The impact of transsphenoidal surgery on neurocognitive function: A systematic review

Adnan Alsumali; David J Cote; Quentin R Regestein; Erin Crocker; Abdulaziz Alzarea; Hasan A Zaidi; Wenya Linda Bi; Hassan Y Dawood; Marike L Broekman; Martine J E van Zandvoort; Rania A Mekary; Timothy R Smith

doi:10.1016/j.jocn.2017.01.015

The impact of transsphenoidal surgery on neurocognitive function: A systematic review

J Clin Neurosci. 2017 Aug:42:1-6. doi: 10.1016/j.jocn.2017.01.015. Epub 2017 Feb 16.

Authors

Affiliations

¹ MCPHS University, 179 Longwood Ave., Boston, MA, USA.
² Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA. Electronic address: david_cote@hms.harvard.edu.
³ Department of Psychiatry, Brigham and Women's Hospital, 1249 Boylston St., Boston, MA 02215, USA.
⁴ Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.
⁵ Department of Neurosurgery, University Medical Centre, Utrecht, The Netherlands.
⁶ Department of Neurosurgery, University Medical Centre, Utrecht, The Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
⁷ MCPHS University, 179 Longwood Ave., Boston, MA, USA; Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.

PMID: 28215426
DOI: 10.1016/j.jocn.2017.01.015

Abstract

Background: Cognitive impairment following transsphenoidal surgery (TSS) among patients with pituitary tumors has been intermittently reported and is not well established. We performed a systematic review to summarize the impact of TSS on cognitive function.

Methods: We conducted a systematic search of the literature using the PubMed, Cochrane, and Embase databases through October 2014. Studies were selected if they reported cognitive status after surgery and included at least 10 adult patients with pituitary tumors undergoing either endoscopic or microscopic TSS.

Results: After removing 69 duplicates, 758 articles were identified, of which 24 were selected for full text review after screening titles and abstracts. After reviewing full texts, nine studies with a combined total of 682 patients were included in the final analysis. Eight studies were cross-sectional and one was longitudinal. These studies used a wide variety of neurocognitive tests to assess memory, attention and executive function post-operatively. Of the eight studies, six reported impairments in verbal and non-verbal memory post-operatively, while others found no association related to memory, and some reported an improvement in episodic, verbal, or logical memory. While four studies found an impaired association between TSS and attention or executive function, another four studies did not.

Conclusion: The current literature on cognitive impairments after TSS is limited and inconsistent. This review demonstrates that patients undergoing TSS may experience a variety of effects on executive function and memory post-operatively, but changes in verbal memory are most common.

Keywords: Neurocognitive function; Pituitary tumors; Transsphenoidal surgery.

Publication types

Review
Systematic Review

MeSH terms

Adenoma / surgery*
Attention
Cognition Disorders / epidemiology
Cognition Disorders / etiology*
Cognition*
Humans
Memory
Neurosurgical Procedures / adverse effects*
Neurosurgical Procedures / methods
Pituitary Neoplasms / surgery*
Postoperative Complications / epidemiology*
Verbal Behavior