Reversibility of Cognitive and Psychiatric Impairments Following Surgical Resection of Frontotemporal Meningiomas: A Predictive Factor Analysis

Reversibility of Cognitive and Psychiatric Impairments Following Surgical Resection of Frontotemporal Meningiomas: A Predictive Factor Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reversibility of Cognitive and Psychiatric Impairments Following Surgical Resection of Frontotemporal Meningiomas: A Predictive Factor Analysis Kahyen Ko, Yoo-Jin Park, Kihwan Hwang, Yong Ho Park, Na-Young Ryu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8915545/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Cognitive and psychiatric impairments are common in patients with frontotemporal meningiomas. While meningiomas are often histologically benign, they can cause significant morbidity through mass effect and peritumoral edema. Compared to gliomas, the reversibility of these impairments following surgical resection is relatively under-investigated. This study aimed to evaluate postoperative neuropsychological changes and identify tumor-related prognostic factors in patients with frontotemporal meningiomas. Methods We retrospectively reviewed 29 patients who underwent surgical resection for frontotemporal meningiomas and completed both pre- and post-operative neuropsychological assessments (Neurooncologic Psychological Test [NOPT], Seoul Neuropsychological Screening Battery–II [SNSB-II], or Bundang Neuropsychological Testing Protocol–M1 [BNTP-M1]). Multivariable linear regression analysis was performed using Δ change scores (postoperative minus preoperative) to identify independent radiologic predictors for recovery in each domain. Results Postoperatively, patients demonstrated significant improvements across all tested domains: attention (p = 0.002), language (p = 0.041), memory (p < 0.001), visuospatial function (p = 0.024), executive function (p < 0.001), and psychiatric symptoms (p = 0.043). Multivariable analysis identified several domain-specific predictors for functional recovery. The presence of mass effect independently predicted greater postoperative gains in attention (β = 1.10, p = 0.020), whereas frontal lobe involvement was a negative predictor for language improvement (β=-2.97, p = 0.004). Regarding executive function, convexity origin was associated with diminished recovery in Stroop test performance (β=-27.42, p = 0.050), while a higher edema index significantly predicted better recovery in the COWAT scores (β = 2.52, p = 0.020). Notably, frontal base origin emerged as a strong negative predictor for psychiatric recovery (β=−14.91, p = 0.005), suggesting more persistent emotional dysfunction in these patients. Conclusions Neuropsychological impairments in frontotemporal meningioma patients are substantially reversible following surgical decompression. Recovery trajectories are highly dependent on tumor-related factors such as mass effect, edema, and anatomical origin. These findings support early surgical intervention and underscore the need for tailored rehabilitation strategies based on preoperative radiologic characteristics. Meningioma Frontal lobe Temporal lobe Neuropsychological tests Cognitive recovery Figures Figure 1 Figure 2 Figure 3 Introduction Meningiomas are the second most common primary brain tumors in adults, accounting for approximately 35% of all primary central nervous system (CNS) neoplasms [ 1 ]. They represent nearly 15% of all intracranial tumors and 25% of intraspinal tumors [ 1 ]. Although mostly benign, meningiomas can lead to substantial neurocognitive and psychiatric disturbances owing to mass effects on adjacent brain structures [ 2 ], particularly when involving the frontal or temporal lobes, which are essential for cognitive and emotional functions [ 2 ]. Patients with frontotemporal meningiomas frequently present with cognitive deficits, including impaired memory, attention, and executive function, as well as psychiatric symptoms, such as depression and anxiety [ 3 – 6 ]. Although meningiomas are often histologically benign, the impact of their location and size on the surrounding brain tissue should not be underestimated. In the frontal or temporal lobes, they can disrupt brain function through a direct mass effect on adjacent tissue and peritumoral edema, leading to neurocognitive deficits and psychiatric symptoms [ 7 ]. These neurological sequelae can persist even after surgical resection, potentially affecting patients' quality of life, social reintegration, and return to work. However, the "benign" label often assigned to meningiomas can lead to underestimation of these non-oncological morbidities, including cognitive and emotional problems, which have historically received less research attention compared to other CNS neoplasms [ 7 ]. Consequently, studies specifically addressing subjective cognitive complaints and long-term functional outcomes in patients with meningioma remain scarce [ 8 ]. These neuropsychological impairments can substantially reduce patients’ quality of life, affecting employment, social interactions, and independent daily functioning. In working-age adults, even mild cognitive or psychiatric symptoms may delay return to work or cause occupational disabilities. Moreover, persistent mood disturbances, such as apathy, irritability, or depression, may be misattributed to personality or aging rather than recognized as tumor-related. Despite their clinical relevance, these outcomes are often underappreciated because most meningiomas are histologically benign. Cognitive dysfunction in patients with brain tumors has been extensively studied in gliomas [ 6 ]; however, fewer studies have examined neuropsychological outcomes specific to meningiomas, resulting in a notable gap in the literature. Psychiatric symptoms associated with meningiomas are also less frequently documented and often limited to case reports or small case series, restricting the generalizability of the findings on cognitive and emotional disturbances [ 9 – 12 ]. This study aimed to identify prognostic factors associated with neuropsychological dysfunction in patients with meningioma using domain-specific neuropsychological assessments conducted before and after surgery. By focusing on memory, executive function, and psychiatric symptoms, it sought to clarify the cognitive and emotional effects of meningiomas and provide insights to improve clinical management of these impairments. Methods Patient Selection A retrospective review was conducted on all patients with meningioma who underwent surgical resection at Seoul National University Bundang Hospital between January 2003 and December 2023 (N = 1,528). Of these, 505 were excluded because their tumors did not involve the frontal or temporal lobes. The remaining 1,023 patients with meningiomas involving the frontal, temporal lobes, or both were screened for eligibility. Further inclusion required completion of both pre- and postoperative neuropsychological examinations, which were available for 31 patients (3.0%). Two patients were excluded because of postoperative complications, including hydrocephalus (n = 1) and incomplete tumor resection (n = 1), resulting in a final cohort of 29 patients who underwent gross total resection (GTR) and completed paired neuropsychological assessments (Figure 1). All the included patients had histopathologically confirmed meningiomas, comprising 18 WHO grade I and 11 WHO grade II tumors. Educational attainment, defined as the total number of years of formal education, was self-reported during the preoperative neuropsychological assessment. Demographic, clinical, radiologic, and operative data were retrospectively obtained from the institutional electronic medical records (EMR) for comprehensive analysis. Patient Demographics and Clinical Data Collection Demographic and clinical information were obtained retrospectively from the EMR, including age, sex, years of education, hand dexterity, tumor laterality, dominant hemisphere, and preoperative neurological status. Hand dominance was defined according to the preferred hand used for fine motor tasks. The dominant hemisphere was determined based on handedness, language assessment, and clinical evaluation, where applicable. Additional clinical parameters, including prior treatment, postoperative adjuvant therapy, and the interval between pre- and postoperative neuropsychological evaluations, were recorded (Table 1). Magnetic Resonance Imaging (MRI) Evaluation All patients underwent preoperative MRI within 24 h before surgery using a navigation-ready protocol, including contrast-enhanced T1-weighted thin-section and T2-weighted sequences. MRI was used to determine tumor-originating dura (anterior falx, frontal base, convexity, parasagittal ridge, or sphenoid ridge), laterality (right, left, or bilateral), lobar involvement (frontal, temporal, or frontotemporal), and multiplicity. The tumor and peritumoral edema volumes were measured on contrast-enhanced T1-weighted and T2-weighted images, respectively, using 3D Slicer (version 5.2). Regions of interest were manually segmented on consecutive axial slices, and the volumes of the tumor, edema, and their sum were automatically calculated. Peritumoral edema was quantified using the Edema Index (EI) = (V_tumor + V_edema) / V_tumor – 1 and categorized as none (EI ≈ 0), mild (EI 2) according to established grading systems [13-15]. The distribution of edema severity in this cohort mirrored that shown in Table 1 (none, 6.9%; mild, 31.0%; moderate, 24.1%; and severe, 37.9%). Postoperative MRI was performed within 48 h of surgery using an identical protocol. Residual contrast enhancement was compared with the operative notes to determine the extent of resection (EOR), which was classified volumetrically as follows: GTR: > 95% tumor removal Near-total resection (NTR): 90–95% removal Subtotal resection (STR): 50–90% removal Partial resection (PR): < 50% removal [16] These MRI-based parameters were incorporated into analyses of tumor characteristics, peritumoral edema, and treatment outcomes. Mass effect was defined as radiological evidence of brain compression, including sulcal effacement, ventricular compression, midline shift > 5 mm, or herniation, reflecting mechanical distortion of adjacent brain tissue rather than isolated intracranial hypertension. Neuropsychological Examinations Comprehensive neuropsychological testing was performed before and after surgery to assess attention, language, memory, visuospatial ability, executive function, and psychiatric status. Cognitive impairment occurs most frequently in patients with frontal or temporal meningiomas, which are critical for memory, attention, and emotional regulation [2]. All patients completed one of three validated test batteries: the Neurooncological Psychological Test (NOPT), Seoul Neuropsychological Screening Battery–II (SNSB-II), or Bundang Neuropsychological Testing Protocol–M1 (BNTP-M1). Selection depended on the referring department (neurology, psychiatry, or neurosurgery); however, as all three departments assessed the same cognitive and psychiatric domains, test type was not considered in the analysis [17,18]. Each participant underwent a structured, comprehensive evaluation of cognitive and emotional functions routinely used for individualized treatment planning and rehabilitation [2]. Standard subtests included [13, 14,19-23]: Attention: Digit Span (forward or backward), Trail Making Test–A [19] Language and related function: Korean Boston Naming Test (S-K-BNT) [20] Memory: Seoul Verbal Learning Test (immediate or delayed recall), Rey–Osterrieth Complex Figure Test (delayed recall) [20,23] Visuospatial function: Rey–Osterrieth Complex Figure Test (copy) [20,23] Executive function: Stroop Color–Word Test, Controlled Oral Word Association Test (COWAT; verbal fluency) [20] Psychiatric status: Korean Neuropsychiatric Inventory [21,22] Among the 29 patients, 27 completed NOPT and 2 completed SNSB-II preoperatively; postoperatively, 2 completed BNTP-M1 and 2 completed SNSB-II. Despite procedural differences, all batteries assessed the same domains, allowing direct comparison. Testing was conducted a median of 7 days before surgery (interquartile range [IQR] 3–16) and 182 days after surgery (IQR 90–361). Relative to MRI, testing was performed a median of 5 days before imaging (IQR 1.75–24.25). These consistent intervals minimized timing bias. Statistical