MOOD CHANGES AFTER SURGERY FOR TUMORS OF THE CEREBRAL-CORTEX

Objective: To identify cortical lesion sites associated with particula r mood states. Design: A prospective study of patients with tumors aff ecting the cerebral cortex. The patients were examined neuropsychologi cally 1 to 5 days preoperatively and 2 to 10 days, several months, and several years postoperatively. Only data from the preoperative and th e first postoperative examination were considered in this report. Sett ing: Neurosurgical department of the University of Heidelberg (Germany ). Patients and Subjects: A consecutive sample of 141 patients with br ain tumors (84 female and 57 male) with cortical lesions caused by mic rosurgical tumor resection; 29 clinical control patients (having under gone surgery for slipped disks); and 18 normal control subjects. Main Outcome Measure: Preoperative and postoperative mood state as measured with an adjective checklist. Results: (1) Patients with lesions of th e ventral frontal cortex or lesions of the temporoparietal cortex repo rted postoperatively significantly (P<.01) worse mood states (anxiety/ depression, irritability/anger, fatigue) than did patients in the othe r lesion and control groups. (2) A more detailed lesion analysis revea led that lesions of heteromodal frontal or parietal association cortex es, combined with paralimbic lesions, were responsible for the negativ e mood states. Lesions of the sensorimotor cortexes ameliorated the ne gative effects of heteromodal and paralimbic lesions. (3) Lesion later ality did not influence the mood states. Conclusions: Heteromodal cort exes may be especially concerned with emotionally relevant operations. A loss of these functions deprives limbic structures of one of their main sources of input and is therefore likely also to produce changes in feelings, that is, emotional states.