# Perioperative neurocognitive functioning in elderly patients undergoing awake craniotomy for high grade glioma

## TL;DR

This study examines neurocognitive outcomes in elderly patients undergoing awake craniotomy for brain tumors, finding that age and comorbidities do not worsen outcomes.

## Contribution

The study demonstrates that awake craniotomy is safe for elderly patients with high-grade gliomas, with neurocognitive decline not linked to age or comorbidities.

## Key findings

- Elderly patients with high-grade gliomas show similar baseline neurocognitive impairment rates as younger patients.
- Postoperative decline in verbal learning and memory is common but not associated with age or tumor volume.
- Awake craniotomy is relatively safe for elderly patients with eloquent gliomas.

## Abstract

Older patients may be at particular risk of decline in neurocognitive function (NCF) following brain tumor resection, particularly when tumors are near-eloquent regions.

We identified 95 patients of advanced age (≥60 years) with newly diagnosed, left hemisphere, high-grade eloquent glioma who underwent a first-time awake craniotomy for tumor resection. All patients had comprehensive neuropsychological evaluations preoperatively and a subset of patients (N = 45) completed postoperative assessment.

Median age at surgery was 66 years (range, 60-81) and tumors were most commonly located in the temporal (56%) and frontal (27%) lobes. Preoperatively, most patients exhibited NCF impairment on at least 1 neuropsychological test, most frequently in verbal learning (66%) and memory (71%). Localization in temporal regions conveyed greater impairment to memory, and patients with frontal tumors exhibited poorer executive functioning. Following awake resection, neurocognitive decline was most frequent in verbal learning (41%) and memory (38%). Postoperative change in neurocognitive performance was not associated with more advanced age, comorbidities, frailty, or tumor volume or extent of resection.

Advanced age, frailty, and medical comorbidities were not significantly associated with poorer NCF outcome. Postoperative decline was greatest when patients present with high levels of baseline functioning and tumors involve the mesial temporal lobe. Importantly, rates of baseline impairment and postoperative decline in this older age sample were similar to other cohorts, including younger patients and lower grade tumors. Findings support the relative safety of awake craniotomy for resection of eloquent glioma in advanced age individuals.