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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  • 1 Department of Neurosurgery, Technische Universität München, Munich; and
  • 2 Department of Clinical Psychology, Private University of Applied Sciences, Göttingen, Germany
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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.

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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.

  • 1

    Auerbach SM: Trait-state anxiety and adjustment to surgery. J Consult Clin Psychol 40:264271, 1973

  • 2

    Benz LS, Wrensch MR, Schildkraut JM, Bondy ML, Warren JL, Wiemels JL, : Quality of life after surgery for intracranial meningioma. Cancer 124:161166, 2018

    • Search Google Scholar
    • Export Citation
  • 3

    Bullinger M, Kirchberger I: SF-36 Fragebogen zum Gesundheitszustand. Göttingen: Hogrefe-Verlag, 1998

  • 4

    Bunevicius A: Personality traits, patient-centered health status and prognosis of brain tumor patients. J Neurooncol 137:593600, 2018

    • Search Google Scholar
    • Export Citation
  • 5

    Bunevicius A, Tamasauskas S, Deltuva V, Tamasauskas A, Radziunas A, Bunevicius R: Predictors of health-related quality of life in neurosurgical brain tumor patients: focus on patient-centered perspective. Acta Neurochir (Wien) 156:367374, 2014

    • Search Google Scholar
    • Export Citation
  • 6

    Chan RC, Thompson GB: Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 60:5260, 1984

    • Search Google Scholar
    • Export Citation
  • 7

    D’Angelo C, Mirijello A, Leggio L, Ferrulli A, Carotenuto V, Icolaro N, : State and trait anxiety and depression in patients with primary brain tumors before and after surgery: 1-year longitudinal study. J Neurosurg 108:281286, 2008

    • Search Google Scholar
    • Export Citation
  • 8

    Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL: Epidemiology of meningiomas post-Public Law 107-206: The Benign Brain Tumor Cancer Registries Amendment Act. Cancer 121:24002410, 2015

    • Search Google Scholar
    • Export Citation
  • 9

    Drewes C, Sagberg LM, Jakola AS, Solheim O: Quality of life in patients with intracranial tumors: does tumor laterality matter? J Neurosurg 125:14001407, 2016

    • Search Google Scholar
    • Export Citation
  • 10

    Goebel S, Mehdorn HM: Development of anxiety and depression in patients with benign intracranial meningiomas: a prospective long-term study. Support Care Cancer 21:13651372, 2013

    • Search Google Scholar
    • Export Citation
  • 11

    Gupta RK, Kumar R: Benign brain tumours and psychiatric morbidity: a 5-years retrospective data analysis. Aust N Z J Psychiatry 38:316319, 2004

    • Search Google Scholar
    • Export Citation
  • 12

    Hautzinger M, Bailer M: Allgemeine Depressionsskala (ADS). Weinheim: Beltz Test, 1993

  • 13

    Holen A, Sund A, Weisaeth L: The Alexander Kielland Disaster March 27th 1980: Psychological Reactions Among the Survivors. Oslo: Oslo University, 1983

    • Search Google Scholar
    • Export Citation
  • 14

    Jakola AS, Gulati M, Gulati S, Solheim O: The influence of surgery on quality of life in patients with intracranial meningiomas: a prospective study. J Neurooncol 110:137144, 2012

    • Search Google Scholar
    • Export Citation
  • 15

    Jones SH, Iannone AF, Patel KS, Anchouche K, Raza SM, Anand VK, : The impact of age on long-term quality of life after endonasal endoscopic resection of skull base meningiomas. Neurosurgery 79:736745, 2016

    • Search Google Scholar
    • Export Citation
  • 16

    Kalkanis SN, Quiñones-Hinojosa A, Buzney E, Ribaudo HJ, Black PM: Quality of life following surgery for intracranial meningiomas at Brigham and Women’s Hospital: a study of 164 patients using a modification of the functional assessment of cancer therapy-brain questionnaire. J Neurooncol 48:233241, 2000

    • Search Google Scholar
    • Export Citation
  • 17

    Kelleher MO, Fernandes MF, Sim DW, O’Sullivan MG: Health-related quality of life in patients with skull base tumours. Br J Neurosurg 16:1620, 2002

    • Search Google Scholar
    • Export Citation
  • 18

    Kemper CJ, Lutz J, Bähr T, Rüddel H, Hock M: Construct validity of the Anxiety Sensitivity Index-3 in clinical samples. Assessment 19:89100, 2012

    • Search Google Scholar
    • Export Citation
  • 19

    Laux L, Glanzmann P, Schaffner P, Spielberger CD: Das State-Trait-Angstinventar. Weinheim: Beltz Test, 1981

  • 20

    Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, : The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 131:803820, 2016

