Recurrent Low-Grade Gliomas: Does Reoperation Affect Neurocognitive Functioning?

BACKGROUND:Reoperations in patients with recurrent low-grade gliomas (RLGG) were proposed to control tumor residual and delay the risk of malignant transformation over time.OBJECTIVE:To investigate neurocognitive outcomes in patients with RLGG who underwent a second surgery with awake monitoring.METHODS:In this retrospective study, patients who underwent a second awake surgery for RLGG were included. Patients had presurgical and 3-mo postsurgical neuropsychological assessments. Data were converted into Z-scores and combined by the cognitive domain. Number of patients with cognitive deficits (Z-score <-1.65), variations of Z-scores, and extent of resection (EOR) were analyzed.RESULTS:Sixty-two patients were included (mean age: 41.2 +/- 10.0 yr). None had permanent neurological deficits postoperatively. Eight patients (12.9%) had a cognitive deficit preoperatively. Four additional patients (6.5%) had a cognitive deficit 3 mo after reoperation. Among other patients, 13 (21.0%) had a mild decline without cognitive deficits while 29 (46.8%) had no change of their performances and 8 (12.9%) improved. Overall, 94.2% of the patients returned to work. There were no correlations between EOR and Z-scores. Total/subtotal resections were achieved in 91.9% of the patients (mean residual: 3.1 cm(3)). Fifty-eight patients (93.5%) were still alive after an overall follow-up of 8.3 yr.CONCLUSION:Reoperation with awake monitoring in patients with RLGG was compatible with an early recovery of neuropsychological abilities. Four patients (6.5%) presented a new cognitive deficit at 3 mo postoperatively. Total/subtotal resections were achieved in most patients. Based on these favorable outcomes, reoperation should be considered in a more systematic way.

Automated summary

The study showed that reoperation with awake monitoring in RLGG patients can lead to early recovery of neurocognitive abilities, with most patients experiencing no permanent neurological deficits postoperatively. However, 6.5% of patients developed new cognitive deficits at 3 months postoperatively. Most patients achieved total/subtotal resections, indicating favorable outcomes for reoperation in RLGG patients.