# Perioperative neuropsychological assessment reveals dynamic changes in neurocognitive function following brain tumor surgery

## TL;DR

This study examines how brain tumor surgery affects cognitive functions, finding that some abilities worsen while others improve, with awake craniotomy helping reduce cognitive decline.

## Contribution

The study reveals dynamic changes in neurocognitive function after brain tumor surgery and highlights the benefits of awake craniotomy.

## Key findings

- Most cognitive domains worsened post-surgery, except memory which improved.
- Awake craniotomy was associated with less cognitive decline compared to general anesthesia.
- Visuomotor speed was most affected by subtotal tumor resection.

## Abstract

Research has shown that patients with primary brain tumours have baseline neurocognitive deficits.

In the present study, we sought to explore the impact of surgical intervention as it is not adequately understood.

Patients with intra-axial tumours undergoing surgery were perioperatively evaluated using a comprehensive neuropsychological battery on domains of Attention and Executive Function, memory, Language, Visuomotor Speed and Visuospatial ability. Assessments were done at baseline and post-operatively around 1 month after the surgery before starting any adjuvant treatment (n = 66).

Excluding memory, all domains showed an increased number of patients with severe deficits post-operatively, though the percentage of patients with overall severe deficits decreased. Memory domain was thought to have the most improvement while visuomotor speed had the highest worsening. Patients who underwent craniotomies under general anaesthesia had significant worsening in the memory domain and had an overall trend for worsening across all domains post-op in comparison to those who underwent awake craniotomies. Visuomotor speed was affected by subtotal resection. Tumour lateralisation to the right influenced performance in the visuospatial domain.

There is significant neurocognitive dysfunction in patients with PBTs in the perioperative period with many dynamic changes in the post-operative performance as compared to the baseline. Awake craniotomy can mitigate some of this decline. Detailed cognitive assessments serially performed over the course of treatment is essential to unearth the evolving changes in neurocognition and customise interventions.

•Neurocognition is very often affected in brain tumours.•We assessed neurocognition before and after brain tumor surgery in 66 cases.•Significant dynamic changes in neurocognition were observed (both improvements and worsening).•Individual domain changes were seen even when overall group assessments appeared unchanged.•Awake craniotomy had a favourable outcome with lesser cognitive decline postoperatively.

Neurocognition is very often affected in brain tumours.

We assessed neurocognition before and after brain tumor surgery in 66 cases.

Significant dynamic changes in neurocognition were observed (both improvements and worsening).

Individual domain changes were seen even when overall group assessments appeared unchanged.

Awake craniotomy had a favourable outcome with lesser cognitive decline postoperatively.