Analysis Statistical analyses were performed using IBM SPSS Statistics (version 21.0; IBM Corp., Armonk, NY, USA) and R (version 4.3.2; R Foundation for Statistical Computing, Vienna, Austria). Continuous variables are presented as mean ± standard deviation or median with IQR, as appropriate, and categorical variables as frequencies and percentages. For neuropsychological outcomes, preoperative and postoperative scores were compared using paired t-tests (two-tailed), given that the measurements were continuous and repeated within the same participants. Chi-square tests are not applicable to paired continuous data. For regression analyses, the Δ-value (postoperative minus preoperative) for each neuropsychological domain was used as the dependent variable. Candidate predictors (p < 0.10) were identified using univariate linear regression and then entered into multivariate linear regression models to determine the independent associations. Age and years of education were included as prespecified covariates in all models. Radiological parameters included tumor volume, EI, mass effect (defined as sulcal effacement, ventricular compression, midline shift > 5 mm, or herniation), lobar involvement, and dural origin. Model fit was assessed using the adjusted R², residual independence with the Durbin–Watson statistic, and multicollinearity with the variance inflation factor (VIF), with VIF > 5 indicating substantial multicollinearity. All statistical tests were two-sided, and significance was defined as p < 0.05. Results Patient Demographics and Tumor Characteristics Among the 1,528 patients with meningioma who underwent surgery during the study period, 29 met all the inclusion criteria (Figure 1). The cohort was predominantly female (79.3%, n = 23), with a mean age of 61.0 ± 9.4 years and a mean educational attainment of 12.4 ± 4.7 years. Tumor distribution and radiologic features are summarized in Table 1. Most lesions were located in the frontal lobe (75.8%), followed by the temporal (13.8%) and frontotemporal (6.9%) regions. The most frequent sites of origin were the convexity (37.9%), anterior falx (31.0%), and frontal base (24.1%). Lateralization analysis revealed right-sided tumors in 51.7% of patients, left-sided tumors in 41.4%, and bilateral involvement in 6.9%. Based on hand dexterity, 55.2% of tumors involved the dominant hemisphere. The mean tumor volume was 72.7 ± 55.2 cm³, with median edema volume of 50.9 cm³ (IQR 28.2–60.0) and combined tumor + edema volume of 123.6 cm³ (IQR 91.6–171.4). A midline shift > 5 mm or mass effect was present in 69.0% of patients (n = 20). Peritumoral edema severity, graded by the EI, was 6.9%, 31.0%, 24.1%, and 37.9 %, respectively. GTR was achieved in 41.4% of patients, NTR in 31.0%, STR in 20.7%, and PR in 6.9% [16]. Neuropsychological assessments were performed a median of 7 days before and 182 days after surgery, consistent with the study design. Effect of Surgical Treatment on Cognitive and Psychiatric Outcomes Higher scores indicated better performance in all cognitive domains (attention, language, memory, visuospatial ability, and executive function), whereas higher scores on the psychiatric scale indicated more severe neuropsychiatric symptoms. Postoperative neuropsychological testing demonstrated significant improvement across all six cognitive and psychiatric domains compared to the preoperative performance (Table 2, Figure 2). The most pronounced gains were observed in memory, executive function, and attention, while language and visuospatial abilities showed significant improvements. Psychiatric symptom scores markedly reduced after surgery, indicating a substantial alleviation of emotional and behavioral disturbances. Collectively, these findings suggest that surgical resection is associated with broad cognitive and emotional recovery, with the greatest benefits in higher-order cognitive functions. The consistent direction of change across all domains supports the notion that tumor-related neuropsychological dysfunction is, to a large extent, reversible following the decompression and resolution of peritumoral edema. Prognostic Factors for Neuropsychological Outcomes Linear regression analyses used Δ (postoperative minus preoperative) change scores for each cognitive and psychiatric domain as dependent variables (Table 3). To identify independent predictors, multivariate linear regression models were constructed for each outcome domain. Age and years of education were included as prespecified covariates in all models, given their well-established influence on neuropsychological performance. Radiologic parameters (including tumor volume, EI, mass effect, lobar involvement, and dural origin) were screened in univariate analyses, and only variables associated with the respective Δ score at p < 0.10 were retained as candidate predictors for the multivariable models. The final multivariable models were built using backward elimination (p < 0.05 for retention), and the results are presented as unstandardized regression coefficients (B) with corresponding p-values. Attention In this cohort, mass effect was defined as radiological evidence of brain compression, including sulcal effacement, ventricular compression, midline shift > 5 mm, or herniation, reflecting mechanical distortion of adjacent brain tissue rather than isolated intracranial hypertension. The presence of mass effect independently predicted greater improvement in attention (B = 1.10, p = 0.02), suggesting that attentional deficits are largely attributable to the reversible compression of the frontal or frontotemporal networks, with functional recovery following surgical decompression. The model’s adjusted R² was 0.22 and Durbin–Watson was 2.04, indicating acceptable model fit and absence of serial correlation. Language Function Frontal lobe involvement was significantly associated with poorer postoperative language improvement (β = –2.97, p = 0.004), consistent with the known localization of expressive language networks. Model adequacy was confirmed by adjusted R² = 0.34 and Durbin–Watson = 2.23. Executive Function For Stroop test performance, tumors originating from the convexity showed less improvement (β = –27.42, p = 0.05). In the COWAT (animal fluency) assessment, a higher EI was associated with improved recovery outcomes (β = 2.52, p = 0.02), indicating the potential reversibility of edema-related executive dysfunction [7,12, 15,16,24]. Adjusted R² values were 0.17 and 0.13, respectively, and VIF values < 2 excluded multicollinearity. Psychiatric Status Tumors located at the frontal base were associated with significantly reduced postoperative improvement in psychiatric symptoms (β = −14.91, p = 0.005), indicating that patients with frontal base meningiomas showed less reduction in depression- or anxiety-related scores after surgery than those whose tumors originated elsewhere. These findings suggest that disruption of the orbitofrontal-limbic circuits by frontal base meningiomas may impede emotional recovery, even after tumor resection. The model demonstrated a good fit (adjusted R² = 0.24, Durbin–Watson test = 1.55). Illustrative Case A 58-year-old woman presented with progressive cognitive decline and depression. Preoperative MRI revealed a 7-cm anterior-falx meningioma with marked peritumoral edema (Figure 3A–B). The patient underwent gross total tumor resection, and follow-up imaging demonstrated resolution of the edema. Comprehensive pre- and postoperative neuropsychological assessments showed substantial improvement across all domains, and her depressive symptoms had completely resolved at 6-month follow-up, illustrating the potential reversibility of tumor-related neuropsychological impairments after surgical decompression. Discussion In this single-center retrospective cohort of patients with frontotemporal meningiomas who completed paired neuropsychological testing, we found significant postoperative improvements across all six cognitive and psychiatric domains, including attention, language, memory, visuospatial ability, executive function, and psychiatric symptoms, in within-participant comparisons. Using Δ change scores (post – pre) as outcomes, multivariable linear regression identified mass effect as a predictor of greater attentional recovery; frontal lobe involvement as a negative predictor of language recovery; convexity origin as a negative predictor of Stroop improvement; frontal-base origin as a negative predictor of psychiatric recovery; and a higher EI as a positive predictor of executive recovery. Taken together, these results provide objective evidence beyond the clinical impression that neuropsychological dysfunction in meningioma is frequently reversible after surgical decompression and delineate domain-specific prognostic factors based on MRI-derived pathology. Importantly, we quantified these effects using validated domain-structured batteries (NOPT, SNSB-II, BNTP-M1) rather than anecdotal observations, thereby addressing a long-standing gap in the literature on meningioma and cognition [2,9-12,17-23]. Meningioma and Cognition: Context and Contribution Although meningiomas are often histologically benign, they can cause substantial cognitive and psychiatric morbidity through mass effect, edema, and network disruption, particularly when located in the frontal or temporal lobes [2,4,11,12,25]. Prior neuro-oncology studies on cognition have focused disproportionately on gliomas (6), whereas the pattern and magnitude of cognitive recovery in meningiomas remain less consistently characterized and are often based on small, non-standardized series [9-12]. By restricting the cohort to frontotemporal tumors, employing paired, domain-specific assessments, and linking outcomes to quantitative MRI features (volumes, EI, and EOR), our study clarifies which domains improve after surgery and why, while providing testable, anatomically plausible hypotheses for patient counseling and rehabilitation planning [2,9-23]. Interpretation of Domain-Specific Predictors Attention and mass effect. The independent association between mass effect and greater attentional improvement suggests that attentional deficits in frontotemporal meningiomas are frequently compression-driven and reversible with decompression, consistent with a mechanistic link between relief of local mass effect and restoration of fronto-subcortical attentional networks. Patients with clear mass effect (sulcal or ventricular compression, midline shift > 5 mm) are likely to experience marked postoperative gains in attention, supporting early surgical intervention in such cases. Language and frontal involvement. Frontal lobe involvement predicted less improvement in postoperative language function, consistent with the role of frontal regions in expressive language. This finding underscores the importance of careful preoperative mapping and surgical precision for frontal lobe meningiomas, particularly in areas critical for language production. Executive function and edema. A higher EI predicts better executive recovery, consistent with reversible, edema-related dysfunction, rather than irreversible parenchymal damage [12-15,24]. These findings align with prior work showing the variable cognitive impact of edema and support edema-mitigation strategies (e.g., corticosteroids or anti-inflammatory approaches) in selected cases [26-29]. Clinically, patients with prominent peritumoral edema may be particularly good candidates for surgical decompression, with expectations of substantial postoperative improvement in executive and attentional domains. Psychiatric outcomes and frontal-base origin. Among tumor-related factors, frontal-based origin independently predicted a smaller degree of postoperative improvement in psychiatric symptoms. This finding likely reflects the involvement of the orbitofrontal–limbic network, which regulates mood regulation, motivation, and social cognition. Even after decompression, microstructural or network-level disruptions in these regions may persist, limiting full emotional recovery. Accordingly, patients with frontal-based meningiomas may benefit from early psychiatric co-management and integrated emotional rehabilitation, in addition to cognitive therapy. These findings underscore that tumor origin, not just volume or edema, can influence domain-specific trajectories of recovery, particularly in the affective and behavioral domains. Role of Age and Cognitive