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Establishing valid neuropsychological assessments in patients with gliomas undergoing awake surgery

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Becker, J. (2017). Establishing valid neuropsychological assessments in patients with gliomas undergoing awake surgery. PhD Thesis, Christian-Albrechts-University, Kiel, Germany.

Cite as: https://hdl.handle.net/21.11116/0000-0004-8F51-0
The present work highlights various requirements for neuropsychological assessment in the context of glioma patients undergoing awake craniotomy. The first study assessed the validity of the Brief Cognitive Status Exam (BCSE) compared to already established cognitive screening instruments such as Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in patients with intracranial tumors. For screening purposes, the MoCA turned out to be the best available tool, in clinical as well as research settings. However, a comprehensive neuropsychological test battery could not be replaced by any screening tool. Beside a differentiated cognitive performance profile, a test battery in particular provides additional information on a patient’s eligibility for an awake craniotomy and information for individual composition of intraoperative tasks. The second study outlined the lack of a standardized tools for sensory-motor assessment in awake craniotomies. In consequence, the “Sensory-Motor Profile - awake“ (SPM-a) was introduced as a feasible tool for pre-, intra- and postoperative assessment. Its validation with other scales for sensory and motor assessment as well as evaluation of its reliability are goals for future multicenter studies. The case report of a highgrade glioma in a patient with a congenital absent hemisphere illustrated the large potential of the human brain for neuroplasticity. Neuroplasticity can be considered as key concept in the context of awake craniotomy determining multiple medical decisions. The results of the presented studies are integrated into a comprehensive model of neuropsychological assessment for glioma patients with the goal to outline the concept of a personalized therapeutic management of these patients. Long-term objective is an improvement of the neuropsychological information supply for medical decision making, and in particular the improvement of the protocol for awake surgeries.