Review of Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas: A longitudinal, within-patient design study — Lemaitre, 2022

Awake surgery using intra-operative electrical mapping has become the gold-standard way to maximize the amount of resection (EOR) while conserving key brain regions. No large, longitudinal, homogeneous series of DLGG has investigated cognitive recovery after awake mapping-guided neurosurgery. Methods: 157 DLGG patients' cognitive state was studied longitudinally. Before and three months following awake mapping-based surgery, neuropsychological tests were performed. Z-scores and variants were used to count patients with cognitive deficits or deterioration. Clinical, surgical, and histological variables were evaluated for neuro-cognitive outcomes. 87 patients (55.4%) reported cognitive deficits before surgery. Three preoperative (baseline) and postoperative domains showed significant differences (Executive, Psychomotor Speed and Attention, Verbal Episodic Memory). 86% of patients had no postoperative cognitive impairment, and 10% improved. EOR was 92.3% 7.8%. Cognitive impairment was associated with EOR, postoperative volume, and tumor lateralization. No patients had persistent neurologic deficits after surgery, however 5.8% didn't return to work. 5-year survival was 82.2%. It's the largest longitudinal neuropsychological series yet documented. 86% of patients with extensive resections showed no cognitive deterioration, and 5.8% didn't return to work. This research supports awake surgery with cognitive mapping in DLGG patients.

Lemaitre AL, Herbet G, Ng S, Moritz-Gasser S, Duffau H. Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas: A longitudinal, within-patient design study. Neuro Oncol. 2022 May 4;24(5):781-793. doi: 10.1093/neuonc/noab275. PMID: 34850187; PMCID: PMC9071329.