Reserve Older age is linked to an increased vulnerability to executive and memory dysfunction in neuro-oncology, likely reflecting lower cognitive reserves and reduced plasticity [24,30,31]. In our cohort, age and years of education were not significant independent predictors of postoperative neuropsychological recovery in multivariable models. This finding suggests that in frontotemporal meningiomas, the anatomical characteristics of the tumor (location, mass effect, edema, and origin site) may play a more decisive role for functional recovery than demographic or educational factors. This pattern supports the concept that meningioma-related deficits are largely driven by reversible mechanical and edematous effects that can be substantially alleviated by surgical decompression. Therefore, even older patients or those with lower educational attainment can achieve meaningful cognitive and emotional recovery when the tumor is amenable to GTR, reinforcing the rationale for timely surgical intervention. Clinical Implications First, routine pre- and postoperative domain-specific neuropsychological screening should be integrated into the care pathway for frontotemporal meningioma using validated batteries available across departments (NOPT, SNSB-II, BNTP-M1) [17-20]. Second, MRI-derived markers (mass effect, EI, frontal involvement, and tumor origin) can enhance preoperative counseling, set realistic domain-specific expectations, and guide targeted rehabilitation. For example, patients with a clear mass effect or high EI can be counseled that a marked improvement in attention and executive function is likely after surgical decompression. For tumors involving the frontal lobe, especially in eloquent areas, functional mapping and precision surgery should be emphasized to optimize language outcomes. For frontal-base meningiomas, early psychiatric involvement and structured emotional rehabilitation should be considered, given the limited recovery of psychiatric symptoms. Third, early edema control (e.g., perioperative steroids, when appropriate) may augment recovery in the executive and attention domains, particularly in patients with a high EI [13-15,26-29]. Finally, documenting paired changes using standardized tools facilitates objective follow-up and timely referral for cognitive or psychiatric rehabilitation, enabling personalized domain-specific rehabilitation planning. Strengths and Limitations Strengths include a paired within-participant design, standardized domain assessments, precise MRI quantification (contrast-enhanced T1 for tumor, T2 for edema, 3D Slicer volumetry), a priori Δ-based outcomes, and predefined regression diagnostics (adjusted R², Durbin–Watson statistic, VIF). Limitations include the small, single-center sample (n = 29), potential selection bias (only patients able to complete paired testing), heterogeneity of test batteries across departments (mitigated by domain parity) [17-20], and lack of neurodegenerative biomarkers (e.g., medial temporal atrophy rating and amyloid positron emission tomography) that might clarify comorbid age-related processes [26,32]. The follow-up interval (median, 182 days) may not capture longer-term trajectories or the effects of adjunct treatments between tests, which, although infrequent, could confound recovery in a minority of patients (Table 1). Future Directions Prospective, multicenter studies using harmonized neuropsychological batteries, longer follow-up periods, and the integration of advanced imaging (diffusion or perfusion, connectomics) and neurodegenerative markers are warranted [13-16,26-29,32]. Interventional studies testing domain-targeted cognitive rehabilitation and edema-modulating strategies could determine causality and optimize outcomes. Finally, combining MRI features with baseline neuropsychological data to build predictive models may enable personalized counseling and rehabilitation planning at the point of care. Conclusion This study demonstrated that cognitive and psychiatric impairments in patients with frontotemporal meningiomas are largely reversible following surgical resection. Domain-specific neuropsychological assessments revealed significant postoperative improvements in attention, memory, language, visuospatial ability, executive function, and psychiatric symptoms. Tumor-related factors, particularly mass effect, frontal lobe involvement, and frontal-base origin, are key determinants of recovery trajectories, underscoring the importance of anatomical location and mechanical compression in neuropsychological outcomes. These findings support early neuropsychological screening, individualized surgical planning, and multidisciplinary rehabilitation tailored to tumor location and affected domains. Abbreviations BNTP-M1: Bundang Neuropsychological Testing Protocol–M1 CNS: Central nervous system COWAT: Controlled Oral Word Association Test EI: Edema Index EMR: Electronic medical records EOR: Extent of resection GTR: Gross total resection IQR: Interquartile range KHIDI: Korea Health Industry Development Institute K-NPI: Korean Neuropsychiatric Inventory MRI: Magnetic resonance imaging NOPT: Neurooncological Psychological Test NTR: Near-total resection PET: Positron emission tomography PR: Partial resection SNSB-II: Seoul Neuropsychological Screening Battery–II STR: Subtotal resection VIF: Variance inflation factor Declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board of Seoul National University Bundang Hospital (No. [##-###]). The requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of the study. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to patient privacy restrictions but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) and funded by the Ministry of Health and Welfare, Republic of Korea (grant number: RS-2023-KH136120). Authors' contributions KHK wrote the main manuscript text. YJP contributed to data collection. KH and CYK supervised the study and reviewed the manuscript. All authors read and approved the final manuscript. Acknowledgement Not applicable. 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Neurobiol Aging. 2017;60:164-72. Zacharaki EI, Wang S, Chawla S, et al. The role of peritumoral edema in brain tumor segmentation in MR images: evaluation of a generative model. AJNR Am J Neuroradiol. 2008;29:1053-62. Jain R, Scarpace L, Ellika S, et al. Peritumoral brain edema: a volumetric analysis of glioblastoma multiforme. AJNR Am J Neuroradiol. 2007;28:1870-4. Ho ML, Rojas R, Eisenberg RL. Cerebral edema. AJR Am J Roentgenol. 2012;199:W258–73. doi:10.2214/AJR.11.8081. Armstrong CL, Morrow L. Handbook of Medical Neuropsychology: Applications of Cognitive Neuroscience. New York, NY: Springer; 2010. Stern Y. Cognitive reserve. Neuropsychologia. 2009;47:2015-28. Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, et al. Atrophy of medial temporal lobes on MRI in “probable” Alzheimer’s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry. 1992;55:967-72. Tables Table 1. Baseline Demographic and Tumor Characteristics of Patients with Frontotemporal Meningiomas Characteristic Patient No. (%) Patient demographics Total patients 29 Female 23 (79.3%) Male 6 (20.7%) Age, mean ± SD (years) 61.0 ± 9.4 Years of education, mean ± SD (years) 12.4 ± 4.7 Tumor Characteristics Lateralization Left 12 (41.4%) Right 15 (51.7%) Bilateral 2 (6.9%) Dominant hemisphere † Nondominant 13 (44.8%) Dominant 16 (55.2%) Location Frontal 23 (75.8%) Temporal 4 (13.8%) Frontotemporal 2 (6.9%) Site of origin Anterior falx 9 (31.0%) Frontal base 7 (24.1%) Convexity 11 (37.9%) Parasagittal 1 (3.4%) Sphenoid 1 (3.4%) Tumor volume, mean ± SD (cm³) 72.7 ± 55.2 Peritumoral edema volume, median (IQR) (cm³) 50.9 (28.2–60.0) Tumor + Edema volume, median (IQR) (cm³) 123.6 (91.6–171.4) Midline shift/mass effect § Present 20 (69.0%) Absent 9 (31.0%) Edema Index ‡ No 2 (6.9%) Mild 9 (31.0%) Moderate 7 (24.1%) Severe 11 (37.9%) Treatment-Related Characteristics of the Patients Extent of Resection Gross total resection (GTR): > 95% removal (Simpson grade I–II) 12 (41.4%) Near-total resection (NTR): 90–95% removal (Simpson grade III) 9 (31.0%) Subtotal resection (STR): 50–90% removal (Simpson grade IV) 6 (20.7%) Partial resection (PR): < 50% removal (Simpson grade V) 2 (6.9%) Additional Treatment Between Neuropsychological Assessments None 23 (79.3%) Radiotherapy (RTx) 5 (17.2%) Gamma knife surgery 2 (6.9%) Re-excision 1 (3.4%) † Dominant hemisphere determination based on hand dominance. ‡ Edema Index (EI) = (V₍tumor+edema₎ / V₍tumor₎) − 1; equivalent to V₍edema₎ / V₍tumor₎; categorized as none (≈ 0), mild ( 2). §Mass effect was defined as radiological evidence of brain compression, including sulcal effacement, ventricular compression, midline shift of > 5 mm, or herniation. Table 2. Cognitive and Psychiatric Outcomes Before and After Surgery Domain Pre-op Mean (SD) Post-op Mean (SD) p-value Attention 3.45 (± 0.82) 4.21 (± 0.97) 0.002** Language 11.03 (± 1.32) 11.86 (± 1.40) 0.041* Memory 3.59 (± 1.10) 6.17 (± 1.32) 0.000*** Visuospatial 30.16 (± 2.01) 31.54 (± 2.34) 0.024* Executive function (Stroop Test) 58.61 (± 6.92) 87.29 (± 8.11) 0.000*** Executive function (CW Task) 7.91 (± 1.78) 11.97 (± 2.10) 0.000*** Psychiatric symptoms 6.00 (± 1.50) 1.67 (± 0.95) 0.043* This table illustrates the statistically significant improvements observed in cognitive function and psychiatric symptoms following surgical treatment, with marked differences in several key domains. In all cognitive domains, higher scores indicate better performance, whereas for psychiatric symptoms, higher scores indicate more severe psychopathology; thus, postoperative increases in cognitive scores and decreases in psychiatric symptom scores consistently reflect clinical improvement. p < 0.05 indicates statistical significance (*). p < 0.01 indicates high significance (**). p < 0.001 indicated very high significance (***). Table 3. Linear Regression Analysis of Tumor Characteristics, Edema Severity, and Improvement in Cognitive and Psychiatric Functions Predictor Variables Attention Language Function Executive function§ Executive function|| Psychiatric status Age .02 (.40) -.05 (.22) .81 (.26) .05 (.66) .06 (.78) Education .02 (.64) -.06 (.43) -.73 (.65) .23 (.32) -.29 (.49) Edema Index† .33 (.18) .73 (.06) 12.82 (.08) 2.52 (.02*) - Mass Effect‡ 1.10 (.02*) - - - - Frontal lobe involvement - -2.97 (.004**) - - - Convexity origin - - -27.42 (.05*) - - Frontal base origin - - - - -14.91 (.005**) Constant -2.15 -0.36 -28.38 -7.28 -1.53 Model Summary R2 (adj. R2) .33 (.22) .43 (.34) .30 (.17) .23 (.13) .34 (.24) Durbin–Watson 2.04 2.23 1.90 1.87 1.55 VIF range 1.11 0.90–1.00 1.01–1.19 1.01–1.11 1.01–1.04 Note: Values are presented as the unstandardized regression coefficient B, followed by the p-values in parentheses. Bold text indicates statistical significance (*p < 0.05 indicates statistical significance, **p < 0.01 indicates highly significantce; ***p < 0.001 indicates very highly significantce). Hyphen (-) denotes variables that were not included in the final multivariable model. The Memory and Visuospatial domains were excluded from this table, as the multivariable analysis identified no significant independent predictors for these outcomes. † Edema Index (EI) = (V₍tumor+edema₎ / V₍tumor₎) − 1; equivalent to V₍edema₎ / V₍tumor₎; categorized as none (≈0), mild (2). ‡ Mass effect: Mass effect was defined as radiological evidence of brain compression, including sulcal effacement, ventricular compression, midline shift > 5 mm, or herniation, and was treated as a binary variable (present vs. absent). § Executive function—Stroop test. