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

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.