    • Search Google Scholar
    • Export Citation
  • 21

    Maercker A, Michael T: Posttraumatische Belastungsstörungen, in Margraf J, Schneider S (eds): Lehrbuch der Verhaltenstherapie. Störungen im Erwachsenenalter—Spezielle Indikatoren—Glossar, ed 3. Berlin: Springer, 2009, pp 105124

    • Search Google Scholar
    • Export Citation
  • 22

    Miao Y, Lu X, Qiu Y, Jiang J, Lin Y: A multivariate analysis of prognostic factors for health-related quality of life in patients with surgically managed meningioma. J Clin Neurosci 17:446449, 2010

    • Search Google Scholar
    • Export Citation
  • 23

    Mohsenipour I, Deusch E, Gabl M, Hofer M, Twerdy K: Quality of life in patients after meningioma resection. Acta Neurochir (Wien) 143:547553, 2001

    • Search Google Scholar
    • Export Citation
  • 24

    Moliterno J, Cope WP, Vartanian ED, Reiner AS, Kellen R, Ogilvie SQ, : Survival in patients treated for anaplastic meningioma. J Neurosurg 123:2330, 2015

    • Search Google Scholar
    • Export Citation
  • 25

    Poon MTC, Fung LHK, Pu JKS, Leung GKK: Outcome comparison between younger and older patients undergoing intracranial meningioma resections. J Neurooncol 114:219227, 2013

    • Search Google Scholar
    • Export Citation
  • 26

    Pringle AM, Taylor R, Whittle IR: Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. Br J Neurosurg 13:4651, 1999

    • Search Google Scholar
    • Export Citation
  • 27

    Rankin J: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 2:200215, 1957

  • 28

    Shiban E, Lehmberg J, Hoffmann U, Thiel J, Probst T, Friedl M, : Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery. Eur J Psychotraumatol 9:1423824, 2018

    • Search Google Scholar
    • Export Citation
  • 29

    van Nieuwenhuizen D, Klein M, Stalpers LJA, Leenstra S, Heimans JJ, Reijneveld JC: Differential effect of surgery and radiotherapy on neurocognitive functioning and health-related quality of life in WHO grade I meningioma patients. J Neurooncol 84:271278, 2007

    • Search Google Scholar
    • Export Citation
  • 30

    Veilleux N, Goffaux P, Boudrias M, Mathieu D, Daigle K, Fortin D: Quality of life in neurooncology—age matters. J Neurosurg 113:325332, 2010

    • Search Google Scholar
    • Export Citation
  • 31

    von der Schulenburg JMG, Claes C, Greiner W, Uber A: Die deutsche Version des EuroQol-Fragebogens. Z Gesundheitswiss 6:320, 1998

  • 32

    Wenz H, Wenz R, Groden C, Schmieder K, Fontana J: The pre-interventional psychiatric history—an underestimated confounder in benign intracranial lesions studies. Clin Neurol Neurosurg 137:116120, 2015

    • Search Google Scholar
    • Export Citation
  • 33

    Wenz H, Wenz R, Maros ME, Groden C, Schmieder K, Fontana J: The neglected need for psychological intervention in patients suffering from incidentally discovered intracranial aneurysms. Clin Neurol Neurosurg 143:6570, 2016

    • Search Google Scholar
    • Export Citation
  • 34

    Wu A, Garcia MA, Magill ST, Chen W, Vasudevan HN, Perry A, : Presenting symptoms and prognostic factors for symptomatic outcomes following resection of meningioma. World Neurosurg 111:e149e159, 2018

    • Search Google Scholar
    • Export Citation
  • 35

    Yamashiro S, Nishi T, Koga K, Kaji M, Goto T, Muta D, : [Self-assessed quality of life in patients who underwent surgery for asymptomatic meningiomas.] No Shinkei Geka 35:11491155, 2007 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 36

    Yao CM, Kahane A, Monteiro E, Gentili F, Zadeh G, de Almeida JR: Preferences and utilities for health states after treatment of olfactory groove meningioma: endoscopic versus open. J Neurol Surg B Skull Base 78:315323, 2017

    • Search Google Scholar
    • Export Citation
  • 37

    Zamanipoor Najafabadi AH, Peeters MCM, Dirven L, Lobatto DJ, Groen JL, Broekman MLD, : Impaired health-related quality of life in meningioma patients—a systematic review. Neuro Oncol 19:897907, 2017

    • Search Google Scholar
    • Export Citation
  • 38

    Zweckberger K, Hallek E, Vogt L, Giese H, Schick U, Unterberg AW: Prospective analysis of neuropsychological deficits following resection of benign skull base meningiomas. J Neurosurg 127:12421248, 2017

    • Search Google Scholar
    • Export Citation

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