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviews received at journal 16 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers agreed at journal 02 Mar, 2026 Reviews received at journal 28 Feb, 2026 Reviewers agreed at journal 28 Feb, 2026 Reviewers invited by journal 23 Feb, 2026 Editor invited by journal 22 Feb, 2026 Editor assigned by journal 19 Feb, 2026 Submission checks completed at journal 19 Feb, 2026 First submitted to journal 19 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8915545","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595861954,"identity":"713c71ec-17e5-4ae3-9d64-b0ff412c5cb8","order_by":0,"name":"Kahyen Ko","email":"","orcid":"","institution":"Seoul National University Bundang Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kahyen","middleName":"","lastName":"Ko","suffix":""},{"id":595861957,"identity":"f37d6f34-879d-47c5-9eda-591d8199a5a7","order_by":1,"name":"Yoo-Jin Park","email":"","orcid":"","institution":"Seoul National University","correspondingAuthor":false,"prefix":"","firstName":"Yoo-Jin","middleName":"","lastName":"Park","suffix":""},{"id":595861960,"identity":"c8654680-3cab-49b3-8134-3daf6ca9df35","order_by":2,"name":"Kihwan Hwang","email":"","orcid":"","institution":"Seoul National University Bundang Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kihwan","middleName":"","lastName":"Hwang","suffix":""},{"id":595861963,"identity":"3788bf64-7c41-4de1-8bc3-2b87132bde1e","order_by":3,"name":"Yong Ho Park","email":"","orcid":"","institution":"Seoul National University Bundang Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"Ho","lastName":"Park","suffix":""},{"id":595861968,"identity":"be0a0db3-fa23-4ce3-8f7c-e3a330d4e66b","order_by":4,"name":"Na-Young Ryu","email":"","orcid":"","institution":"Seoul National University Bundang Hospital","correspondingAuthor":false,"prefix":"","firstName":"Na-Young","middleName":"","lastName":"Ryu","suffix":""},{"id":595861975,"identity":"b1eb4777-4f52-4d4b-b04f-7ee709618e5c","order_by":5,"name":"Min Jae Baek","email":"","orcid":"","institution":"Seoul National University Bundang Hospital","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"Jae","lastName":"Baek","suffix":""},{"id":595861977,"identity":"252f20ef-ba1d-4c22-82d6-08659d25884b","order_by":6,"name":"Jung Ho Han","email":"","orcid":"","institution":"Seoul National University Bundang Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jung","middleName":"Ho","lastName":"Han","suffix":""},{"id":595861978,"identity":"938d7aa6-3f4f-4f3d-8cf5-297769621917","order_by":7,"name":"Sang-Yun Kim","email":"","orcid":"","institution":"Seoul National University Bundang Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sang-Yun","middleName":"","lastName":"Kim","suffix":""},{"id":595861979,"identity":"eb34ad68-eee7-47b8-993f-f4158a8e1fa1","order_by":8,"name":"Chae-Yong Kim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYDACCSjNjy5AWItkA8laDA4Qq4V/dvPDxzwVd+w2nz97TIKhxo5BcvYB/Fok7hwzNuY58yx52428NAmGY8kM0nwJ+LUYSCSYSfO2HU42u8FjJsHAdoBBjoeAwwwk0r//Bmkx7j8D1PKPKC05ZsxALXYGDDlmEoxtBxikCWmRuJFTLDnnzOEEIMPYIrEvmUeyh4AW/hnpGz+8qThsz99/xvDGh292chJnCGgBASagUxIbQKwEBgZCzoIAxh8MDPZEqRwFo2AUjIKRCQBlPDv/6G9X2AAAAABJRU5ErkJggg==","orcid":"","institution":"Seoul National University Bundang Hospital","correspondingAuthor":true,"prefix":"","firstName":"Chae-Yong","middleName":"","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2026-02-19 08:39:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8915545/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8915545/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103567828,"identity":"7cd599ec-3fd0-4f62-866b-0be535f56e7e","added_by":"auto","created_at":"2026-02-27 07:35:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":144017,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow Diagram of Patient Selection for the Study Cohort\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis flowchart illustrates the inclusion and exclusion process from the initial 1,528 patients who underwent surgical treatment for meningiomas to the final 29 patients with frontotemporal involvement who completed both pre- and postoperative neuropsychological evaluations.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8915545/v1/b1633c2b88e4991796e70a13.png"},{"id":104398294,"identity":"cdd2c0f0-8282-409b-9149-f1a36b7806d2","added_by":"auto","created_at":"2026-03-11 12:01:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":80042,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMean Differences in Cognitive Function and Psychiatric Symptoms Before and After Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis bar graph illustrates the mean differences in cognitive function and psychiatric symptoms between preoperative (black bars) and postoperative (white bars) evaluations, as detailed in Table 2. Each cognitive domain showed a statistically significant difference based on paired t-tests. Black bars = pre-OP; white bars = post-OP.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8915545/v1/03531c56004a0c2df9a57dea.png"},{"id":104399320,"identity":"73223873-ebab-4b23-82a5-01d400600892","added_by":"auto","created_at":"2026-03-11 12:05:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":255299,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRepresentative Case Showing Pre- and Postoperative MRI and Neuropsychological Recovery.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Preoperative gadolinium‑enhanced T1‑weighted MRI demonstrating a large frontal meningioma with marked contrast enhancement and a significant mass effect on adjacent brain tissue. ​\u003c/p\u003e\n\u003cp\u003e(B) Preoperative T2‑weighted MRI showing extensive peritumoral edema surrounding the tumor, consistent with compression of the frontotemporal networks, followed by postoperative imaging at 6 months, confirming gross total resection and near-complete edema resolution. ​\u003c/p\u003e\n\u003cp\u003e(C) Neuropsychological scores across all cognitive (attention, language, memory, visuospatial ability, and executive function) and psychiatric domains show marked postoperative improvement, illustrating the broad reversibility of tumor-induced neuropsychological deficits after surgical decompression.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8915545/v1/abc0a5d17f156dfee3964e72.png"},{"id":104407667,"identity":"b3e0135c-94ba-4836-88f5-9bd27983f36c","added_by":"auto","created_at":"2026-03-11 12:39:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1960234,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8915545/v1/148184c1-5bc5-4546-8e5b-45e6e690fabb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reversibility of Cognitive and Psychiatric Impairments Following Surgical Resection of Frontotemporal Meningiomas: A Predictive Factor Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMeningiomas are the second most common primary brain tumors in adults, accounting for approximately 35% of all primary central nervous system (CNS) neoplasms [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. They represent nearly 15% of all intracranial tumors and 25% of intraspinal tumors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although mostly benign, meningiomas can lead to substantial neurocognitive and psychiatric disturbances owing to mass effects on adjacent brain structures [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], particularly when involving the frontal or temporal lobes, which are essential for cognitive and emotional functions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with frontotemporal meningiomas frequently present with cognitive deficits, including impaired memory, attention, and executive function, as well as psychiatric symptoms, such as depression and anxiety [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although meningiomas are often histologically benign, the impact of their location and size on the surrounding brain tissue should not be underestimated. In the frontal or temporal lobes, they can disrupt brain function through a direct mass effect on adjacent tissue and peritumoral edema, leading to neurocognitive deficits and psychiatric symptoms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These neurological sequelae can persist even after surgical resection, potentially affecting patients' quality of life, social reintegration, and return to work. However, the \"benign\" label often assigned to meningiomas can lead to underestimation of these non-oncological morbidities, including cognitive and emotional problems, which have historically received less research attention compared to other CNS neoplasms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Consequently, studies specifically addressing subjective cognitive complaints and long-term functional outcomes in patients with meningioma remain scarce [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese neuropsychological impairments can substantially reduce patients\u0026rsquo; quality of life, affecting employment, social interactions, and independent daily functioning. In working-age adults, even mild cognitive or psychiatric symptoms may delay return to work or cause occupational disabilities. Moreover, persistent mood disturbances, such as apathy, irritability, or depression, may be misattributed to personality or aging rather than recognized as tumor-related. Despite their clinical relevance, these outcomes are often underappreciated because most meningiomas are histologically benign.\u003c/p\u003e \u003cp\u003eCognitive dysfunction in patients with brain tumors has been extensively studied in gliomas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]; however, fewer studies have examined neuropsychological outcomes specific to meningiomas, resulting in a notable gap in the literature. Psychiatric symptoms associated with meningiomas are also less frequently documented and often limited to case reports or small case series, restricting the generalizability of the findings on cognitive and emotional disturbances [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aimed to identify prognostic factors associated with neuropsychological dysfunction in patients with meningioma using domain-specific neuropsychological assessments conducted before and after surgery. By focusing on memory, executive function, and psychiatric symptoms, it sought to clarify the cognitive and emotional effects of meningiomas and provide insights to improve clinical management of these impairments.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003ePatient Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective review was conducted on all patients with meningioma who underwent surgical resection at Seoul National University Bundang Hospital between January 2003 and December 2023 (N = 1,528). Of these, 505 were excluded because their tumors did not involve the frontal or temporal lobes. The remaining 1,023 patients with meningiomas involving the frontal, temporal lobes, or both were screened for eligibility.\u003c/p\u003e\n\u003cp\u003eFurther inclusion required completion of both pre- and postoperative neuropsychological examinations, which were available for 31 patients (3.0%). Two patients were excluded because of postoperative complications, including hydrocephalus (n = 1) and incomplete tumor resection (n = 1), resulting in a final cohort of 29 patients who underwent gross total resection (GTR) and completed paired neuropsychological assessments (Figure 1).