Kognitiv funktion, livskvalitet och funktionella nätverk i hjärnan : före och efter gliomkirurgi

The aim of this thesis was to investigate how cognitive function and quality of life are affected by glioma surgery in the supplementary motor area (SMA) and the lower primary motor cortex (M1), as well as to explore possible changes in functional network connectivity after surgery in the SMA. Sixteen patients subject to resective neurosurgical procedures due to gliomas in either the SMA or the M1 were studied. Neuropsychological tests, Quality of Life (QoL) questionnaires and resting state functional magnetic imaging sequences were administered before surgery and at follow-up. Neuropsychological testing was also performed 1-2 days after SMA resection. SMA resections were associated with significant but transient impairments of cognitive control. However, subjective sense of volition and long-term perception of QoL remained intact. Changes in interhemispheric connectivity in the sensorimotor network after SMA resections were variable between patients and non-significant at the group level. Resections of the lower M1 were associated with a slight impairment of maximal speech speed but not with clinically significant declines in QoL or cognitive function.  Glioma resections in the SMA and lower M1 may affect aspects of cognitive and motor function. However, thanks to the brain’s capacity for functional reorganization and compensation this will typically not cause permanent and significant negative effects on cognitive function or QoL

Kognitiv funktion, livskvalitet och funktionella nätverk i hjärnan : före och efter gliomkirurgi

The aim of this thesis was to investigate how cognitive function and quality of life are affected by glioma surgery in the supplementary motor area (SMA) and the lower primary motor cortex (M1), as well as to explore possible changes in functional network connectivity after surgery in the SMA. Sixteen patients subject to resective neurosurgical procedures due to gliomas in either the SMA or the M1 were studied. Neuropsychological tests, Quality of Life (QoL) questionnaires and resting state functional magnetic imaging sequences were administered before surgery and at follow-up. Neuropsychological testing was also performed 1-2 days after SMA resection. SMA resections were associated with significant but transient impairments of cognitive control. However, subjective sense of volition and long-term perception of QoL remained intact. Changes in interhemispheric connectivity in the sensorimotor network after SMA resections were variable between patients and non-significant at the group level. Resections of the lower M1 were associated with a slight impairment of maximal speech speed but not with clinically significant declines in QoL or cognitive function.  Glioma resections in the SMA and lower M1 may affect aspects of cognitive and motor function. However, thanks to the brain’s capacity for functional reorganization and compensation this will typically not cause permanent and significant negative effects on cognitive function or QoL

Neuropsychological Function and Quality of Life after Resection of Suspected Lower-Grade Glioma in the Face Primary Motor Area

The negative side effects of neurosurgical resection of the lower third of the primary motor cortex (M1) are often described as relatively mild. However, detailed descriptions of how these resections affect neurocognitive function, speech, mental health and quality of life (QoL) are sparse. In the present study, seven patients with suspected lower-grade glioma (WHO II-III) in the inferior M1 were assessed for facial motor function, cognitive function, anxiety and QoL before and after awake surgical resections. The main finding was that after surgery, six of the seven patients experienced a mild facial motor dysfunction, mainly affecting the mouth, tongue and throat. At the group level, we were also able to observe a significant postoperative decline in maximum verbal speed, whereas no negative effects on measures of word production (i.e., verbal fluency) were seen. Self-reported QoL data suggest that some patients experienced increased social isolation postoperatively but do not lend support to the interpretation that this was caused by direct neurological side effects of the surgery. The results appear to support the general notion that awake surgery in the lower M1 can be performed safely and with postoperative deficits that are most often perceived by the patient as tolerable

Neuropsychological Function and Quality of Life after Resection of Suspected Lower-Grade Glioma in the Face Primary Motor Area

The negative side effects of neurosurgical resection of the lower third of the primary motor cortex (M1) are often described as relatively mild. However, detailed descriptions of how these resections affect neurocognitive function, speech, mental health and quality of life (QoL) are sparse. In the present study, seven patients with suspected lower-grade glioma (WHO II-III) in the inferior M1 were assessed for facial motor function, cognitive function, anxiety and QoL before and after awake surgical resections. The main finding was that after surgery, six of the seven patients experienced a mild facial motor dysfunction, mainly affecting the mouth, tongue and throat. At the group level, we were also able to observe a significant postoperative decline in maximum verbal speed, whereas no negative effects on measures of word production (i.e., verbal fluency) were seen. Self-reported QoL data suggest that some patients experienced increased social isolation postoperatively but do not lend support to the interpretation that this was caused by direct neurological side effects of the surgery. The results appear to support the general notion that awake surgery in the lower M1 can be performed safely and with postoperative deficits that are most often perceived by the patient as tolerable

Neuropsychological Function and Quality of Life after Resection of Suspected Lower-Grade Glioma in the FacePrimary Motor Area

The negative side effects of neurosurgical resection of the lower third of the primary motorcortex (M1) are often described as relatively mild. However, detailed descriptions of how theseresections affect neurocognitive function, speech, mental health and quality of life (QoL) are sparse. Inthe present study, seven patients with suspected lower-grade glioma (WHO II-III) in the inferior M1were assessed for facial motor function, cognitive function, anxiety and QoL before and after awakesurgical resections. The main finding was that after surgery, six of the seven patients experienced amild facial motor dysfunction, mainly affecting the mouth, tongue and throat. At the group level,we were also able to observe a significant postoperative decline in maximum verbal speed, whereasno negative effects on measures of word production (i.e., verbal fluency) were seen. Self-reportedQoL data suggest that some patients experienced increased social isolation postoperatively but donot lend support to the interpretation that this was caused by direct neurological side effects of thesurgery. The results appear to support the general notion that awake surgery in the lower M1 canbe performed safely and with postoperative deficits that are most often perceived by the patient astolerable

Phenomenology of glioma resection in the dorsal medial frontal cortex

BACKGROUND: During the latest decades the hypothesis that the subjective experience of free will is determined by preconscious activity in the dominant dorsal medial frontal cortex (dMFC) has repeatedly challenged our commonly held concepts of moral responsibility. AIMS OF THE STUDY: To investigate whether dMFC activity determines the sense of free will and to investigate effects of resections in this area on Quality of life (QoL). METHODS: A cohort of nine patients affected by transient declines in speech and movement skills after surgery involving the left dMFC answered questions about their postoperative, subjective experiences of volition in relation to symptoms. In eight cases resections were performed as part of glioma surgery and in the ninth case a meningioma adjacent to the dMFC was resected. In addition, a QoL questionnaire was administrated before and after surgery. RESULTS: None of the patients perceived the transient disabilities related to surgery as associated with a loss or absence of volition. No declines in QoL were detected after surgery. Two QoL domains showed improved function (motor dysfunction and future uncertainty). CONCLUSIONS:The subjective sense of volition is not contingent on dMFC activity. Surgical resections of this area are not typically associated with declines in QoL