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Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review

ALMEIDA GONDAR, Renato, et al.

Abstract

Clinical outcomes after surgery for intracranial meningiomas might be overvalued as cognitive dimensions and quality of life are probably underreported. This review aims to summarize the current state of cognitive screening and treatment-related outcomes after meningioma surgery. We present a systematic review (Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P) 2015-based) of cognitive outcomes after intracranial meningioma surgery. A total of 1572 patients (range 9-261) with a mean age of 58.4 years (range 23-87), and predominantly female (n = 1084, 68.9%) were identified. Mean follow-up time after treatment was 0.86 ± 0.3 years. Neuropsychological assessment was very heterogeneous, but five dimensions of cognition were described: memory (19/22); attention (18/22); executive functions (17/22); language (11/22); flexibility (11/22 studies). Cognitive abilities were impaired in 18 studies (81.8%), but only 1 showed deterioration in all dimensions simultaneously. Memory was the most affected. with significant post-therapy impairment in 9 studies (40.9%). Postoperatively, only 4 studies (18.2%) [...]

ALMEIDA GONDAR, Renato, et al . Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review. Cancers , 2021, vol. 13, no. 8, p. 1846

DOI : 10.3390/cancers13081846 PMID : 33924372

Available at:

http://archive-ouverte.unige.ch/unige:155138

Disclaimer: layout of this document may differ from the published version.

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1

Author, year, design

Sample

size (n) Gender

Mean age (y

± SD, range

)

Mean educatio n (y ± SD

or level)

Location

Assessment measuremen

t tools

Cognition dimensions tested

Difference between pre- and post- op or against control group

Follow- up (y)

Van Lonkhuizen,

2019, prospective

242 168 F &

74 M

57.2 (23‐

82)

5th level

101 Left &

113 Right //

142 Frontal

& 100 Non‐

frontal

Central Nervous System Vital

Signs tests

Verbal and visual memory, reaction time, complex attention and cognitive

flexibility

• Worsening of SCF, anxiety and depression before and at 1y (p <

0.01) with surgery

• No difference after surgery

1

Rijnen, 2019,

prospective 261 189 F &

72 M

57.8 ± 11.7 (23‐

82)

14.0 ± 3.7

106 Left, 124 Right

and 31 Bilateral //

154 Frontal and 107

Non‐

frontal

Central Nervous System Vital

Signs tests

Verbal and visual memory, reaction time, complex attention and cognitive

flexibility

• Worsening of verbal memory, visual memory, processing speed, psychomotor speed, reaction time, attention complex and cognitive

flexibility with surgery (p<0.05)

1

Van Nieuwenhuiz

en, 2019, retrospective

21 14 F &

7 M

55.3 (10.6)

4.0 (1.8) level

13 Convexity,

5 Skull base & 3

Orbital

Central Nervous System Vital

Signs tests

Verbal and working memory, attention, executive functioning and

cognitive flexibility

• Significant correlation between preoperative cerebral edema and tumor volume and postoperative

cognitive functioning

0.4

Pranckevičien ė, 2019, prospective

93 68 F &

25 M

63.8 +/‐

10.7

n.a

36 Left, 37 Right and 20 Bilateral

HVLT‐R, EORTC, QLQ‐30 and

QLQ‐BN20

Verbal, working and visual memory and complex

attention

• Worsening of Working memory, Delayed recall and recognition,

Flatter learning slope and less effective acquisition compared to

control group

n.a

Van Nieuwenhuiz

en, 2018, retrospective

20 14 F &

6 M

51.4

(10.9) 4 (6) level

12 Frontal, 4 Parietal, 2 Temporal

and 2 Occipital

Central Nervous System Vital

Signs tests

Verbal and working memory, attention and

executive functioning

• None n.a

(3)

2

Di Cristofori, 2018, prospective

41 15 F &

26 M 74 (70–

87)

n.a

7 Skull base, 9 Falx

cerebri, 7 Posterior fossa and

18 Convexity

Raven Matrices, Objects and

Verbs naming, ideomotor

apraxia, Token Test,

among others

Verbal and working memory, attention, executive functioning,

language

• Improvement in Language, memory, attention, executive verbal functions, executive non‐

verbal functions and praxis with surgery (p<0.01)

1

Zweckberger, 2017, prospective

58 47 F &

11 M

56.4 ±

12.5 n.a

46 Anterior skull base,

5 Middle and 7 Posterior

fossa

HVLT‐R, EORTC, QLQ‐30 and

QLQ‐BN20

Verbal, working and visual memory, attention, executive functioning,

language

• Improvement of Verbal learning, visual learning memory, Visuomotor processing speed and

working memory (p<0.05) with surgery

1

Hendrix, 2017,

prospective 12 7 F & 5 M

62.0 ±

13.2 n.a

1 Left, 5 Right and 6 Bilateral

Central Nervous System Vital

Signs tests

Verbal and working memory, attention, executive functioning,

language

• Worsening of Verbal fluency and Perceptual speed compared to

control group

0.17

Abel, 2016,

retrospective 70 45 F &

25 M

62.1 ±

12.6 13.5 ± 2.5

23 ventromed

ial & 47 non‐

ventromed ial prefrontal

cortex

Others

Verbal and visual memory, attention and orientation,

executive functioning, language skills, cognitive

flexibility

• Worsening of behavior and specifically adaptive functions

with surgery

n.a

Liouta, 2016,

prospective 54 38 F &

16 M

56.8 ±

12.8 10.2 ± 2.4

17 Left, 27 Right and 10 Bilateral

// 28 Convexity

and 26 Skull base

Wechsler Adult Intelligence

Scale‐III Digit Span, TMT Parts A

and B,

Memory, executive functioning, language and

cognitive flexibility

• Verbal deficits more pronounced in the left than right hemisphere

• No deterioration in neurocognitive function after surgery

1

(4)