\u003c/p\u003e\n\u003cp\u003eAll the included patients had histopathologically confirmed meningiomas, comprising 18 WHO grade I and 11 WHO grade II tumors. Educational attainment, defined as the total number of years of formal education, was self-reported during the preoperative neuropsychological assessment. Demographic, clinical, radiologic, and operative data were retrospectively obtained from the institutional electronic medical records (EMR) for comprehensive analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Demographics and Clinical Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic and clinical information were obtained retrospectively from the EMR, including age, sex, years of education, hand dexterity, tumor laterality, dominant hemisphere, and preoperative neurological status. Hand dominance was defined according to the preferred hand used for fine motor tasks. The dominant hemisphere was determined based on handedness, language assessment, and clinical evaluation, where applicable. Additional clinical parameters, including prior treatment, postoperative adjuvant therapy, and the interval between pre- and postoperative neuropsychological evaluations, were recorded (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMagnetic Resonance Imaging (MRI) Evaluation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent preoperative MRI within 24 h before surgery using a navigation-ready protocol, including contrast-enhanced T1-weighted thin-section and T2-weighted sequences. MRI was used to determine tumor-originating dura (anterior falx, frontal base, convexity, parasagittal ridge, or sphenoid ridge), laterality (right, left, or bilateral), lobar involvement (frontal, temporal, or frontotemporal), and multiplicity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe tumor and peritumoral edema volumes were measured on contrast-enhanced T1-weighted and T2-weighted images, respectively, using 3D Slicer (version 5.2). Regions of interest were manually segmented on consecutive axial slices, and the volumes of the tumor, edema, and their sum were automatically calculated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePeritumoral edema was quantified using the Edema Index (EI) = (V_tumor + V_edema) / V_tumor \u0026ndash; 1 and categorized as none (EI \u0026asymp; 0), mild (EI \u0026lt; 1), moderate (EI = 1\u0026ndash;2), or severe (EI \u0026gt; 2) according to established grading systems [13-15]. The distribution of edema severity in this cohort mirrored that shown in Table 1 (none, 6.9%; mild, 31.0%; moderate, 24.1%; and severe, 37.9%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePostoperative MRI was performed within 48 h of surgery using an identical protocol. Residual contrast enhancement was compared with the operative notes to determine the extent of resection (EOR), which was classified volumetrically as follows:\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eGTR: \u0026gt; 95% tumor removal\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNear-total resection (NTR): 90\u0026ndash;95% removal\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSubtotal resection (STR): 50\u0026ndash;90% removal\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePartial resection (PR): \u0026lt; 50% removal [16]\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThese MRI-based parameters were incorporated into analyses of tumor characteristics, peritumoral edema, and treatment outcomes.\u003c/p\u003e\n\u003cp\u003eMass effect was defined as radiological evidence of brain compression, including sulcal effacement, ventricular compression, midline shift \u0026gt; 5 mm, or herniation, reflecting mechanical distortion of adjacent brain tissue rather than isolated intracranial hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNeuropsychological Examinations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComprehensive neuropsychological testing was performed before and after surgery to assess attention, language, memory, visuospatial ability, executive function, and psychiatric status. Cognitive impairment occurs most frequently in patients with frontal or temporal meningiomas, which are critical for memory, attention, and emotional regulation [2].\u003c/p\u003e\n\u003cp\u003eAll patients completed one of three validated test batteries: the Neurooncological Psychological Test (NOPT), Seoul Neuropsychological Screening Battery\u0026ndash;II (SNSB-II), or Bundang Neuropsychological Testing Protocol\u0026ndash;M1 (BNTP-M1). Selection depended on the referring department (neurology, psychiatry, or neurosurgery); however, as all three departments assessed the same cognitive and psychiatric domains, test type was not considered in the analysis [17,18]. Each participant underwent a structured, comprehensive evaluation of cognitive and emotional functions routinely used for individualized treatment planning and rehabilitation [2].\u003c/p\u003e\n\u003cp\u003eStandard subtests included [13, 14,19-23]:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eAttention:\u003c/strong\u003e Digit Span (forward or backward), Trail Making Test\u0026ndash;A [19]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLanguage and related function:\u003c/strong\u003e Korean Boston Naming Test (S-K-BNT) [20]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMemory:\u003c/strong\u003e Seoul Verbal Learning Test (immediate or delayed recall), Rey\u0026ndash;Osterrieth Complex Figure Test (delayed recall) [20,23]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVisuospatial function:\u003c/strong\u003e Rey\u0026ndash;Osterrieth Complex Figure Test (copy) [20,23]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eExecutive function:\u003c/strong\u003e Stroop Color\u0026ndash;Word Test, Controlled Oral Word Association Test (COWAT; verbal fluency) [20]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePsychiatric status:\u003c/strong\u003e Korean Neuropsychiatric Inventory [21,22]\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAmong the 29 patients, 27 completed NOPT and 2 completed SNSB-II preoperatively; postoperatively, 2 completed BNTP-M1 and 2 completed SNSB-II. Despite procedural differences, all batteries assessed the same domains, allowing direct comparison.\u003c/p\u003e\n\u003cp\u003eTesting was conducted a median of 7 days before surgery (interquartile range [IQR] 3\u0026ndash;16) and 182 days after surgery (IQR 90\u0026ndash;361). Relative to MRI, testing was performed a median of 5 days before imaging (IQR 1.75\u0026ndash;24.25). These consistent intervals minimized timing bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics (version 21.0; IBM Corp., Armonk, NY, USA) and R (version 4.3.2; R Foundation for Statistical Computing, Vienna, Austria). Continuous variables are presented as mean \u0026plusmn; standard deviation or median with IQR, as appropriate, and categorical variables as frequencies and percentages.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor neuropsychological outcomes, preoperative and postoperative scores were compared using paired t-tests (two-tailed), given that the measurements were continuous and repeated within the same participants. Chi-square tests are not applicable to paired continuous data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor regression analyses, the \u0026Delta;-value (postoperative minus preoperative) for each neuropsychological domain was used as the dependent variable. Candidate predictors (p \u0026lt; 0.10) were identified using univariate linear regression and then entered into multivariate linear regression models to determine the independent associations. Age and years of education were included as prespecified covariates in all models.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRadiological parameters included tumor volume, EI, mass effect (defined as sulcal effacement, ventricular compression, midline shift \u0026gt; 5 mm, or herniation), lobar involvement, and dural origin. Model fit was assessed using the adjusted R\u0026sup2;, residual independence with the Durbin\u0026ndash;Watson statistic, and multicollinearity with the variance inflation factor (VIF), with VIF \u0026gt; 5 indicating substantial multicollinearity. All statistical tests were two-sided, and significance was defined as p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient Demographics and Tumor Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 1,528 patients with meningioma who underwent surgery during the study period, 29 met all the inclusion criteria (Figure 1). The cohort was predominantly female (79.3%, n = 23), with a mean age of 61.0 \u0026plusmn; 9.4 years and a mean educational attainment of 12.4 \u0026plusmn; 4.7 years.\u003c/p\u003e\n\u003cp\u003eTumor distribution and radiologic features are summarized in Table 1. Most lesions were located in the frontal lobe (75.8%), followed by the temporal (13.8%) and frontotemporal (6.9%) regions. The most frequent sites of origin were the convexity (37.9%), anterior falx (31.0%), and frontal base (24.1%). Lateralization analysis revealed right-sided tumors in 51.7% of patients, left-sided tumors in 41.4%, and bilateral involvement in 6.9%. Based on hand dexterity, 55.2% of tumors involved the dominant hemisphere.\u003c/p\u003e\n\u003cp\u003eThe mean tumor volume was 72.7 \u0026plusmn; 55.2 cm\u0026sup3;, with median edema volume of 50.9 cm\u0026sup3; (IQR 28.2\u0026ndash;60.0) and combined tumor + edema volume of 123.6 cm\u0026sup3; (IQR 91.6\u0026ndash;171.4). A midline shift \u0026gt; 5 mm or mass effect was present in 69.0% of patients (n = 20).\u003c/p\u003e\n\u003cp\u003ePeritumoral edema severity, graded by the EI, was 6.9%, 31.0%, 24.1%, and 37.9 %, respectively. GTR was achieved in 41.4% of patients, NTR in 31.0%, STR in 20.7%, and PR in 6.9% [16]. Neuropsychological assessments were performed a median of 7 days before and 182 days after surgery, consistent with the study design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect of Surgical Treatment on Cognitive and Psychiatric Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigher scores indicated better performance in all cognitive domains (attention, language, memory, visuospatial ability, and executive function), whereas higher scores on the psychiatric scale indicated more severe neuropsychiatric symptoms. Postoperative neuropsychological testing demonstrated significant improvement across all six cognitive and psychiatric domains compared to the preoperative performance (Table 2, Figure 2). The most pronounced gains were observed in memory, executive function, and attention, while language and visuospatial abilities showed significant improvements. Psychiatric symptom scores markedly reduced after surgery, indicating a substantial alleviation of emotional and behavioral disturbances. Collectively, these findings suggest that surgical resection is associated with broad cognitive and emotional recovery, with the greatest benefits in higher-order cognitive functions. The consistent direction of change across all domains supports the notion that tumor-related neuropsychological dysfunction is, to a large extent, reversible following the decompression and resolution of peritumoral edema.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrognostic Factors for Neuropsychological Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLinear regression analyses used \u0026Delta; (postoperative minus preoperative) change scores for each cognitive and psychiatric domain as dependent variables (Table 3). To identify independent predictors, multivariate linear regression models were constructed for each outcome domain. Age and years of education were included as prespecified covariates in all models, given their well-established influence on neuropsychological performance. Radiologic parameters (including tumor volume, EI, mass effect, lobar involvement, and dural origin) were screened in univariate analyses, and only variables associated with the respective \u0026Delta; score at p \u0026lt; 0.10 were retained as candidate predictors for the multivariable models. The final multivariable models were built using backward elimination (p \u0026lt; 0.05 for retention), and the results are presented as unstandardized regression coefficients (B) with corresponding p-values.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAttention\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn this cohort, mass effect was defined as radiological evidence of brain compression, including sulcal effacement, ventricular compression, midline shift \u0026gt; 5 mm, or herniation, reflecting mechanical distortion of adjacent brain tissue rather than isolated intracranial hypertension. The presence of mass effect independently predicted greater improvement in attention (B = 1.10, p = 0.02), suggesting that attentional deficits are largely attributable to the reversible compression of the frontal or frontotemporal networks, with functional recovery following surgical decompression. The model\u0026rsquo;s adjusted R\u0026sup2; was 0.22 and Durbin\u0026ndash;Watson was 2.04, indicating acceptable model fit and absence of serial correlation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLanguage Function\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrontal lobe involvement was significantly associated with poorer postoperative language improvement (\u0026beta; = \u0026ndash;2.97, p = 0.004), consistent with the known localization of expressive language networks. Model adequacy was confirmed by adjusted R\u0026sup2; = 0.34 and Durbin\u0026ndash;Watson = 2.23.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExecutive Function\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor Stroop test performance, tumors originating from the convexity showed less improvement (\u0026beta; = \u0026ndash;27.42, p = 0.05). In the COWAT (animal fluency) assessment, a higher EI was associated with improved recovery outcomes (\u0026beta; = 2.52, p = 0.02), indicating the potential reversibility of edema-related executive dysfunction [7,12, 15,16,24]. Adjusted R\u0026sup2; values were 0.17 and 0.13, respectively, and VIF values \u0026lt; 2 excluded multicollinearity.