Prakash Swetha, Gooderham Peter, Akagami Ryojo
Division of Neurosurgery, University of British Columbia Faculty of Medicine, Vancouver, Canada.
University of Alberta Faculty of Medicine, Edmonton, Canada.
J Neurol Surg B Skull Base. 2023 Mar 10;85(2):189-201. doi: 10.1055/a-2028-6373. eCollection 2024 Apr.
Emotional lability (EL), the uncontrollable and unmotivated expression of emotion, is a rare and distressing symptom of brainstem compression. In published case reports, EL from an extra-axial posterior fossa tumor was alleviated by tumor resection. The primary aim herein was to radiographically establish the degree of compression from mass lesions onto brainstem structures. Secondarily, we compared changes in patient-reported quality of life (QOL) pre- and postoperatively. A retrospective review of posterior fossa tumors treated between 2002 and 2018 at Vancouver General Hospital revealed 11 patients with confirmed EL. Each case was matched to three controls. A lateral brainstem compression scale characterized mass effect at the level of the medulla, pons, and midbrain in preoperative axial T2-weighted fluid-attenuated inversion recovery magnetic resonance imaging (FLAIR MRI) scans. Compression and clinical variables were compared between patient groups. Short Form-36 version 1 health surveys were retrospectively obtained from patient charts to compare pre- versus postoperative changes in survey scores between EL and control patients. EL symptoms ceased postoperatively for all EL patients. EL tumors exert greater compression onto the pons ( = 0.03) and EL patients more commonly have cerebellar findings preoperatively ( = 0.003). Patients with EL-causing tumors experienced greater improvement postoperatively in "Health Change" ( = 0.05), which was maintained over time. Findings suggest that compression onto the pons inhibits control over involuntary, stereotyped expression of emotion. This adds to evidence that EL may be attributed to cerebellum deafferentation from cortical and limbic structures through the basis pontis, leading to impaired modulation of emotional response. QOL results augment benefits of offering patients EL-alleviating tumor resection surgery.
情感不稳定（EL），即无法控制且无动机的情感表达，是脑干受压的一种罕见且令人痛苦的症状。在已发表的病例报告中，轴外后颅窝肿瘤导致的EL通过肿瘤切除得以缓解。本文的主要目的是通过影像学确定肿块病变对脑干结构的压迫程度。其次，我们比较了患者报告的术前和术后生活质量（QOL）的变化。
对2002年至2018年在温哥华总医院接受治疗的后颅窝肿瘤进行回顾性研究，发现11例确诊为EL的患者。每个病例与三个对照进行匹配。在术前轴向T2加权液体衰减反转恢复磁共振成像（FLAIR MRI）扫描中，一个侧位脑干压迫量表用于表征延髓、脑桥和中脑水平的占位效应。比较患者组之间的压迫和临床变量。从患者病历中回顾性获取简式36健康调查1版，以比较EL患者和对照患者术前与术后调查分数的变化。
所有EL患者术后EL症状均消失。EL肿瘤对脑桥的压迫更大（P = 0.03），EL患者术前更常见小脑病变（P = 0.003）。导致EL的肿瘤患者术后在“健康变化”方面有更大改善（P = 0.05），且这种改善随时间持续存在。
研究结果表明，对脑桥的压迫会抑制对情感的非自主、刻板表达的控制。这进一步证明EL可能归因于小脑通过脑桥基底部与皮质和边缘结构的传入神经切断，导致情感反应调节受损。生活质量结果增加了为患者提供缓解EL的肿瘤切除手术的益处。
