Early Neurocognitive Outcome Post Resection of Adult Supratentorial Gliomas at the Kenyatta National Hospital
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Date
2023Author
Mwangi, Jefferson W
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
Introduction: Gliomas are among the commonest primary brain tumors in our setting.
Despite significant advances in molecular diagnosis and elucidation of pathogenesis, the
prognosis remains poor especially for High grade gliomas. Maximal safe resection is the
first step in the multimodal management of gliomas. However, surgical resection is limited
by the lack of a clearly defined brain-tumor interface which is due to tumoral infiltration
beyond the radiologically defined boundaries. Traditionally, Overall Survival, progression
free survival and Extent of resection are used to define oncologic outcome in gliomas.
Oncologic outcome however, does not reflect the complete patient status and hence the need
for functional outcome determination. Cognitive outcome which is a key functional outcome
measure in gliomas is the subject of this study.
Study Design: Prospective Cohort Study.
Broad Objective: To determine the Early Neurocognitive outcome post resection of adult
supratentorial gliomas at the KNH. (Kenyatta National Hospital)
Study area: Neurosurgery Unit at the KNH. (Kenyatta National Hospital)
Study Population: Adult patients with supratentorial gliomas presenting to KNH.
(Kenyatta National Hospital)
Sample size: We examined twenty patients (20) with supratentorial gliomas who met the
inclusion criteria.
Data collection: An interviewer based questionnaire incorporating the ACE III
(Addenbrooke Cognitive Examination III ) Cognitive Assessment tool was administered at
three instances as follows:- Within two weeks Preoperatively (T0), at one week
postoperatively (T1) and at four weeks postoperatively (T2).
Data Analysis: Statistical Package for Social Sciences version 23.0 software was used for
analysis. The pre and post operative cognitive scores were then analyzed to determine the
cognitive outcome and presented as frequencies and proportions for categorical data or as
means with standard deviations for continuous data. The overall and domain specific early
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cognitive scores were analyzed and presented as frequencies, proportions and means with
standard deviation. The relationship between cognitive outcome and extent of resection as
well as that of the histologic subtype was assessed with the use of Fisher's Exact test.
Statistical significance was considered where the p-value was <0.05.
Results :- Ninety five percent (95 %) of patients had cognitive impairment at baseline. Mean
age of presentation was 34.3 years for LGG (Low grade glioma) and 43.8 years for HGG
(High Grade Glioma). 55% of patients had LGG while 45% had HGG. Overall, there was
transient decline in cognition from T0-T1 and a gradual improvement beyond the baseline
from T1-T2. This improvement was across all domains but was significant in the total ACE
score (P- value 0.025), memory (P -value 0.008) and fluency (P -value 0.001). LGG showed
the greatest improvement in cognition especially in the fluency domain (P- value 0.030).
Sixty percent (60 % )of the tumors were subtotally resected while 40 % were grossly
resected. The subtotally resected tumors showed significant cognitive change in the domains
of Attention (P-value 0.029), fluency (P-value 0.045) and Visuospatial association (P-value
0.017). Grossly resected tumors had a significant cognitive change in memory (P- value
0.046) and fluency (P- values 0.024).
Conclusion: Surgery for supratentorial gliomas results in a transient decline in cognition one
week postoperatively after which significant improvement in cognition beyond the baseline is
noted one month post operatively. The transient decline is likely due to the effects of surgery
on the tumor bed and the subcortical circuits while the improvement is likely due to enhanced
plasticity and reduction in mass effect from the tumor. LGG have the most significant
improvement in cognition especially in the domains of memory and fluency. Extent of
resection and histologic subtype likely have no significant effect on the change in total ACE
III cognitive scores at one month postoperatively.
Publisher
University of Nairobi
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Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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