A prospective study of cognitive functions following conventional radiotherapy for supratentorial gliomas in young adults: 4-year results.

PURPOSE: To evaluate the effects of limited field conventional cerebral radiotherapy (RT) on cognitive functions of adults. METHODS AND MATERIALS: A prospective neuropsychological study was performed on 17 patients who underwent conventional limited field RT for a low-grade glioma or for a good-prognosis anaplastic glioma. Results were compared with 14 control patients with low-grade gliomas who did not receive radiotherapy. RESULTS: A transient significant decrease of performances for the Reaction Time test was observed at 6 months in the irradiated group with return to baseline values 12 months post-RT. Subsequently, no other significant changes were observed over a 48-month follow-up period in the irradiated and nonirradiated groups. Nonetheless, when the scores of each patient were considered over time instead of the mean values of the group, one irradiated patient (5.8%) experienced progressive deterioration while two irradiated patients (11.7%) experienced long-lasting improvement. Individual changes did not occur in the control group. CONCLUSION: This study suggests that a transient early delayed drop of neuropsychological performances at 6 months is frequent following limited field conventional RT, but the risk of long-term cognitive dysfunction after irradiation is low, at least in the first 4 years after RT and when it is administered alone in young adults.

[Supratentorial gliomas: neuropsychological study of long-term survivors]. / Gliomes sus-tentoriels: étude neuropsychologique des survivants à long terme.

A battery of psychologic tests was administered to 32 patients, aged from 26 to 61 years, who had survived 2 years or more after treatment with surgery and radiotherapy for supratentorial gliomas (18 low grade and 14 high grade) without evidence of recurrent tumor on MRI. Two groups were identified. A first group of 17 patients had neuropsychologic scores similar to estimated premorbid level (group I). A second group of 15 patients had abnormal neuropsychologic scores, lower that their estimated premorbid level (group II). In comparison with "normal" patients, those with abnormal neuropsychologic scores were older at the time of treatment, had a lower post-operative Karnofski Performance Status, a longer delay between surgery and the date of the tests and more often had left sided lesions. Comparison of Karnofski Performance Status between the post-operative time point and the date of neuropsychological evaluation did not show a significant change over time in groups I and II except in 3 patients who experienced progressive deterioration. Vigorous treatment of gliomas with surgery, radiotherapy and sometimes chemotherapy does not induce a substantial cognitive dysfunction in about half of the long term survivors (53%). Cognitive dysfunction is identified in the other half that could be related to post-operative sequelae (due to the tumor itself or to surgery) and/or to radiotherapy- and chemotherapy-induced delayed toxicity.

[Functional prognosis in skull injuries with signs of axial damage. Value of the quality of the arousal phase (series of 80 cases)]. / Le pronostic fonctionnel du traumatisme crânien avec signes de souffrance axiale. Valeur de la qualité de la phase d'éveil (série de 80 cas).

In a series of 80 diffuse brain injuries with early clinical signs of brainstem dysfunction without shift of the midline on the first CT SCAN investigation; the authors have studied the time course of recovery. Among several neurological parameters, they have choosen two steps: first one the spontaneous opening of the eyes, which marks a restoration of vigilance, second one the capacity to execute simple commands which marks the end of unconsciousness). The duration of the period of recovery (delta) (between the eyes opening and the obays commands) was variable from 0 to 173 days. But it was a good statistic correlation (p less than 0,001) between the length of this period and the functional outcome at one year.

Functional recovery after surgical resection of low grade gliomas in eloquent brain: hypothesis of brain compensation.

OBJECTIVES: To describe functional recovery after surgical resection of low grade gliomas (LGG) in eloquent brain areas, and discuss the mechanisms of compensation. METHODS: Seventy-seven right-handed patients without deficit were operated on for a LGG invading primary and/or secondary sensorimotor and/or language areas, as shown anatomically by pre-operative MRI and intraoperatively by electrical brain stimulation and cortico-subcortical mapping. RESULTS: Tumours involved 31 supplementary motor areas, 28 insulas, 8 primary somatosensory areas, 4 primary motor areas, 4 Broca's areas, and 2 left temporal language areas. All patients had immediate post-operative deficits. Recovery occurred within 3 months in all except four cases (definitive morbidity: 5%). Ninety-two percent of the lesions were either totally or extensively resected on post-operative MRI. CONCLUSIONS: These findings suggest that spatio-temporal functional re-organisation is possible in peritumoural brain, and that the process is dynamic. The recruitment of compensatory areas with long term perilesional functional reshaping would explain why: before surgery, there is no clinical deficit despite the tumour growth in eloquent regions; immediately after surgery, the occurrence of a deficit, which could be due to the resection of invaded areas participating (but not essential) to the function; and why three months after surgery, almost complete recovery had occurred. This brain plasticity, which decreases the long term risk of surgical morbidity, may be used to extend the limits of surgery in eloquent areas.