Skip to main content
SpringerLink
Log in

A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group.

Methods

Forty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning.

Results

The majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients’ Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors.

Conclusions

Although patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tos M, Charabi S, Thomsen J (1998) Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results. Eur Arch Otorhinolaryngol 255:1–6. https://doi.org/10.1007/s004050050012

    Article  CAS  PubMed  Google Scholar 

  2. Foley RW, Shirazi S, Maweni RM et al (2017) Signs and symptoms of acoustic neuroma at initial presentation: an exploratory analysis. Cureus 9:e1846. https://doi.org/10.7759/cureus.1846

    Article  PubMed  PubMed Central  Google Scholar 

  3. Carlson ML, Tveiten ØV, Driscoll CL et al (2015) What drives quality of life in patients with sporadic vestibular schwannoma? Laryngoscope 125:1697–1702. https://doi.org/10.1002/lary.25110

    Article  PubMed  Google Scholar 

  4. McLaughlin EJ, Bigelow DC, Lee JYK et al (2015) Quality of life in acoustic neuroma patients. Otol Neurotol 36:653–656. https://doi.org/10.1097/MAO.0000000000000674

    Article  PubMed  Google Scholar 

  5. Bateman N, Nikolopoulos TP, Robinson K et al (2000) Impairments, disabilities, and handicaps after acoustic neuroma surgery. Clin Otolaryngol 25:62–65. https://doi.org/10.1046/j.1365-2273.2000.00326.x

    Article  CAS  PubMed  Google Scholar 

  6. Ribeyre L, Frère J, Gauchard G et al (2015) Preoperative balance control compensation in patients with a vestibular schwannoma: does tumor size matter? Clin Neurophysiol 126:787–793. https://doi.org/10.1016/j.clinph.2014.07.022

    Article  PubMed  Google Scholar 

  7. Sandooram D, Grunfeld EA, McKinney C et al (2004) Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma. Clin Otolaryngol 29:621–627. https://doi.org/10.1111/j.1365-2273.2004.00881.x

    Article  CAS  PubMed  Google Scholar 

  8. Martin HC, Sethi J, Lang D et al (2001) Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. J Neurosurg 94:211–216. https://doi.org/10.3171/jns.2001.94.2.0211

    Article  CAS  PubMed  Google Scholar 

  9. British Association of Otolaryngologists – Head & Neck Surgeons (ed) (2002) Clinical effectiveness guidelines on acoustic neuroma (vestibular schwannoma). http://www.dohns.org/DOHNS/Resources_files/Vestibular%20Schwannoma%20Guidelines.pdf

  10. Tucha O, Smely C, Preier M et al (2000) Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47:324–334. https://doi.org/10.1097/00006123-200008000-00011

    Article  CAS  PubMed  Google Scholar 

  11. Goebel S, Stark AM, Kaup L et al (2011) Distress in patients with newly diagnosed brain tumours. Psychooncology 20:623–630. https://doi.org/10.1002/pon.1958

    Article  CAS  PubMed  Google Scholar 

  12. Pringle A-M, Taylor R, Whittle IR (1999) Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. Br J Neurosurg 13:46–51. https://doi.org/10.1080/02688699944177

    Article  CAS  PubMed  Google Scholar 

  13. Taphoorn MJB, Sizoo EM, Bottomley A (2010) Review on quality of life issues in patients with primary brain tumors. Oncologist 15(6):618–626. https://doi.org/10.1634/theoncologist.2009-0291

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hio S, Kitahara T, Uno A et al (2013) Psychological condition in patients with an acoustic tumor. Acta Otolaryngol 133:42–46. https://doi.org/10.3109/00016489.2012.709322

    Article  PubMed  Google Scholar 

  15. Kolb B, Whishaw IQ (2015) Fundamentals of human neuropsychology, 7th edn. Worth Publ, New York

    Google Scholar 

  16. Schmahmann J (1998) The cerebellar cognitive affective syndrome. Brain 121:561–579. https://doi.org/10.1093/brain/121.4.561

    Article  PubMed  Google Scholar 

  17. Mariën P, D’aes T (2015) “Brainstem cognitive affective syndrome” following disruption of the cerebrocerebellar network. Cerebellum 14:221–225. https://doi.org/10.1007/s12311-014-0624-x