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePsychiatric Status\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTumors located at the frontal base were associated with significantly reduced postoperative improvement in psychiatric symptoms (\u0026beta; = \u0026minus;14.91, p = 0.005), indicating that patients with frontal base meningiomas showed less reduction in depression- or anxiety-related scores after surgery than those whose tumors originated elsewhere. These findings suggest that disruption of the orbitofrontal-limbic circuits by frontal base meningiomas may impede emotional recovery, even after tumor resection. The model demonstrated a good fit (adjusted R\u0026sup2; = 0.24, Durbin\u0026ndash;Watson test = 1.55).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIllustrative Case\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 58-year-old woman presented with progressive cognitive decline and depression. Preoperative MRI revealed a 7-cm anterior-falx meningioma with marked peritumoral edema (Figure 3A\u0026ndash;B). The patient underwent gross total tumor resection, and follow-up imaging demonstrated resolution of the edema. Comprehensive pre- and postoperative neuropsychological assessments showed substantial improvement across all domains, and her depressive symptoms had completely resolved at 6-month follow-up, illustrating the potential reversibility of tumor-related neuropsychological impairments after surgical decompression.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this single-center retrospective cohort of patients with frontotemporal meningiomas who completed paired neuropsychological testing, we found significant postoperative improvements across all six cognitive and psychiatric domains, including attention, language, memory, visuospatial ability, executive function, and psychiatric symptoms, in within-participant comparisons. Using \u0026Delta; change scores (post \u0026ndash; pre) as outcomes, multivariable linear regression identified mass effect as a predictor of greater attentional recovery; frontal lobe involvement as a negative predictor of language recovery; convexity origin as a negative predictor of Stroop improvement; frontal-base origin as a negative predictor of psychiatric recovery; and a higher EI as a positive predictor of executive recovery.\u003c/p\u003e\n\u003cp\u003eTaken together, these results provide objective evidence beyond the clinical impression that neuropsychological dysfunction in meningioma is frequently reversible after surgical decompression and delineate domain-specific prognostic factors based on MRI-derived pathology. Importantly, we quantified these effects using validated domain-structured batteries (NOPT, SNSB-II, BNTP-M1) rather than anecdotal observations, thereby addressing a long-standing gap in the literature on meningioma and cognition [2,9-12,17-23].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeningioma and Cognition: Context and Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough meningiomas are often histologically benign, they can cause substantial cognitive and psychiatric morbidity through mass effect, edema, and network disruption, particularly when located in the frontal or temporal lobes [2,4,11,12,25]. Prior neuro-oncology studies on cognition have focused disproportionately on gliomas (6), whereas the pattern and magnitude of cognitive recovery in meningiomas remain less consistently characterized and are often based on small, non-standardized series [9-12].\u003c/p\u003e\n\u003cp\u003eBy restricting the cohort to frontotemporal tumors, employing paired, domain-specific assessments, and linking outcomes to quantitative MRI features (volumes, EI, and EOR), our study clarifies which domains improve after surgery and why, while providing testable, anatomically plausible hypotheses for patient counseling and rehabilitation planning [2,9-23].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation of Domain-Specific Predictors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAttention and mass effect.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe independent association between mass effect and greater attentional improvement suggests that attentional deficits in frontotemporal meningiomas are frequently compression-driven and reversible with decompression, consistent with a mechanistic link between relief of local mass effect and restoration of fronto-subcortical attentional networks. Patients with clear mass effect (sulcal or ventricular compression, midline shift \u0026gt; 5 mm) are likely to experience marked postoperative gains in attention, supporting early surgical intervention in such cases.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLanguage and frontal involvement.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrontal lobe involvement predicted less improvement in postoperative language function, consistent with the role of frontal regions in expressive language. This finding underscores the importance of careful preoperative mapping and surgical precision for frontal lobe meningiomas, particularly in areas critical for language production.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExecutive function and edema.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA higher EI predicts better executive recovery, consistent with reversible, edema-related dysfunction, rather than irreversible parenchymal damage [12-15,24]. These findings align with prior work showing the variable cognitive impact of edema and support edema-mitigation strategies (e.g., corticosteroids or anti-inflammatory approaches) in selected cases [26-29]. Clinically, patients with prominent peritumoral edema may be particularly good candidates for surgical decompression, with expectations of substantial postoperative improvement in executive and attentional domains.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePsychiatric outcomes and frontal-base origin.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong tumor-related factors, frontal-based origin independently predicted a smaller degree of postoperative improvement in psychiatric symptoms. This finding likely reflects the involvement of the orbitofrontal\u0026ndash;limbic network, which regulates mood regulation, motivation, and social cognition. Even after decompression, microstructural or network-level disruptions in these regions may persist, limiting full emotional recovery.\u003c/p\u003e\n\u003cp\u003eAccordingly, patients with frontal-based meningiomas may benefit from early psychiatric co-management and integrated emotional rehabilitation, in addition to cognitive therapy. These findings underscore that tumor origin, not just volume or edema, can influence domain-specific trajectories of recovery, particularly in the affective and behavioral domains.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRole of Age and Cognitive Reserve\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOlder age is linked to an increased vulnerability to executive and memory dysfunction in neuro-oncology, likely reflecting lower cognitive reserves and reduced plasticity [24,30,31]. In our cohort, age and years of education were not significant independent predictors of postoperative neuropsychological recovery in multivariable models. This finding suggests that in frontotemporal meningiomas, the anatomical characteristics of the tumor (location, mass effect, edema, and origin site) may play a more decisive role for functional recovery than demographic or educational factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis pattern supports the concept that meningioma-related deficits are largely driven by reversible mechanical and edematous effects that can be substantially alleviated by surgical decompression. Therefore, even older patients or those with lower educational attainment can achieve meaningful cognitive and emotional recovery when the tumor is amenable to GTR, reinforcing the rationale for timely surgical intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, routine pre- and postoperative domain-specific neuropsychological screening should be integrated into the care pathway for frontotemporal meningioma using validated batteries available across departments (NOPT, SNSB-II, BNTP-M1) [17-20].\u003c/p\u003e\n\u003cp\u003eSecond, MRI-derived markers (mass effect, EI, frontal involvement, and tumor origin) can enhance preoperative counseling, set realistic domain-specific expectations, and guide targeted rehabilitation. For example, patients with a clear mass effect or high EI can be counseled that a marked improvement in attention and executive function is likely after surgical decompression. For tumors involving the frontal lobe, especially in eloquent areas, functional mapping and precision surgery should be emphasized to optimize language outcomes. For frontal-base meningiomas, early psychiatric involvement and structured emotional rehabilitation should be considered, given the limited recovery of psychiatric symptoms.\u003c/p\u003e\n\u003cp\u003eThird, early edema control (e.g., perioperative steroids, when appropriate) may augment recovery in the executive and attention domains, particularly in patients with a high EI [13-15,26-29].\u003c/p\u003e\n\u003cp\u003eFinally, documenting paired changes using standardized tools facilitates objective follow-up and timely referral for cognitive or psychiatric rehabilitation, enabling personalized domain-specific rehabilitation planning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStrengths include a paired within-participant design, standardized domain assessments, precise MRI quantification (contrast-enhanced T1 for tumor, T2 for edema, 3D Slicer volumetry), a priori \u0026Delta;-based outcomes, and predefined regression diagnostics (adjusted R\u0026sup2;, Durbin\u0026ndash;Watson statistic, VIF).\u003c/p\u003e\n\u003cp\u003eLimitations include the small, single-center sample (n = 29), potential selection bias (only patients able to complete paired testing), heterogeneity of test batteries across departments (mitigated by domain parity) [17-20], and lack of neurodegenerative biomarkers (e.g., medial temporal atrophy rating and amyloid positron emission tomography) that might clarify comorbid age-related processes [26,32]. The follow-up interval (median, 182 days) may not capture longer-term trajectories or the effects of adjunct treatments between tests, which, although infrequent, could confound recovery in a minority of patients (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFuture Directions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProspective, multicenter studies using harmonized neuropsychological batteries, longer follow-up periods, and the integration of advanced imaging (diffusion or perfusion, connectomics) and neurodegenerative markers are warranted [13-16,26-29,32]. Interventional studies testing domain-targeted cognitive rehabilitation and edema-modulating strategies could determine causality and optimize outcomes. Finally, combining MRI features with baseline neuropsychological data to build predictive models may enable personalized counseling and rehabilitation planning at the point of care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that cognitive and psychiatric impairments in patients with frontotemporal meningiomas are largely reversible following surgical resection. Domain-specific neuropsychological assessments revealed significant postoperative improvements in attention, memory, language, visuospatial ability, executive function, and psychiatric symptoms.\u003c/p\u003e \u003cp\u003eTumor-related factors, particularly mass effect, frontal lobe involvement, and frontal-base origin, are key determinants of recovery trajectories, underscoring the importance of anatomical location and mechanical compression in neuropsychological outcomes. These findings support early neuropsychological screening, individualized surgical planning, and multidisciplinary rehabilitation tailored to tumor location and affected domains.