Orepic Pavo, Iannotti Giannina Rita, Haemmerli Julien, Goga Cristina, Park Hyeong-Dong, Betka Sophie, Blanke Olaf, Michel Christoph M, Bondolfi Guido, Schaller Karl
Laboratory of Cognitive Neuroscience, NeuroX Institute and Brain Mind Institute, Faculty of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.
Functional Brain Mapping Lab, Department of Fundamental Neurosciences, University of Geneva, Geneva, Switzerland; Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Cortex. 2023 Nov;168:157-166. doi: 10.1016/j.cortex.2023.08.006. Epub 2023 Aug 25.
Personality changes following neurosurgical procedures remain poorly understood and pose a major concern for patients, rendering a strong need for predictive biomarkers. Here we report a case of a female patient in her 40s who underwent resection of a large sagittal sinus meningioma with bilateral extension, including resection and ligation of the superior sagittal sinus, that resulted in borderline personality disorder. Importantly, we captured clinically-observed personality changes in a series of experiments assessing self-other voice discrimination, one of the experimental markers for self-consciousness. In all experiments, the patient consistently confused self- and other voices - i.e., she misattributed other-voice stimuli to herself and self-voice stimuli to others. Moreover, the electroencephalogram (EEG) microstate, that was in healthy participants observed when hearing their own voice, in this patient occurred for other-voice stimuli. We hypothesize that the patient's personality alterations resulted from a gradual development of a venous collateral hemodynamic network that impacted venous drainage of brain areas associated with self-consciousness. In addition, resection and ligation of the superior sagittal sinus significantly aggravated personality alterations through postoperative decompensation of a direct frontal lobe compression. Experimentally mirroring clinical observations, these findings are of high relevance for developing biomarkers of post-surgical personality alterations.
神经外科手术后的人格变化仍未得到充分理解，这给患者带来了重大担忧，因此迫切需要预测性生物标志物。在此，我们报告一例40多岁的女性患者，她接受了大型矢状窦脑膜瘤切除术，肿瘤双侧扩展，包括切除和结扎上矢状窦，术后出现了边缘型人格障碍。重要的是，我们在一系列评估自我与他人声音辨别能力的实验中捕捉到了临床上观察到的人格变化，自我与他人声音辨别能力是自我意识的实验标志物之一。在所有实验中，该患者始终混淆自我与他人的声音——也就是说，她将他人声音刺激误认为是自己的，而将自己的声音刺激误认为是他人的。此外，健康参与者在听到自己声音时观察到的脑电图（EEG）微状态，在该患者身上却出现在他人声音刺激时。我们推测，患者的人格改变是由于静脉侧支血流动力学网络的逐渐发展，影响了与自我意识相关脑区的静脉引流。此外，上矢状窦的切除和结扎通过术后额叶直接压迫的代偿失调显著加重了人格改变。这些发现通过实验反映了临床观察结果，对于开发术后人格改变的生物标志物具有高度相关性。