    Article  PubMed  Google Scholar 

  18. Garrard P (2002) Cognitive dysfunction after isolated brain stem insult. An underdiagnosed cause of long term morbidity. J Neurol Neurosurg Psychiatry 73:191–194. https://doi.org/10.1136/jnnp.73.2.191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kim TW, Kim Y-H, Kim KH et al (2014) White matter hyperintensities and cognitive dysfunction in patients with infratentorial stroke. Ann Rehabil Med 38:620–627. https://doi.org/10.5535/arm.2014.38.5.620

    Article  PubMed  PubMed Central  Google Scholar 

  20. Meskal I, Gehring K, van der Linden SD et al (2015) Cognitive improvement in meningioma patients after surgery: clinical relevance of computerized testing. J Neurooncol 121:617–625. https://doi.org/10.1007/s11060-014-1679-8

    Article  PubMed  Google Scholar 

  21. Lezak MD, Howieson DB, Bigler ED, Tranel D (2012) Neuropsychological Assessment, 5th edn. University Press, Oxford

    Google Scholar 

  22. Armstrong CL, Goldstein B, Shera D et al (2003) The predictive value of longitudinal neuropsychologic assessment in the early detection of brain tumor recurrence. Cancer 97(3):649–656. https://doi.org/10.1002/cncr.11099

    Article  PubMed  Google Scholar 

  23. Talacchi A, d’Avella D, Denaro L et al (2012) Cognitive outcome as part and parcel of clinical outcome in brain tumor surgery. J Neurooncol 108(2):327–332. https://doi.org/10.1007/s11060-012-0818-3

    Article  CAS  PubMed  Google Scholar 

  24. Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 191–205

    Google Scholar 

  25. Taphoorn MJB, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3:159–168. https://doi.org/10.1016/S1474-4422(04)00680-5

    Article  PubMed  Google Scholar 

  26. Barona ACRL (1986) An improved estimate of premorbid IQ for blacks and whites on the WAIS-R. Int J Clin Neuropsychol 8:169–173

    Google Scholar 

  27. Osterrieth PA (1944) Le test de copie d’une figure complexe; contribution à l’étude de la perception et de la mémoire. Arch Psychol 30:206–356

    Google Scholar 

  28. Warrington EK, James M (1992) Testbatterie für visuelle 584Objekt- und Raumwahrnehmung (VOSP). 585Thames Valley Test Company, Burry St Edmunds

  29. Schenkenberg T, Bradford DC, Ajax ET (1980) Line bisection and unilateral visual neglect in patients with neurologic impairment. Neurology 30(5):509. https://doi.org/10.1212/WNL.30.5.509

    Article  CAS  PubMed  Google Scholar 

  30. Härting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J (eds) (2000) Wechsler Gedächtnistest - Revidierte Fassung (WMS-R). Huber, Bern

  31. Tombaugh T (2004) Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol 19(2):203–214. https://doi.org/10.1016/S0887-6177(03)00039-8

    Article  PubMed  Google Scholar 

  32. Zimmermann P, Fimm B (1994) Testbatterie zur Aufmerksamkeitsprüfung. PSYTEST, Herzogenrath

  33. Benton AL, Hamsher Kd (1989) Multilingual Aphasia Examination. AJA Associates, Iowa City

  34. Goebel S, Fischer R, Ferstl R et al (2009) Normative data and psychometric properties for qualitative and quantitative scoring criteria of the Five-point Test. Clin Neuropsychol 23(4):675–690. https://doi.org/10.1080/13854040802389185

    Article  PubMed  Google Scholar 

  35. Helmstaedter C, Durwen HF (1990) VLMT: a useful tool to assess and differentiate verbal memory performance. Schweizer Archiv für Neurologie Neurochirurgie Psychiatrie 14(1):21–30

    Google Scholar 

  36. Hubert W, Poeck K, Willmes-von-Hinckeldey K et al (1983) Aachener aphasie test. Hogrefe Verlag GmbH & Co., Göttingen

    Google Scholar 

  37. Hermann-Lingen C, Buss U, Snaith RP (2011) HADS-D Hospital Anxiety and Depression Scale-German Version: Deutsche Adaptation der Hospital Anxiety and Depression Scale (HADS) von R. P. Snaith und A. S. Zigmond

  38. Grulke N, Bailer H, Schmutzer G et al (2006) Standardization of the German short version of “profile of mood states” (POMS) in a representative sample—short communication. Psychother Psychosom Med Psychol 56(9–10):403–405. https://doi.org/10.1055/s-2006-940129

