The relevant psychological burden of having a benign brain tumor: a prospective study of patients undergoing surgical treatment of cranial meningiomas

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OBJECTIVE

Meningiomas are the most common intracranial neoplasm. Evidence concerning surgical management and outcome is abundant, while the implications for the quality of life (QOL) of a patient confronted with the diagnosis and undergoing surgery are unclear. The authors conducted a prospective study to evaluate QOL in relation to psychological comorbidities comorbidities.

METHODS

A prospective study of patients undergoing elective surgery for the removal of an intracranial meningioma was performed. The authors evaluated depression (Allgemeine Depressionsskala K score) and anxiety (Post-Traumatic Stress Scale–10 [PTSS-10]; State Trait Anxiety Inventory–State Anxiety and –Trait Anxiety [STAI-S and STAI-T]; and Anxiety Sensitivity Index–3 [ASI-3]) scores before surgery and at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative QOL as measured by the 36-Item Short Form Health Survey and EQ-5L questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined.

RESULTS

A total of 78 patients undergoing resection of a meningioma between January 2013 and September 2017 participated in the preoperative psychological screening and 71 patients fully completed postoperative follow-up examination after 1 year of follow-up. At presentation, 48 patients (67.7%) had abnormal anxiety scores, which decreased to 29.6% (p = 0.003). On follow-up at 12 months, mean EQ-5L visual analog scale scores were significantly lower in patients with pathological scores on the PTSS-10 (0.84 vs 0.69; p = 0.004), STAI-S (0.86 vs 0.68; p = 0.001), and STAI-T (0.85 vs 0.71; p = 0.011). Neurological status (modified Rankin Scale) improved slightly and showed some correlation with psychological comorbidities QOL scores (p = 0.167). There was a nonsignificant increase of EQ-5L scores over the period of follow-up (p = 0.174) in the repeated-measures analysis. In the regression analysis, impaired QOL and physical disability on follow-up correlated with elevated preoperative anxiety and depression levels.

CONCLUSIONS

The QOL and physical disability of patients undergoing resection of an intracranial meningioma highly depend on preoperative anxiety and depression levels. Stress and anxiety scores generally decrease after the resection, which leads us to conclude that there is a tremendous emotional burden caused by an upcoming surgery, necessitating close psychooncological support in order to uphold functional outcome and health-related QOL in the postoperative course.

ABBREVIATIONS ADS = Allgemeine Depressionsskala; ASI-3 = Anxiety Sensitivity Index–3; MCS = Mental Component Summary; mRS = modified Rankin Scale; PCS = Physical Component Summary; PTSS-10 = Post-Traumatic Stress Scale–10; QOL = quality of life; SF-36 = 36-Item Short Form Health Survey; STAI-S = State Trait Anxiety Inventory–State Anxiety; STAI-T = STAI–Trait Anxiety; VAS = visual analog scale; WHO = World Health Organization.
Article Information

Contributor Notes

Correspondence Arthur Wagner: Klinikum rechts der Isar, Technische Universität München, Munich, Germany. arthur.wagner@tum.de.INCLUDE WHEN CITING Published online January 11, 2019; DOI: 10.3171/2018.8.JNS181343.

A.W. and Y.S. contributed equally to this work.

Disclosures Dr. E. Shiban reports being a consultant for Nevro.
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