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBNTP-M1: Bundang Neuropsychological Testing Protocol\u0026ndash;M1\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CNS: Central nervous system\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;COWAT: Controlled Oral Word Association Test\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;EI: Edema Index\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;EMR: Electronic medical records\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;EOR: Extent of resection\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;GTR: Gross total resection\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;IQR: Interquartile range\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;KHIDI: Korea Health Industry Development Institute\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;K-NPI: Korean Neuropsychiatric Inventory\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;MRI: Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;NOPT: Neurooncological Psychological Test\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;NTR: Near-total resection\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;PET: Positron emission tomography\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;PR: Partial resection\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;SNSB-II: Seoul Neuropsychological Screening Battery\u0026ndash;II\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;STR: Subtotal resection\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;VIF: Variance inflation factor\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board of Seoul National University Bundang Hospital (No.\u0026nbsp;[##-###]). The requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to patient privacy restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by a grant from the Korea Health Technology R\u0026amp;D Project through the Korea Health Industry Development Institute (KHIDI) and funded by the Ministry of Health and Welfare, Republic of Korea (grant number: RS-2023-KH136120).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKHK wrote the main manuscript text. YJP contributed to data collection. KH and CYK supervised the study and reviewed the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOstrom QT, Gittleman H, Liao P, Rouse C, Chen Y, Dowling J, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007\u0026ndash;2011. Neuro Oncol. 2014;16 Suppl 4:iv1\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eKang MJ, Pyun J-M, Baek MJ, Hwang K, Han JH, Park YH, et al. Predictors of pre-operative cognitive impairment in meningioma patients over 60 years old. BMC Neurol. 2020;20:225. doi:10.1186/s12883-020-01806-0.\u003c/li\u003e\n\u003cli\u003eLouis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131:803-20.\u003c/li\u003e\n\u003cli\u003eWhittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet. 2004;363:1535-43.\u003c/li\u003e\n\u003cli\u003eEngelhard HH, Villano JL, Porter KR, et al. The role of temozolomide in the treatment of brain metastases: a review. J Neurooncol. 2009;92:405-15.\u003c/li\u003e\n\u003cli\u003eTalacchi A, Santini B, Savazzi S, Gerosa M. Cognitive effects of tumour and surgical treatment in glioma patients. J Neurooncol. 2011;103:541-9.\u003c/li\u003e\n\u003cli\u003eArvaniti M, Paspaliaris V, Tsoukas G, Koutsi V, Fountas KN. Postoperative cognitive dysfunction and quality of life in patients with intracranial meningiomas: A systematic review. World Neurosurg. 2025;193:137\u0026ndash;46. https://doi.org/10.1016/j.wneu.2024.08.083.\u003c/li\u003e\n\u003cli\u003eJ\u0026ouml;rntell H, B\u0026auml;cklund LG, Kristiansson P. Cognitive and emotional problems in patients after cerebral meningioma resection. J Rehabil Med. 2014;46:674\u0026ndash;9. https://doi.org/10.2340/16501977-1795.\u003c/li\u003e\n\u003cli\u003eMukand JA, Blackinton DD, Crincoli MG, Lee JJ, Santos BB. Incidence of neurologic deficits and rehabilitation of patients with brain tumors. Am J Phys Med Rehabil. 2001;80:346-50.\u003c/li\u003e\n\u003cli\u003eTeixidor P, Ducray F, Gentet JC, et al. Neurocognitive and behavioral impact of a right temporal low-grade glioma. Acta Neurol Belg. 2006;106:27-30.\u003c/li\u003e\n\u003cli\u003eLiouta E, Koutsarnakis C, Liakos F, Stranjalis G. Effects of intracranial meningioma location, size, and surgery on neurocognitive functions: a 3-year prospective study. J Neurosurg. 2016;124:1578-84.\u003c/li\u003e\n\u003cli\u003eYoshioka H, Hama S, Taniguchi E, Sugiyama K, Arita K, Kurisu K. Peritumoral brain edema associated with meningioma: influence of vascular endothelial growth factor expression and vascular blood supply. Cancer. 1999;85:936-44.\u003c/li\u003e\n\u003cli\u003eBitzer M, W\u0026ouml;ckel L, Morgalla M, Keller C, Friese S, Heiss E, et al. Peritumoural brain oedema in intracranial meningiomas: influence of tumour size, location and histology. Acta Neurochir (Wien). 1997;139:1136-42.\u003c/li\u003e\n\u003cli\u003eIde M, Jimbo M, Kubo O, Yamamoto M, Imanaga H. Peritumoral brain edema associated with meningioma\u0026mdash;histological study of the tumor margin and surrounding brain. Neurol Med Chir (Tokyo). 1992;32:65-71.\u003c/li\u003e\n\u003cli\u003eKim MS, Oh CW, Han DH. Growth of basilar artery aneurysm after ventriculo-peritoneal shunt. J Clin Neurosci. 2002;9:696\u0026ndash;702.\u003c/li\u003e\n\u003cli\u003eSimpson D. The recurrence of intracranial meningiomas after surgical removal and their further treatment. J Neurol Neurosurg Psychiatry. 1957;20:22-39.\u003c/li\u003e\n\u003cli\u003eKang Y, Chin J, Lee BH, Na DL, Park JS. Seoul Neuropsychological Screening Battery\u0026ndash;II (SNSB-II). Incheon, Korea: Human Brain Research \u0026amp; Consulting Co.; 2012.\u003c/li\u003e\n\u003cli\u003eThe Neurooncologic Psychological Test (NOPT) and Bundang Neuropsychological Testing Protocol-M1 (BNTP-M1) are standardized institutional protocols validated for neurooncologic and postoperative cognitive evaluation at tertiary referral hospitals in Korea.\u003c/li\u003e\n\u003cli\u003eReitan RM. Trail Making Test: Manual for Administration and Scoring. Tucson, AZ: Reitan Neuropsychology Laboratory; 1992.\u003c/li\u003e\n\u003cli\u003eStrauss E, Sherman EMS, Spreen O. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. 3rd ed. New York, NY: Oxford University Press; 2006.\u003c/li\u003e\n\u003cli\u003eCummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eKang SJ, Choi SH, Lee BH, et al. The reliability and validity of the Korean Neuropsychiatric Inventory (K-NPI). J Korean Neurol Assoc. 2004;22:1\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eRey A. L\u0026rsquo;examen clinique en psychologie. Paris, France: Presses Universitaires de France; 1964.\u003c/li\u003e\n\u003cli\u003evan Nieuwenhuizen D, Slot KM, Klein M, Verbaan D, Aliaga ES, Heimans JJ, et al. The association between preoperative edema and postoperative cognitive functioning and health-related quality of life in WHO grade I meningioma patients. Acta Neurochir. 2019;161:579-88.\u003c/li\u003e\n\u003cli\u003ePeng Y, Shao C, Gong Y, Wu X, Tang W, Shi S. Relationship between apathy and tumor location, size, and brain edema in patients with intracranial meningioma. Neuropsychiatr Dis Treat. 2015;11:1685-93.\u003c/li\u003e\n\u003cli\u003eSoldan A, Pettigrew C, Cai Q, Wang J, Wang MC, Moghekar A, et al. Cognitive reserve and long-term change in cognition in aging and preclinical Alzheimer\u0026apos;s disease. Neurobiol Aging. 2017;60:164-72.\u003c/li\u003e\n\u003cli\u003eZacharaki EI, Wang S, Chawla S, et al. The role of peritumoral edema in brain tumor segmentation in MR images: evaluation of a generative model. AJNR Am J Neuroradiol. 2008;29:1053-62.\u003c/li\u003e\n\u003cli\u003eJain R, Scarpace L, Ellika S, et al. Peritumoral brain edema: a volumetric analysis of glioblastoma multiforme. AJNR Am J Neuroradiol. 2007;28:1870-4.\u003c/li\u003e\n\u003cli\u003eHo ML, Rojas R, Eisenberg RL. Cerebral edema. AJR Am J Roentgenol. 2012;199:W258\u0026ndash;73. doi:10.2214/AJR.11.8081.\u003c/li\u003e\n\u003cli\u003eArmstrong CL, Morrow L. Handbook of Medical Neuropsychology: Applications of Cognitive Neuroscience. New York, NY: Springer; 2010.\u003c/li\u003e\n\u003cli\u003eStern Y. Cognitive reserve. Neuropsychologia. 2009;47:2015-28.\u003c/li\u003e\n\u003cli\u003eScheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, et al. Atrophy of medial temporal lobes on MRI in \u0026ldquo;probable\u0026rdquo; Alzheimer\u0026rsquo;s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry. 1992;55:967-72.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline Demographic and Tumor Characteristics of Patients with Frontotemporal Meningiomas\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient No. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient demographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e23 (79.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, mean \u0026plusmn; SD (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e61.0 \u0026plusmn; 9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of education, mean \u0026plusmn; SD (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e12.4\u0026nbsp;\u0026plusmn;\u0026nbsp;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLateralization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Left\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e12 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Right\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e15 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDominant hemisphere\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Nondominant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e13 (44.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Dominant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e16 (55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Frontal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e23 (75.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Temporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Frontotemporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSite of origin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Anterior falx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Frontal base\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Convexity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e11 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Parasagittal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u0026emsp; Sphenoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor volume, mean \u0026plusmn; SD (cm\u0026sup3;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e72.7\u0026nbsp;\u0026plusmn;\u0026nbsp;55.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeritumoral edema volume, median (IQR) (cm\u0026sup3;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e50.9 (28.2\u0026ndash;60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor + Edema volume, median (IQR) (cm\u0026sup3;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e123.6 (91.6\u0026ndash;171.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMidline shift/mass effect\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Present\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e20 (69.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Absent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEdema Index\u003c/strong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eNo \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e11 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment-Related Characteristics of the Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtent of Resection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eGross total resection (GTR): \u0026gt; 95% removal (Simpson grade I\u0026ndash;II)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e12 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eNear-total resection (NTR): 90\u0026ndash;95% removal (Simpson grade III)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eSubtotal resection (STR): 50\u0026ndash;90% removal (Simpson grade IV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003ePartial resection (PR): \u0026lt; 50% removal (Simpson grade V)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdditional Treatment Between Neuropsychological Assessments\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e23 (79.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eRadiotherapy (RTx)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eGamma knife surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 461px;\"\u003e\n \u003cp\u003eRe-excision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026dagger; Dominant hemisphere determination based on hand dominance.