    Article  PubMed  Google Scholar 

  39. Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI J Natl Cancer Inst 85(5):365–376. https://doi.org/10.1093/jnci/85.5.365

    Article  CAS  PubMed  Google Scholar 

  40. Smet HJ de, Paquier P, Verhoeven J et al (2013) The cerebellum: its role in language and related cognitive and affective functions. Brain Lang 127(3):334–342. https://doi.org/10.1016/j.bandl.2012.11.001

    Article  PubMed  Google Scholar 

  41. Bodranghien F, Bastian A, Casali C et al (2016) Consensus paper: revisiting the symptoms and signs of cerebellar syndrome. Cerebellum 15(3):369–391. https://doi.org/10.1007/s12311-015-0687-3

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kansal K, Yang Z, Fishman AM et al (2017) Structural cerebellar correlates of cognitive and motor dysfunctions in cerebellar degeneration. Brain 140(3):707–720. https://doi.org/10.1093/brain/aww327

    Article  PubMed  Google Scholar 

  43. Kopelman MD (2002) Disorders of memory. Brain 125(10):2152–2190. https://doi.org/10.1093/brain/awf229

    Article  PubMed  Google Scholar 

  44. Jacobson S, Marcus EM, Pugsley S (2018) Brain stem functional localization. In: Jacobson S, Marcus EM, Pugsley S (eds) Neuroanatomy for the neuroscientist, vol 5. Springer, Cham, pp 169–204

    Chapter  Google Scholar 

  45. Perciavalle V, Apps R, Bracha V et al (2013) Consensus paper: current views on the role of cerebellar interpositus nucleus in movement control and emotion. Cerebellum 12(5):738–757. https://doi.org/10.1007/s12311-013-0464-0

    Article  PubMed  Google Scholar 

  46. Cronin T, Arshad Q, Seemungal BM (2017) Vestibular deficits in neurodegenerative disorders: balance, dizziness, and spatial disorientation. Front Neurol 8:538. https://doi.org/10.3389/fneur.2017.00538

    Article  PubMed  PubMed Central  Google Scholar 

  47. Karnath H-O, Dieterich M (2006) Spatial neglect—a vestibular disorder? Brain 129(Pt 2):293–305. https://doi.org/10.1093/brain/awh698

    Article  PubMed  Google Scholar 

  48. Kralj-Hans I, Baizer JS, Swales C et al (2007) Independent roles for the dorsal paraflocculus and vermal lobule VII of the cerebellum in visuomotor coordination. Exp Brain Res 177(2):209–222. https://doi.org/10.1007/s00221-006-0661-x

    Article  PubMed  Google Scholar 

  49. Carrera E, Tononi G (2014) Diaschisis: past, present, future. Brain 137(Pt 9):2408–2422. https://doi.org/10.1093/brain/awu101

    Article  PubMed  Google Scholar 

  50. Obrador S (1975) Brain stem vascular lesions affecting alertness and responsiveness. J Neurosurg Sci 19(4):211–214

    CAS  PubMed  Google Scholar 

  51. Sturm W, Willmes K (2001) On the functional neuroanatomy of intrinsic and phasic alertness. Neuroimage 14(1 Pt 2):S76–S84. https://doi.org/10.1006/nimg.2001.0839

    Article  CAS  Google Scholar 

  52. Rooney AG, Carson A, Grant R (2011) Depression in cerebral glioma patients: a systematic review of observational studies. J Natl Cancer Inst 103(1):61–76. https://doi.org/10.1093/jnci/djq458

    Article  PubMed  Google Scholar 

  53. Bunevicius A, Tamasauskas S, Deltuva V et al (2014) Predictors of health-related quality of life in neurosurgical brain tumor patients: Focus on patient-centered perspective. Acta Neurochir (Wien) 156(2):367–374. https://doi.org/10.1007/s00701-013-1930-7

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Maren Hinck for valuable support during manuscript preparation.

Author information

Authors and Affiliations

  1. Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Olshausenstraße 62, 24118, Kiel, Germany

    Simone Goebel

  2. Mehdorn Consilium, Prüner Gang 7, 24103, Kiel, Germany

    Hubertus Maximilian Mehdorn

Authors
  1. Simone Goebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hubertus Maximilian Mehdorn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simone Goebel.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goebel, S., Mehdorn, H.M. A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle. J Neurooncol 140, 145–153 (2018). https://doi.org/10.1007/s11060-018-2944-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-018-2944-z

Keywords

Search

Navigation