The Neuropsychological Impacts of Supratotal Glioma Resection: A Systematic Review

Background Supratotal resection (SpTR) has emerged as a compelling surgical target for gliomas, with a strong signal toward improved survival. However, the balance between resections extending into tumor-infiltrated normal brain and preservation of higher-order cognitive function remains poorly defined. This systematic review aims to characterize formal neuropsychological (NP) outcomes following glioma SpTR. Methods A PRISMA-adherent systematic search was conducted across six electronic databases. Inclusion criteria required patients with WHO Grade 2–4 gliomas undergoing SpTR with standardized NP assessment. Quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Results 55 studies reported SpTR for glioma, but only 11 (20%) utilized formal NP testing as an outcome. 80% of studies omitting NP testing focused exclusively on high-grade glioma (HGG). Cognitive data was available from 2 studies in HGG and 9 studies in LGG. Early post-operative cognitive declines were reported in 55.5% of extractable cohorts, predominantly in the domains of executive function and memory/learning. The majority of these studies report cognitive recovery after 3-6 months. Long-term permanent cognitive morbidity was indeed very low (∼1%), but critical appraisal revealed a high risk of bias. Conclusions While current evidence suggests SpTR is functionally safe, these findings are limited by high risk of bias and a lack of comparative controls. A reporting gap remains in functional-cognitive outcomes after HGG surgery. Standardized, anatomically-anchored NP testing will be essential to validate the "onco-functional balance" of supratotal margins.