This thesis investigates the long-term effects of awake glioma surgery in eloquent areas on cognition. The general assumption is that neurological recovery takes place within 3 months; no detailed cognitive follow-up studies have been conducted yet. Glioma patients (N=45) were tested pre- and postoperatively (3 months and 1 year) with a neuropsychological test-protocol assessing language, memory, attention and executive functions. Spontaneous speech was examined pre- and 3 months postoperatively as well as the relation of cognition and emotional factors on global quality of life (QoL). The influence of tumor- and treatment related factors on cognition was also investigated. Impairments were present in all cognitive domains on all test-moments. Permanent improvement postoperatively was found on a memory test. Language was the most sensitive domain for recovery. One language test deteriorated at short-term, and remained impaired at 1 year postoperatively. Two language tests improved between 3 months and 1 year. In addition to language tests, a spontaneous speech analysis was necessary to determine the quality of language production. A case study also underlined the importance of spontaneous speech monitoring intraoperatively to detect disturbances. Global QoL remained relatively stable, with depression as the only predictor for QoL change. Tumor- and treatment related factors were no clear risk-factors for cognitive change. Our results show that cognitive recovery takes longer than 3 months and that language, including spontaneous speech, is a crucial element of cognition to assess. Glioma surgery is possible without inducing major cognitive damage. Patients can be informed about the long-term cognitive prognosis.

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Keywords cognition, language, glioma surgery, eloquent areas, longitudinal follow-up study
Promotor C.M.F. Dirven (Clemens)
Publisher Erasmus University Rotterdam
Sponsor Financial support by the Stichting Afasie Nederland (SAN) and Erasmus University Rotterdam is gratefully acknowledged.
ISBN 978-90-5335-858-0
Persistent URL hdl.handle.net/1765/51531
Satoer, D.D. (2014, June 20). Speaking on the Edge: The protection of cognition after glioma surgery in eloquent areas. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/51531