment, and prevention of seizures in patients with meningioma is an important goal, because tumor-related epilepsy significantly impacts patient quality of life. Methods The authors performed a systematic review of PubMed for manuscripts published between January 1980 and September 2014, examining rates of pre- and postoperative seizures in supratentorial meningioma, and evaluating potential predictors of seizures with separate meta-analyses. Results The authors identified 39 observational case series for inclusion in the study, but no controlled trials. Preoperative seizures were observed in 29.2% of 4709 patients with supratentorial meningioma, and were significantly predicted by male sex (OR 1.74, 95% CI 1.30–2.34); an absence of headache (OR 1.77, 95% CI 1.04–3.25); peritumoral edema (OR 7.48, 95% CI 6.13–9.47); and non–skull base location (OR 1.77, 95% CI 1.04–3.25). After surgery, seizure freedom was achieved in 69.3% of 703 patients with preoperative epilepsy, and was more than twice as likely in those without peritumoral edema, although an insufficient number of studies were available for formal meta-analysis of this association. Of 1085 individuals without preoperative epilepsy who underwent resection, new postoperative seizures were seen in 12.3% of patients. No difference in the rate of new postoperative seizures was observed with or without perioperative prophylactic anticonvulsants. Conclusions Seizures are common in supratentorial meningioma, particularly in tumors associated with brain edema, and seizure freedom is a critical treatment goal. Favorable seizure control can be achieved with resection, but evidence does not support routine use of prophylactic anticonvulsants in patients without seizures. Limitations associated with systematic review and meta-analysis should be considered when interpreting these results.

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“…Tumor removal has been reported to result in complete seizure freedom in 53-90 % of meningioma patients with preoperative seizures [6,16,15,25]. For the remaining patients who are not seizure free after surgery, quality of life is significantly decreased [47]. Interestingly, meningiomas and other slow-growing tumors are associated with epilepsy more often than rapidly growing tumors.…”

Section: Introductionmentioning

confidence: 99%

Intracranial meningiomas and seizures: a review of the literature

et al. 2015

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Long-term Impact of Cognitive Deficits and Epilepsy on Quality of Life in Patients With Low-Grade Meningiomas

Abstract: The HRQOL of most patients with WHO Grade I meningiomas is comparable to that of the general population. However, HRQOL is worse in patients with major cognitive deficits and those using AEDs, irrespective of seizure control.

Cited by 93 publications

References 32 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

Seizures in supratentorial meningioma: a systematic review and meta-analysis

Intracranial meningiomas and seizures: a review of the literature

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