1Department of Neurosurgery, Technische Universität München, Munich; and.
2Department of Clinical Psychology, Private University of Applied Sciences, Göttingen, Germany.
J Neurosurg. 2019 Jan 11;131(6):1840-1847. doi: 10.3171/2018.8.JNS181343. Print 2019 Dec 1.
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.
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.
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.
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.
脑膜瘤是最常见的颅内肿瘤。关于脑膜瘤的手术治疗和预后的证据很多，但对于诊断为脑膜瘤并接受手术的患者的生活质量（QOL）的影响尚不清楚。作者进行了一项前瞻性研究，以评估与心理合并症相关的 QOL。
对 78 例行颅内脑膜瘤切除术的患者进行前瞻性研究。作者评估了术前和术后 3 个月和 12 个月的抑郁（一般抑郁量表 K 评分）和焦虑（创伤后应激量表-10 [PTSS-10]；状态特质焦虑量表-状态焦虑和特质焦虑 [STAI-S 和 STAI-T]；焦虑敏感指数-3 [ASI-3]）评分。分析了术前心理负担与术后 36 项简明健康调查和 EQ-5L 问卷测量的 QOL 之间的相关性。检查了这些精神合并症对临床结果的发生率和影响。
2013 年 1 月至 2017 年 9 月期间，共 78 例患者接受了脑膜瘤切除术，其中 78 例患者在术前进行了心理筛查，71 例患者在术后 1 年的随访中完成了术后随访检查。在入组时，48 例患者（67.7%）有异常焦虑评分，降至 29.6%（p=0.003）。在 12 个月的随访中，PTSS-10（0.84 对 0.69；p=0.004）、STAI-S（0.86 对 0.68；p=0.001）和 STAI-T（0.85 对 0.71；p=0.011）病理评分异常的患者的平均 EQ-5L 视觉模拟评分显著降低。神经状态（改良 Rankin 量表）略有改善，与心理合并症 QOL 评分有一定相关性（p=0.167）。在重复测量分析中，EQ-5L 评分在随访期间没有显著增加（p=0.174）。在回归分析中，随访时 QOL 受损和躯体残疾与术前焦虑和抑郁水平升高相关。
接受颅内脑膜瘤切除术的患者的 QOL 和躯体残疾高度依赖于术前的焦虑和抑郁水平。术后，焦虑和抑郁评分普遍下降，这表明手术前存在巨大的情绪负担，需要密切的心理肿瘤学支持，以维持术后的功能结局和健康相关的 QOL。
