Pre-operative and post-operative psychiatric manifestations in patients with supratentorial meningiomas

In the present study, we have tried to delineate the nature of psychiatric abnormalities caused by supratentorial meningiomas and the effect of surgery on them. We have tried to find the patient and tumor characters influencing the psychiatric abnormalities and their post-operative outcome.

This is a prospective study conducted on patients with supratentorial meningiomas, admitted and operated in neurosurgery department, Nizam's Institute of Medical Sciences, India, from July 2006 to July 2009. We have included fifty-seven patients aged between 15 and 65 years with a clinico-radiological diagnosis of supratentorial meningioma in our study. We later confirmed the diagnosis by histopathological examination of the tumor. We have evaluated the patients for psychiatric manifestations before and after surgery and also analyzed the various clinical and radiological factors influencing the psychiatric status.

We have enrolled 57 patients into the study. Frontal group had 22 patients (38.6%), parietal group had 10 patients (17.5%), temporal group had 10 patients (17.5%), occipital group had 6 patients (10.5%), and suprasellar group had 9 patients (15.8%). Twenty patients (35.1%) presented with psychiatric symptoms. The frequency of psychiatric symptoms was highest in the temporal group (60%) followed by the frontal group (45.5%). Frontal convexity meningiomas presented predominantly with depression, basifrontal and sphenoid wing meningiomas presented with mania or depressive symptoms, Suprasellar lesions and temporal convexity lesions presented with organic delusional disorder. Basifrontal meningiomas also caused organic personality disorders. The frequency of psychiatric symptoms was much higher in meningiomas with volume greater than 35cc compared to the smaller ones, in the frontal group. None of the patients developed new psychiatric symptoms after surgery. Among the twenty patients with psychiatric symptoms, 3 (15%) didnot improve, 8 (40%) improved partly and 9 (45%) improved completely.

Meningiomas, although extra-axial, cause significant psychiatric symptoms up to 35.1%. Frontal and temporal group of meningiomas have the highest frequency of psychiatric symptoms. The frequency of psychiatric symptoms was significantly higher in meningiomas with volume greater than 35cc compared to the smaller ones, in the frontal group. Surgical excision of meningiomas ameliorates the psychiatric symptoms, either completely or partly, in the majority of the patients.