Role of tumor momentum in neurocognitive deficits among pediatric brainstem glioma prior to treatment: a pilot study.
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PURPOSE: To investigate the association between tumor momentum indices and pretreatment neurocognitive function in children with brainstem gliomas (BSGs), and to evaluate their prognostic value for overall survival (OS). METHODS: This prospective pilot study enrolled 34 treatment-naïve children with histopathologically confirmed BSGs and 30 age-matched healthy controls at Beijing Tiantan Hospital, Capital Medical University. Neurocognitive function was assessed using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), and emotional-behavioral performance was screened with the Child Behavior Checklist (CBCL). Tumor momentum was characterized by the MRS-derived Cho/Cr ("image momentum") and the Ki-67 proliferative index ("pathological momentum"). Kaplan-Meier analysis was performed to evaluate OS. RESULTS: Patients scored significantly lower than controls across all WISC-IV composite scores and subtests (p < 0.001). The Cho/Cr ratio was inversely correlated with verbal comprehension (ρ = -0.412, p = 0.015) and independently predicted potential verbal function deficit (OR = 4.281, 95% CI 1.146-15.994, p = 0.031). The Ki-67 index was positively associated with CBCL attention problems in high- versus low-Ki-67 subgroups (p = 0.036). Ki-67 was significantly associated with OS (p = 0.027), whereas neither Cho/Cr nor baseline cognitive status demonstrated prognostic value. CONCLUSION: Our study provides the first direct evidence that treatment-naïve children with BSGs harbor significant neurocognitive impairment assessed by a standardized intelligence scale. The Cho/Cr ratio and the Ki-67 index capture complementary dimensions of tumor biology: the former may serve as a non-invasive biomarker for cognitive risk stratification, while the latter retains its established prognostic value for survival.