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oai:www.repository.cam.ac.uk:1810/3898402025-10-08T01:41:17Zcom_1810_221925com_1810_34581col_1810_224160

WHAT IS THE EFFECT OF GLIOBLASTOMA SURGERY ON COGNITION AND QUALITY OF LIFE? https://doi.org/10.17863/CAM.121609 Wan, Yizhou 0000000231668711 Price, Stephen Cognitive and visual impairments are common in glioblastoma patients. Unlike motor and language function, vision and cognition do not have established intraoperative testing paradigms. It is unclear how tumours and surgery affect postoperative cognition and vision. This thesis investigates the effects of the tumour and surgery on presurgical and postsurgical cognition and vision with structural and diffusion MRI. We also investigated the impact of cognition and visual impairment on health-related quality of life in the early postoperative timepoint, prior to further oncological treatment. The following findings are discussed in this thesis: 1. The main predictor of postoperative cognition was preoperative cognitive score in that domain. Cognitive impairment was associated with reduced Global health status. Resection surgery was not associated with cognitive impairment but was associated with higher self- reported Motor and Communication deficit. 2. Age (log(OR): 0.01 [0.01, 0.21], p = 0.039), Steroid dose (log(OR): -0.24 [-0.49, 0.00], p = 0.048), right sided tumours (log(OR): -2.1 [-4.1, -0.09], p = 0.040) and MGMT unmethylated tumours (log(OR): 2.3 [0.71, 3.9], p = 0.004) were significantly associated with postoperative VF deficit. Tumours in the left temporo-parietal junction impacting the left optic radiations was associated with preoperative visual field (VF) deficit. Microstructural integrity in bilateral white matter tracts was associated with early postoperative deficits. Left sided tracts 18 impacted included the optic radiation, SLF and sagittal stratum. Right sided tracts impacted included the anterior and posterior limbs of the internal capsule and SLF. Apart from self-reported cognitive functioning (-9.8 [95% CI: -18, 0.07], p = 0.039), VF deficit was not significantly associated with any other HRQOL domain measured using the EORTC QLQ-30 and BN-20 and the NEI-VFQ25. 3. Preoperative and postoperative Attention impairment were associated with tumours affecting the white matter in proximity to the right caudate head and increased streamline density in the right frontal lobe tracts, including the superior corona radiata, SLF, external capsule, anterior limb of internal capsule, genu and body of the corpus callosum. Changes in diffusion microstructure metrics in these tracts associated with both preoperative and postoperative Attention impairment. Resection of tumours located in the left middle temporal gyrus, impacting the left posterior thalamic radiation and optic radiation were associated with worse postoperative Executive function. Multiple tracts in the left temporo-parietal junction exhibited changes in microstructural metrics associated with early postoperative impairment in Executive function. Late postoperative impairment was associated with more extensive bilateral tracts including the splenium of corpus callosum and white matter of the bilateral frontal lobes. Preoperative spatial function impairment was associated with tumours centred within the splenium of the corpus callosum, left posterior thalamic radiation, including the optic radiation and left tapetum. Postoperative spatial function impairment was associated with microstructural changes in the white matter in both temporal lobes and left frontal lobe. University of Cambridge 2025-03-19 Thesis Doctoral Doctor of Philosophy (PhD) eng CRUK Clinical Research Fellowship RCS and Brain Research UK Clinical Research Fellowship https://www.repository.cam.ac.uk/handle/1810/389840 embargo 2026-10-07 https://www.repository.cam.ac.uk/bitstreams/04f33855-d341-4aaa-97cb-ae0d81339e6f/download c5cf57412bd1f4097800c13bb4aa7e62 https://www.repository.cam.ac.uk/bitstreams/03b21eda-56dd-4fcf-9c57-7644277b40b6/download 87eda9de84448d1f82354d60eee3eb5f http://purl.org/NET/rdflicense/allrightsreserved brain tumours glioblastoma neuroimaging surgery cognition vision