Chinese Medical Journal 2011;124(17):2593-2598
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Original article Emotion and cognitive function assessment of patients with central neurocytoma resection through transcortical frontal approach: a 5-year postoperative follow-up study SHI Zhi-feng, SUN Da-liang, SONG Jian-ping, YAO Yu and MAO Ying Keywords: central neurocytoma; transcortical frontal approach; cognition; emotions; follow-up studies Background Central neurocytoma accounts for 0.1% of primary brain tumor that often occurs in young adults. Surgery is the main treatment for central neurocytoma and the rate of 5-year survival reaches up to over 90%. This study aimed to assess the effect of transcortical frontal approach to surgical resection of central neurocytoma on emotion and cognitive function 5 years after surgery. Methods Telephone following-up visits were used in this study. By means of neuropsychological testing, assayed emotion, memory and abstract thinking ability of 18 patients undergoing central neurocytoma resection by transcortical frontal approach for 5 years or more, with another 21 normal cases as control group were enrolled. The data were analyzed statistically by paired t test with SPSS11.5. Results Patients whose central neurocytoma was removed by transcortical frontal approach were not affected on calculating ability 5 years after operation while ability of memory declined sharply (P=0.000), the older, the more sharply (P=0.036). Ability of abstract thinking was significantly reduced (P=0.000), the older, the more significantly as well (P=0.012); additionally, anxiety and depression occurred in patients rather more than those of control group (P=0.000), especially cognitive impairment. Conclusions Transcortical frontal approach for surgical resection of central neurocytoma has certain long-term influence on patients’ life quality, vulnerable to anxiety, depression and cognitive impairment, the severity of which was correlated to age. Therefore, improving surgical approach will be of value for better long-term life quality of patients. Chin Med J 2011;124(17):2593-2598
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entral neurocytoma is a rare low-grade neoplasm of central nervous system, the first case of which was reported by Hassoun in 1982.1 With cases reported increasing, a total of over 400 cases have been reported by now. Central neurocytoma accounting for 0.1% of primary brain tumor often occurs in young adults with mean age being 20–30 years old and is not significantly different between male and female. Central neurocytoma often grows in ventricular system, especially at the level of foramen of Monro near septum pellucidum of lateral ventricular which serve as the evidence of its characteristic imaging diagnosis.1,2 Surgery is the main treatment for central neurocytoma and the rate of 5-year survival reaches up to over 90% if total removal. The effect of surgical treatment is more satisfying.3 Recently, more researches focused on neuropsychological dysfunction caused by brain tumor while neuropsychological function, as an important indicator for evaluating prognosis of brain tumor surgery, directly affects postoperative life quality of patients. Frontal lobe, as an important functional area in brain, affects human motion function, sensory function and linguistic function as well as plays a broad role in social learning, personality development and emotional control.4 As central neurocytoma grows in characteristic area, i.e. the area at the level of foramen of Monro near septum pellucidum of lateral ventricular, transcortical frontal
approach was commonly chosen. In such approach, the cortex was incised in front of coronal suture till to lateral ventricular for exposure of tumor. Although the operation easily leads to the damage to frontal cortex and white matter fibers, no neuropsychological assessment has been done to postoperative patients of central neurocytoma, especially to those long-term follow-up patients. This study aimed to assess neuropsychological function of patients undergoing central neurocytoma 5 years and more after surgery from four aspects including memory, calculating ability, executive ability and cognitive DOI: 10.3760/cma.j.issn.0366-6999.2011.17.006 Department of Neurosurgery (Shi ZF, Song JP, Yao Y and Mao Y), Department of Psychiatry (Sun DL), Huashan Hospital, Fudan University, Shanghai 200040, China Correspondence to: Dr. MAO Ying, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China (Tel: 86-21-62489999. Fax: 86-21-62492884. Email:
[email protected]) SHI Zhi-feng and SUN Da-liang contributed equally to this work. This work was supported by grants from the Project for Science and Technology Commission of Shanghai Municipality (No. 10JC1402200 and No. 08411953600), the Project for the National Science Foundation for Distinguished Young Scholars of China (No. 81025013), the Project for the National Natural Science Foundation of China (No. 30872655), the Project for National “985” Engineering of China, the “Dawn Tracking” Program of Shanghai Education Commission, China (No. 10GG01).
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function to receive data of long-term follow-up. METHODS Subjects Study group Selection criteria for study group were as follows: (1) primary central neurocytoma confirmed by pathological diagnosis; (2) undergoing surgical treatment before April 31, 2006; (3) no previous history of brain surgery, or severe psychiatric disorders; (4) operations being transcortical frontal approach and incision of frontal cortex, total resection of tumor under microscopic vision; (5) still alive and without recurrence of tumor before April 31, 2011, during which not treated by radiotherapy, chemotherapy, etc. (6) score of Mini-Mental State Examination (MMSE)
