The Effect of Brain Tumor Extent of Resection on Postoperative Cognition

Introduction: Postoperative cognitive dysfunction (POCD) has been reported following surgical interventions and leads to impaired patient quality of life and worse prognosis. It remains unknown where the extent of resection, though positively correlated with increased survival, has an effect on patient’s postoperative cognition. Resection of the contrast enhancing (CE) and non contrast enhancing (NCE) tumor regions has been shown to improve the overall survival of patients, but the impact of resection on cognitive task performance remains poorly understood. The objective of this study is to understand the relationship between brain tumor extent of resection and post-operative cognitive dysfunction in patients with brain cancer.

Methods: A retrospective analysis of patients with supratentorial primary brain tumors who underwent resection at UCSF between 2012 – 2021 (n = 104). Cognitive function was evaluated using a validated neurocognitive battery: McGurk speech perception, Stroop like attention task, and the Quick Aphasia Battery. To assess the effect of extent of resection on postoperative cognition, we performed a linear regression analysis comparing both contrast enhancing (CE) and non-contrast enhancing (NCE) extent or resection and their relation to the change between their preoperative and postoperative cognition scores at 1 month.

Results: Linear regression analysis demonstrated a positive correlation between extent of resection of CE tumor and postoperative cognitive performance in all 3 measures of cognition at 1 month. Further linear regression analysis of extent of resection of NCE tumor and postoperative cognitive performance in all 3 measures at 1 month did not demonstrate any correlations.

Conclusion : These results suggest that larger extent of resection of the CE region of brain tumors may be associated with improved cognitive outcomes at 1 month.