INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #96 Neuropsychological Functioning and Reliable Change After Awake Craniotomy Holly Phelps, West Virginia University, School of Medicine, Morgantown, United States Brandon Hutson, West Virginia University, School of Medicine, Morgantown, United States Smita Bhatia, West Virginia University, School of Medicine, Morgantown, United States Hilary Clark, West Virginia University, School of Medicine, Morgantown, United States Sanjay Bhatia, West Virginia University, School of Medicine, Morgantown, United States Sonikpreet Aulakh, West Virginia University, School of Medicine, Morgantown, United States Robert Marsh, West Virginia University, School of Medicine, Morgantown, United States Jonathan Sherman, West Virginia University, School of Medicine, Morgantown, United States David Scarisbrick, West Virginia University, School of Medicine, Morgantown, United States Category: Other Keyword 1: neuropsychological assessment Keyword 2: brain tumor Keyword 3: neuro-oncology Objective: Awake craniotomies are often recommended when gliomas are located in eloquent areas (i.e., language or motor). Awake craniotomies are the gold standard in pursuing optimal onco-functional balance, or maximal extent of resection while retaining quality of life. Intra-operative functional mapping is a key component of awake craniotomies and assists with minimizing the risk of damage to eloquent areas. The current study investigated the extent of functional language changes after awake craniotomy by comparing pre-/post-resection neuropsychological assessment scores. Participants and Methods: Participants (n=8) were adults ages 18+ who underwent awake craniotomies for brain tumor resection with live surgical mapping and monitoring using NeuroMapper. They also completed pre/post-resection NP evaluations. Variables of interest included basic demographics (e.g., age, sex, education), tumor characteristics (e.g., area of brain affected, extent of resection [EOR], WHO tumor grade), and pre-/post-NP assessment data. Due to our small sample size and non-normality, we used related-samples Wilcoxon-signed rank tests to compare median values of pre/post-NP assessment raw and scaled scores to assess for language changes in our sample as a whole. We also examined individual changes in language performance using reliable change calculators accounting for practice effects. For exploratory purposes, difference score variables were created for each significant median change on pre/post-NP tests (difference score = T1 score – T2 score). Relationships were then investigated between difference scores and demographic information, tumor characteristics, and assessment data using Mann-Whitney U and Kruskal-Wallis tests for group comparisons, or Spearman’s rho correlations for scale variable relationships. Results: For WRAML Sentence Memory, the median Time 2 raw score (20.50) was significantly lower than the median Time 1 raw score (27.00; z = -2.32, p =.020), with a large effect size (r = -0.82). Exploratory analyses revealed no significant differences between groups (e.g., EOR) and WRAML raw score difference scores, or significant relationships between scale variables (e.g., age) and WRAML raw score difference scores. Significant positive and negative reliable changes were seen on multiple language-mediated tests, including HVLT-R Total and Delayed Recall; DKEFS Letter and Category Fluency and Switching Accuracy; and WRAML Sentence Memory. Other significant reliable changes included Digit Span Backwards and Sequencing; BVMT-R Total Recall and Delayed Recall; and TMT A & B. Conclusions: There were significant changes in patients’ language-mediated scores, both as a group using pre/post comparisons and individually using reliable change methods. Working memory skills may be more sensitive to decline after resection, as evidenced by our most notable finding of significant decline in WRAML Sentence Memory scores. Other research has also shown post-resection declines in working memory, with some evidence that these changes can improve over time. We also found significant reliable declines on other tests targeting working memory. Overall, working memory changes might be related to resection near white matter tracts implicated in both working memory and eloquent areas. Results of individual reliable change revealed that cognitive changes may go beyond both working memory and language-mediated abilities.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #96

Neuropsychological Functioning and Reliable Change After Awake Craniotomy

Holly Phelps, West Virginia University, School of Medicine, Morgantown, United States
Brandon Hutson, West Virginia University, School of Medicine, Morgantown, United States
Smita Bhatia, West Virginia University, School of Medicine, Morgantown, United States
Hilary Clark, West Virginia University, School of Medicine, Morgantown, United States
Sanjay Bhatia, West Virginia University, School of Medicine, Morgantown, United States
Sonikpreet Aulakh, West Virginia University, School of Medicine, Morgantown, United States
Robert Marsh, West Virginia University, School of Medicine, Morgantown, United States
Jonathan Sherman, West Virginia University, School of Medicine, Morgantown, United States
David Scarisbrick, West Virginia University, School of Medicine, Morgantown, United States

Category: Other

Keyword 1: neuropsychological assessment
Keyword 2: brain tumor
Keyword 3: neuro-oncology

Objective:

Awake craniotomies are often recommended when gliomas are located in eloquent areas (i.e., language or motor). Awake craniotomies are the gold standard in pursuing optimal onco-functional balance, or maximal extent of resection while retaining quality of life. Intra-operative functional mapping is a key component of awake craniotomies and assists with minimizing the risk of damage to eloquent areas. The current study investigated the extent of functional language changes after awake craniotomy by comparing pre-/post-resection neuropsychological assessment scores.

Participants and Methods:

Participants (n=8) were adults ages 18+ who underwent awake craniotomies for brain tumor resection with live surgical mapping and monitoring using NeuroMapper. They also completed pre/post-resection NP evaluations. Variables of interest included basic demographics (e.g., age, sex, education), tumor characteristics (e.g., area of brain affected, extent of resection [EOR], WHO tumor grade), and pre-/post-NP assessment data. Due to our small sample size and non-normality, we used related-samples Wilcoxon-signed rank tests to compare median values of pre/post-NP assessment raw and scaled scores to assess for language changes in our sample as a whole. We also examined individual changes in language performance using reliable change calculators accounting for practice effects. For exploratory purposes, difference score variables were created for each significant median change on pre/post-NP tests (difference score = T1 score – T2 score). Relationships were then investigated between difference scores and demographic information, tumor characteristics, and assessment data using Mann-Whitney U and Kruskal-Wallis tests for group comparisons, or Spearman’s rho correlations for scale variable relationships.

Results:

For WRAML Sentence Memory, the median Time 2 raw score (20.50) was significantly lower than the median Time 1 raw score (27.00; z = -2.32, p =.020), with a large effect size (r = -0.82). Exploratory analyses revealed no significant differences between groups (e.g., EOR) and WRAML raw score difference scores, or significant relationships between scale variables (e.g., age) and WRAML raw score difference scores. Significant positive and negative reliable changes were seen on multiple language-mediated tests, including HVLT-R Total and Delayed Recall; DKEFS Letter and Category Fluency and Switching Accuracy; and WRAML Sentence Memory. Other significant reliable changes included Digit Span Backwards and Sequencing; BVMT-R Total Recall and Delayed Recall; and TMT A & B.

Conclusions:

There were significant changes in patients’ language-mediated scores, both as a group using pre/post comparisons and individually using reliable change methods. Working memory skills may be more sensitive to decline after resection, as evidenced by our most notable finding of significant decline in WRAML Sentence Memory scores. Other research has also shown post-resection declines in working memory, with some evidence that these changes can improve over time. We also found significant reliable declines on other tests targeting working memory. Overall, working memory changes might be related to resection near white matter tracts implicated in both working memory and eloquent areas. Results of individual reliable change revealed that cognitive changes may go beyond both working memory and language-mediated abilities.