Neuropsychological functioning following surgery for pediatric low-grade glioma: a prospective longitudinal study.
Neuropsychological functioning following surgery for pediatric low-grade glioma: a prospective longitudinal study.
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DOI：
10.3171/2019.9.peds19357
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发表时间：
2020-03-01
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高存活率导致越来越重视诊断为低级别胶质瘤的儿童的功能结局。大多数结果研究都集中在与放疗相关的风险上，但对单独接受手术治疗的患者的神经心理风险知之甚少。在这里，作者试图检查诊断为低级别胶质瘤的儿童的神经心理轨迹，并在术后监测长达6年。其次，他们探索了神经心理表现的人口学和临床预测因素。32例患者（诊断时中位年龄10.0岁）的神经心理功能在手术后长达6年的时间内每年进行前瞻性评估（基线时距手术的中位天数= 72）。肿瘤位置以幕上为主（65.6%）。结合基于表现和家长报告的测量方法来评估所有患者的智力、记忆、执行功能和精细运动控制。术后基线的二项检验显示，在言语记忆、处理速度、执行功能和精细运动控制方面，低于平均范围（< 16百分位数）的儿童比例显著高于健康同龄人的预期比例（p < 0.05）。即便如此，线性混合模型表明，术后基线的神经心理功能在术后6年内没有显著变化。肿瘤大小越大，反应时间越慢（p < 0.01）。幕上肿瘤的位置和癫痫发作史与父母报告的执行困难相关（p < 0.01）。虽然放疗是儿童脑肿瘤患者神经心理缺陷的已知危险因素，但本研究的结果表明，仅通过手术（不进行放疗或化疗）治疗低级别胶质瘤的儿童仍然容易出现记忆、执行功能和运动功能方面的困难，这种困难会持续一段时间。在研究样本中，超过一半的孩子需要学校的支持服务来解决神经心理上的弱点。虽然低级别胶质瘤通常被认为是一种良性肿瘤，但治疗这种病变的儿童需要持续的监测和干预，以解决由肿瘤本身和手术引起的神经心理弱点。
High survival rates have led to an increased emphasis on the functional outcomes of children diagnosed with low-grade glioma. Most outcomes research has focused on risks associated with radiotherapy, but less is known about neuropsychological risks for patients treated with surgery alone. Here, the authors sought to examine the neuropsychological trajectories of children diagnosed with a low-grade glioma and monitored up to 6 years postsurgery. Secondarily, they explored demographic and clinical predictors of neuropsychological performance. The neuropsychological functioning of 32 patients (median age at diagnosis 10.0 years) was prospectively assessed annually for up to 6 years after surgery (median days from surgery at baseline = 72). Tumor location was predominately supratentorial (65.6%). A combination of performance-based and parent-reported measures was used to assess intelligence, memory, executive functioning, and fine motor control in all patients. Binomial tests at the postoperative baseline revealed that the proportion of children falling below the average range (< 16th percentile) was significantly higher than the rate expected among healthy peers on measures of verbal memory, processing speed, executive functioning, and fine motor control (p < 0.05). Even so, linear mixed models indicated that neuropsychological functioning at the postoperative baseline did not significantly change over time for up to 6 years after surgery across all domains. A larger tumor size was associated with a slower reaction time (p < 0.01). A supratentorial tumor location and history of seizures were associated with more parent-reported executive difficulties (p < 0.01). While radiotherapy is a known risk factor for neuropsychological deficits in pediatric brain tumor patients, findings in this study indicate that children treated for low-grade glioma with surgery alone (without radiotherapy or chemotherapy) remain susceptible to difficulties with memory, executive functioning, and motor functioning that persist over time. Over half of the children in the study sample required school support services to address neuropsychological weaknesses. Although low-grade glioma is often conceptualized as a benign tumor, children treated for this lesion require ongoing monitoring and intervention to address neuropsychological weaknesses resulting from the tumor itself as well as the surgery.