Comparison of the Functional State and Motor Skills of Patients after Cerebral Hemisphere, Ventricular System, and Cerebellopontine Angle Tumor Surgery

Abstract

Brain tumor location is an important factor determining the functional state after brain tumor surgery. We assessed the functional state and course of rehabilitation of patients undergoing surgery for brain tumors and assessed the location-dependent risk of loss of basic motor skills and the time needed for improvement after surgery. There were 835 patients who underwent operations, and 139 (16.6%) required rehabilitation during the inpatient stay. Karnofsky Performance Scale, Barthel Index, and the modified Rankin scale were used to assess functional status, whereas Gait Index was used to assess gait efficiency. Motor skills, overall length of stay (LOS) in hospital, and LOS after surgery were recorded. Patients were classified into four groups: cerebral hemisphere (CH), ventricular system (VS), and cerebellopontine angle (CPA) tumors; and a control group not requiring rehabilitation. VS tumor patients had the lowest scores in all domains compared with the other groups before surgery (p < 0.001). Their performance further deteriorated after surgery and by the day of discharge. They most often required long-lasting postoperative rehabilitation and had the longest LOS (35 days). Operation was most often required for CH tumors (77.7%), and all metrics and LOS parameters were better in these patients (p < 0.001). Patients with CPA tumors had the best outcomes (p < 0.001). Most patients (83.4%) with brain tumors did not require specialized rehabilitation, and LOS after surgery in the control group was on average 5.1 days after surgery. VS tumor patients represent a rehabilitation challenge. Postoperative rehabilitation planning must take the tumor site and preoperative condition into account.

Rehabilitation Outcomes for Patients with Motor Deficits after Initial and Repeat Brain Tumor Surgery

“…We used three commonly used assessment scales: the Barthel index (BI), the Karnofsky performance status scale (KPS), and the modified Rankin scale (MRS). We also assessed gait efficiency with the gait index (GI) [ 21 ] because gait re-education is often the main goal of postoperative rehabilitation. Prior to surgery, there were large intergroup differences in gait efficiency (according to the GI index) and the percentage of patients who could walk independently.…”

“…Despite improvements, only half of the repeat surgery group were able to walk independently, as assessed by the GI scale, while in the first surgery group, 60.2% of participants were able to walk independently with orthopedic aids. There are some data suggesting that active sitting, standing, and independent gait have prognostic value and are strongly correlated with ADL [ 21 ]. Patients who can sit without support soon perform better in ADL [ 34 , 71 ], and standing greatly increases participation in ADL [ 43 ].…”

“…Speed of gait is a known survival factor in patients with brain tumors [ 72 ]. Average LOS values did not differ significantly between groups 18 days in the repeat surgery group and 16.5 days in the first surgery group, over three times longer than LOS after surgery in patients not requiring rehabilitation (5.1 days) [ 21 ].…”

“…Gait efficiency was assessed with the 10-point gait index (GI). On the GI scale, 10 equals correct independent gait, and 1 equals impossible to achieve an upright vertical position; a score of 1–4 means the patient does not walk, 5–6 that the patient walks with the assistance of another person, 7–8 that the patient walks independently with orthopedic equipment, and 9–10 the patient walks on their own [ 21 ]. Patients were assessed with all four scales prior to surgery, immediately after surgery, and upon discharge.…”

“…Frequently used criteria for evaluating the effectiveness of both surgical and adjuvant treatment are the assessment of performance and functional status. While several studies have evaluated the function and mental status of patients with primary brain tumors [ 8 , 21 ], few have evaluated these parameters in patients with recurrent tumors and after reoperation [ 22 , 23 , 24 ]. Of these, most data are on patients with glioblastomas, who often require early reoperation [ 6 , 7 , 11 , 12 , 25 , 26 , 27 , 28 , 29 ].…”