Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada.
J Acad Consult Liaison Psychiatry. 2022 Mar-Apr;63(2):110-118. doi: 10.1016/j.jaclp.2021.06.007. Epub 2021 Jul 3.
Brain tumors are one of the most common solid tumors in pediatric populations, with their treatments having significant neuropsychiatric impact.
The objective of this study was to review the literature on neuropsychiatric sequelae after surgical resection of brain tumors in children and adolescents.
Using a scoping method, we reviewed empirical articles describing pediatric patients with brain tumors who underwent partial or total resection and examined major neuropsychiatric domains postoperatively over time.
The initial search yielded 15,543 articles. After duplicate removal, abstract screening, and review, 44 articles were included. Cognitive deficits were the most widely studied outcomes and found to be associated with tumor location, operative variables, perioperative complications, treatment types, and psychosocial factors. Cerebellar mutism, or posterior fossa syndrome, commonly co-occurred with emotional and behavioral dysregulation after posterior fossa resections. Depression, anxiety, and somatization were frequently grouped together as "distress," with higher rates among pediatric patients with brain tumor than among healthy peers. Problematic school behaviors, antisocial, and attention-deficit traits were increased; however, several other behaviors (e.g., risky sexual behaviors, substance use) were equal or lower when compared to peers. Posttraumatic stress disorder was highly prevalent and often interfered with social functioning. Delirium, eating disorders, and longer-term outcomes received inadequate attention.
Identifying risk factors of neuropsychiatric sequelae and their impact after pediatric brain tumor resection is important for prognostication and the development of tailored management strategies for these children and adolescents.
脑肿瘤是儿童中最常见的实体肿瘤之一，其治疗对神经精神有重大影响。
本研究旨在回顾儿童脑瘤手术后神经精神后遗症的文献。
采用范围界定方法，我们回顾了描述行部分或全部切除术的脑瘤儿科患者的实证文章，并随时间检查了主要神经精神领域的术后情况。
最初的搜索产生了 15543 篇文章。在去除重复项、摘要筛选和审查后，共纳入 44 篇文章。认知缺陷是研究最广泛的结果，并且发现与肿瘤位置、手术变量、围手术期并发症、治疗类型和社会心理因素有关。小脑缄默症或后颅窝综合征，通常与后颅窝切除后情绪和行为失调同时发生。抑郁、焦虑和躯体化经常被归为“困扰”，脑瘤患儿的发生率高于健康同龄人。问题行为、反社会和注意力缺陷的发生率增加；然而，与同龄人相比，其他一些行为（如危险的性行为、物质使用）则相等或更低。创伤后应激障碍的发病率很高，经常干扰社交功能。谵妄、饮食失调和长期结果受到的关注不足。
确定儿童脑瘤切除术后神经精神后遗症的风险因素及其对这些儿童和青少年的影响，对于预测和制定针对这些儿童和青少年的个体化管理策略非常重要。