\u003c/p\u003e\n\u003cp\u003e\u0026Dagger; Edema Index (EI) = (V₍tumor+edema₎ / V₍tumor₎) \u0026minus; 1; equivalent to V₍edema₎ / V₍tumor₎; categorized as none (\u0026asymp; 0), mild (\u0026lt; 1), moderate (1, 2), or severe (\u0026gt; 2).\u003c/p\u003e\n\u003cp\u003e\u0026sect;Mass effect was defined as radiological evidence of brain compression, including sulcal effacement, ventricular compression, midline shift of \u0026gt; 5 mm, or herniation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Cognitive and Psychiatric Outcomes Before and After Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-op Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-op Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.45 (\u0026plusmn; 0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e4.21 (\u0026plusmn; 0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLanguage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e11.03 (\u0026plusmn; 1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e11.86 (\u0026plusmn; 1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.041*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMemory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.59 (\u0026plusmn; 1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e6.17 (\u0026plusmn; 1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVisuospatial\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e30.16 (\u0026plusmn; 2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e31.54 (\u0026plusmn; 2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.024*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExecutive function (Stroop Test)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e58.61 (\u0026plusmn; 6.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e87.29 (\u0026plusmn; 8.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExecutive function (CW Task)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e7.91 (\u0026plusmn; 1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e11.97 (\u0026plusmn; 2.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e6.00 (\u0026plusmn; 1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e1.67 (\u0026plusmn; 0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.043*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThis table illustrates the statistically significant improvements observed in cognitive function and psychiatric symptoms following surgical treatment, with marked differences in several key domains.\u003c/p\u003e\n\u003cp\u003eIn all cognitive domains, higher scores indicate better performance, whereas for psychiatric symptoms, higher scores indicate more severe psychopathology; thus, postoperative increases in cognitive scores and decreases in psychiatric symptom scores consistently reflect clinical improvement.\u003c/p\u003e\n\u003cp\u003ep\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026lt;\u003cem\u003e\u0026nbsp;0.05\u003c/em\u003e indicates statistical significance (*).\u003c/p\u003e\n\u003cp\u003ep\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026lt;\u003cem\u003e\u0026nbsp;0.01\u003c/em\u003e indicates high significance (**).\u003c/p\u003e\n\u003cp\u003ep\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026lt;\u003cem\u003e\u0026nbsp;0.001\u003c/em\u003e indicated very high significance (***).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Linear Regression Analysis of Tumor Characteristics, Edema Severity, and Improvement in Cognitive and Psychiatric Functions\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictor Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLanguage Function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExecutive function\u0026sect;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExecutive function||\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.02 (.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-.05 (.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.81 (.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.05 (.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.06 (.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.02 (.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-.06 (.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-.73 (.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.23 (.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-.29 (.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eEdema Index\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.33 (.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.73 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e12.82 (.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.52 (.02*)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMass Effect\u0026Dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.10 (.02*)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal lobe involvement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-2.97 (.004**)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConvexity origin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-27.42 (.05*)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal base origin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-14.91 (.005**)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-28.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-7.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e-1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel Summary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eR2 (adj. R2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.33 (.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.43 (.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.30 (.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.23 (.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e.34 (.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eDurbin\u0026ndash;Watson\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eVIF range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e0.90\u0026ndash;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.01\u0026ndash;1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.01\u0026ndash;1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.01\u0026ndash;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote:\u003c/p\u003e\n\u003cp\u003eValues are presented as the unstandardized regression coefficient B, followed by the p-values in parentheses. Bold text indicates statistical significance (*p \u0026lt; 0.05 indicates statistical significance, **p \u0026lt; 0.01 indicates highly significantce; ***p \u0026lt; 0.001 indicates very highly significantce). Hyphen (-) denotes variables that were not included in the final multivariable model. The Memory and Visuospatial domains were excluded from this table, as the multivariable analysis identified no significant independent predictors for these outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026dagger; Edema Index (EI) = (V₍tumor+edema₎ / V₍tumor₎) \u0026minus; 1; equivalent to V₍edema₎ / V₍tumor₎; categorized as none (\u0026asymp;0), mild (\u0026lt;1), moderate ((1\u0026ndash;21, 2)), or severe (\u0026gt;2).\u003c/p\u003e\n\u003cp\u003e\u0026Dagger; Mass effect: Mass effect was defined as radiological evidence of brain compression, including sulcal effacement, ventricular compression, midline shift \u0026gt; 5 mm, or herniation, and was treated as a binary variable (present vs. absent).\u003c/p\u003e\n\u003cp\u003e\u0026sect; Executive function\u0026mdash;Stroop test.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Meningioma, Frontal lobe, Temporal lobe, Neuropsychological tests, Cognitive recovery","lastPublishedDoi":"10.21203/rs.3.rs-8915545/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8915545/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCognitive and psychiatric impairments are common in patients with frontotemporal meningiomas. While meningiomas are often histologically benign, they can cause significant morbidity through mass effect and peritumoral edema. Compared to gliomas, the reversibility of these impairments following surgical resection is relatively under-investigated. This study aimed to evaluate postoperative neuropsychological changes and identify tumor-related prognostic factors in patients with frontotemporal meningiomas.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively reviewed 29 patients who underwent surgical resection for frontotemporal meningiomas and completed both pre- and post-operative neuropsychological assessments (Neurooncologic Psychological Test [NOPT], Seoul Neuropsychological Screening Battery\u0026ndash;II [SNSB-II], or Bundang Neuropsychological Testing Protocol\u0026ndash;M1 [BNTP-M1]). Multivariable linear regression analysis was performed using Δ change scores (postoperative minus preoperative) to identify independent radiologic predictors for recovery in each domain.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePostoperatively, patients demonstrated significant improvements across all tested domains: attention (p\u0026thinsp;=\u0026thinsp;0.002), language (p\u0026thinsp;=\u0026thinsp;0.041), memory (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), visuospatial function (p\u0026thinsp;=\u0026thinsp;0.024), executive function (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and psychiatric symptoms (p\u0026thinsp;=\u0026thinsp;0.043). Multivariable analysis identified several domain-specific predictors for functional recovery. The presence of mass effect independently predicted greater postoperative gains in attention (β\u0026thinsp;=\u0026thinsp;1.10, p\u0026thinsp;=\u0026thinsp;0.020), whereas frontal lobe involvement was a negative predictor for language improvement (β=-2.97, p\u0026thinsp;=\u0026thinsp;0.004). Regarding executive function, convexity origin was associated with diminished recovery in Stroop test performance (β=-27.42, p\u0026thinsp;=\u0026thinsp;0.050), while a higher edema index significantly predicted better recovery in the COWAT scores (β\u0026thinsp;=\u0026thinsp;2.52, p\u0026thinsp;=\u0026thinsp;0.020). Notably, frontal base origin emerged as a strong negative predictor for psychiatric recovery (β=\u0026minus;14.91, p\u0026thinsp;=\u0026thinsp;0.005), suggesting more persistent emotional dysfunction in these patients.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNeuropsychological impairments in frontotemporal meningioma patients are substantially reversible following surgical decompression. Recovery trajectories are highly dependent on tumor-related factors such as mass effect, edema, and anatomical origin. These findings support early surgical intervention and underscore the need for tailored rehabilitation strategies based on preoperative radiologic characteristics.\u003c/p\u003e","manuscriptTitle":"Reversibility of Cognitive and Psychiatric Impairments Following Surgical Resection of Frontotemporal Meningiomas: A Predictive Factor Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 07:35:54","doi":"10.21203/rs.3.rs-8915545/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-20T10:53:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T23:27:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-16T13:14:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143103864013275376582084828954210895968","date":"2026-03-04T01:27:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318134712631985039040333745806420395769","date":"2026-03-02T20:35:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-28T14:33:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228272593575138059815223833450628393893","date":"2026-02-28T14:21:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-23T14:52:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-23T04:42:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-19T23:35:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-19T23:35:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2026-02-19T08:25:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"565621cd-d81e-4760-847e-7cc7be0b7bd2","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T07:25:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 07:35:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8915545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8915545","identity":"rs-8915545","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}