Multimodal Approach to Control Modifiable Risk Factors for Cognitive Dysfunction after Surgery for Intracranial Meningiomas

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common yet and serious complication after major surgery, affecting patients across all risk groups. Its pathogenesis is multifactorial, driven by both modifiable factors such as oxidative stress, anesthetic management, and perioperative care and non‑modifiable factors like age and prior neurological injury. Identifying these contributors is key to improving prevention and early intervention strategies.OBJECTIVE: This study assessed the effect of preoperative 4-weeks vitamin supplemental therapy (VST) and adjustment of the effect of anesthetics on the incidence and severity of postoperative cognitive dysfunction (POCD).METHODS: Patients assigned for elective excision of intracranial meningioma were clinically evaluated by radiologic workup. Cognitive function (CF) was evaluated by the mini-mental state examination (MMSE) and patients with MMES≥25 were enrolled in the study. Fifty-four patients received VST and then were randomly divided into conventional anesthesia (CA)-group; received sevoflurane conventional anesthesia and the opioid-free total intravenous anesthesia (OF-TIVA) group; received dexmedetomidine (DEX) based opioid-free total intravenous anesthesia. CF was re-assessed at 48-hours postoperative (PO) and at 7, 14, and 28 days after surgery.RESULTS: The VST significantly improved patients’ distribution among the range of normal CF. The OF-TIVA significantly controlled the presser reflexes during anesthesia and surgery more than CA. Postoperative analgesia received by patients of the OF-TIVA group significantly improved pain scores. The OF-TIVA significantly shortened the intensive care unit (ICU) and hospital stay. The MMSE scores till 2-week PO were significantly lower than after SVT. The MMSE scores were significantly lower with CA compared to OF-TIVA. Statistical analyses defined older age, prolonged operative time, and high PO morphine consumption as positive predictors, while DEX-based OF-TIVA was a negative predictor for deteriorated CF.CONCLUSION: A multivitamin cocktail before elective surgeries might improve the MMSE scores of patients even if having normal CF. Opioid-free DEX-based TIVA and PO analgesia might ameliorate the effects of anesthesia, surgery, and PO pain as risk factors for POCD.