Psychoses after Surgery for Cerebral Glioma: Risk Factors and Outcomes

Background: the problem of postoperative psychosis in patients with cerebral gliomas remains extremely poorly understood. It is assumed that the development of postoperative psychoses prolongs the period of hospitalization and worsens the prognosis of the underlying disease, but the evidence for this is extremely scarce.

The aim was to determine the risk factors for postoperative psychosis and their impact on the results of treatment of brain gliomas.

Patients and Methods: this prospective, single-center observational study included a random sample of patients with glial brain tumors. A psychiatrist examined all patients immediately before and after surgery, as well as upon discharge, after which the results of treatment were determined after 6, 12 and 24 months. The selection criteria were age over 17, initial intervention for a tumor, and a verified diagnosis of cerebral glioma. The main methods were clinical-psychopathological and clinical-statistical, with the determination of significant differences between groups of patients with and without psychosis.

Results: the study included 125 patients (61 women; 64 men), aged from 18 to 73 years (on average 46.4 ± 2.6 years). Postoperative psychosis occurred in 26 (20.8%) patients in the form of isolated psychomotor agitation in 9 patients, isolated confusion in 9, a combination of psychomotor agitation and/or confusion with hallucinations and/or delusions in 8. It was found that the main factors significantly contributing to the occurrence of postoperative psychoses were the age over 60 years (p = 0.00622), weight over 80 kg (p = 0.00466) and such indicators of preoperative mental and somatic health as the presence of cognitive disorders (p = 0.00022), diabetes mellitus (p = 0.03544), hypertension diseases (p = 0.00064), as well as taking psychotropic drugs in the preoperative period (p = 0.00455). Psychoses were less frequent in the presence of structural epilepsy (p = 0.00347). A significant relationship between the occurrence of psychosis and the characteristics of the tumor was noted only in terms of tumor volume (p = 0.04453). Other factors as a slightly more frequent occurrence of psychoses in: a) damage to the median structures, b) preoperative cerebral edema, c) right-sided localization of an isolated lesion of any lobe of one of the hemispheres, as well as a rarer occurrence in isolated damage to the frontal lobe were not significant. Psychosis developed in 4 out of 5 patients with surgical complications requiring postoperative revision (p = 0.00087). Patients with postoperative psychosis had a longer hospital stay (p = 0.00036) and a lower survival rate for 24 months after surgery (p = 0.003166).

Conclusion: to prevent postoperative psychosis in patients with cerebral gliomas, special attention should be paid to the preoperative somatic and mental state of patients. In cases of psychosis, it is necessary to conduct an intensive search for measures to reduce mortality.

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