PURPOSE Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. In order to minimize the harmful effects of surgery, an increasing number of patients undergo awake craniotomy. To investigate whether we can indeed preserve cognitive functioning after state-of-the art awake surgery and to identify factors determining postoperative NCF, we performed a retrospective cohort study. METHODS In diffuse glioma (WHO grade 2-4) patients undergoing awake craniotomy, we studied neurocognitive functioning both pre-operatively and 3-6 months postoperatively. Evaluation covered five neurocognitive domains. We performed analysis of data on group and individual level and evaluated the value of patient-, tumor- and treatment-related factors for predicting change in NCF, using linear and logistic regression analysis. RESULTS We included 168 consecutive patients. Mean NCF-scores of psychomotor speed and visuospatial functioning significantly deteriorated after surgery. The percentage of serious neurocognitive impairments (- 2 standard deviations) increased significantly for psychomotor speed only. Tumor involvement in the left thalamus predicted a postoperative decline in NCF for the domains overall-NCF, executive functioning and psychomotor speed. An IDH-wildtype status predicted decline for overall-NCF and executive functioning. CONCLUSIONS In all cognitive domains, except for psychomotor speed, cognitive functioning can be preserved after awake surgery. The domain of psychomotor speed seems to be most vulnerable to the effects of surgery and early postoperative therapies. Cognitive performance after glioma surgery is associated with a combination of structural and biomolecular effects from the tumor, including IDH-status and left thalamic involvement.

中文翻译：

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胶质瘤患者清醒手术后的神经认知变化：一项回顾性队列研究。

目的神经胶质瘤患者经常发生神经认知功能障碍。治疗和肿瘤本身都是造成这些缺陷的原因。为了最小化手术的有害影响，越来越多的患者进行清醒的开颅手术。为了研究在进行最先进的清醒手术后我们是否确实能够保留认知功能，并确定决定术后NCF的因素，我们进行了一项回顾性队列研究。方法在清醒开颅手术的弥漫性神经胶质瘤（WHO 2-4级）患者中，我们研究了术前和术后3-6个月的神经认知功能。评价涵盖五个神经认知领域。我们对小组和个人水平的数据进行了分析，并评估了患者，肿瘤和治疗相关因素对预测NCF变化的价值，使用线性和逻辑回归分析。结果我们纳入了168位连续患者。手术后精神运动速度和视觉空间功能的平均NCF评分显着下降。严重的神经认知障碍（-2个标准差）的百分比仅对于精神运动速度显着增加。肿瘤累及左丘脑可预测整个NCF，执行功能和精神运动速度方面NCF的术后下降。IDH野生型状态预测整体NCF和执行功能会下降。结论除精神运动速度外，在所有认知领域中，清醒手术后均可保留认知功能。心理运动速度域似乎最容易受到手术和术后早期疗法的影响。