3

COWAT, RBMT Bommakanti,

2016, prospective

57 35 F &

22 M

44.72 (17‐

64)

n.a

20 Left, 20 Right and 17 Bilateral

Others

Verbal, working and visual memory, attention and

executive functioning

• Worst Memory, attention and executive functions (p: n.a) compared to control group

0.25

Campanella, 2015, prospective

16 n.a 57.94

± 11.08

10.81 ± 4.02

9 Left & 7 Right; 6 Frontal, 8

Parietal and 2 Temporal

Central Nervous System Vital

Signs tests

Attention and orientation, executive functioning, language and perception.

• Worsening of Alexithymia and

Self‐maturity with the surgery 0.33

Meskal, 2015,

prospective 68 46 F &

22 M

55.66 (36–

74)

4.90 (4–7) level

30 Left, 33 Right and 5 Bilateral;

39 Frontal

& 29 Non‐

frontal

Central Nervous System Vital

Signs tests

Memory, attention, processing speed, executive functioning and

cognitive flexibility,

• Improvement memory, complex attention, cognitive flexibility, processing speed, and executive

functioning (p < 0.05) with the surgery

0.25

van der Vossen, 2014, retrospective

136 106 F &

30 M

59.1 ±

12.7 n.a

66 Convexity

and 70 Non‐

convexity

CFQ and HADS

Cognitive flexibility, anxiety and depression

• Worsening of cognitive and/or emotional problems in 40% of

patients with surgery

3.0 ± 0.9

Waagemans, 2011, retrospective

89 66 F &

23 M

58.4 ± 13.2

3.8 (2.1) level

37 Left, 25 Right & 27 Bilateral;

45 Convexity

& 44 Non‐

convexity

Others

Working and verbal memory, attention, executive functioning, language and cognitive

flexibility

• Worsening of executive functioning, psychomotor speed, verbal and working memory and information processing capacity (p< 0.05) compared to control

group

1

Krupp, 2009,

retrospective 91 60 F &

31 M

56 ± 10 (31–

75)

n.a

48 Left &

43 Right;

40 Frontal

& 51 Non‐

frontal

Others Language and cognitive flexibility

• Worsening of concentration performance, verbal knowledge, technical ability and word fluency

compared to control group

1.25 ± 0.3

(5)

4

Dijkstra, 2009,

retrospective 89 66 F &

23 M

58.6 ±

12.1 3.8 ± 2.2

37 Left, 25 Right and 27 Bilateral

Others

Executive functioning, Psychomotor speed,

Working memory, Attention, Information processing and Verbal

memory

• Worsening of executive functioning, verbal memory, information processing capacity, psychomotor speed and working memory (p<0.05) compared to

control group

1

Yoshii, 2008,

retrospective 9 n.a 61.8 n.a 4 Left and 5 Right

Central Nervous System Vital

Signs tests

Language, attention, executive functioning, memory, and perception

• Worsening of working memory in

left side compared to control group n.a

Van Nieuwenhuiz

en, 2007, retrospective

18 15 F &

3 M

62.6 ±

11.8 n.a n.a

HVLT‐R, EORTC, QLQ‐30 and

QLQ‐BN20

Verbal, working and visual memo, complex attention

and language

• Worsening of memory compared

to control group (p < 0.05) 1

Steinvorth, 2003, prospective

40 27 F &

13 M

55 ±

14 n.a

13 Left, 22 Right and 2 Bilateral

Others Memory and attention

• Improvement of attention and memory functions with

radiotherapy

1

Tucha, 2003,

prospective 54 37 F &

17 M

57.8 ±

1.5 9.6 ± 0.2

22 Left, 21 Right and 11 Bilateral

Central Nervous System Vital

Signs tests

Verbal and visual memory, psychomotor speed, reaction time, complex attention and cognitive

flexibility

• Worsening of working memory and improvement of attentional

functions with surgery

0‐33 ‐ 0‐

75

Tucha, 2001,

prospective 33 21 F &

12 M

72.8 ±

0.9 n.a

14 Left, 13 Right & 6 Bilateral;

10 Frontal

& 20 Non‐

frontals

Central Nervous System Vital

Signs tests

verbal and visual memory, complex attention, language and cognitive

flexibility

• Improvement of attention and memory functions with surgery

• Worsening of verbal and figural working memory compared to

control group

0.21 ‐ 0.41

Supplementary Table. Detailed description of each cohort (study and patient characteristics). COWAT (Controlled Oral Word Association Test); F (females),

M (males); n.a. (not acknowledged); RBMT (Rivermead Behavioural Memory Test); SD (standard deviation); TMT (Trail making Test); y(years).

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