Depression as a focal symptom in patients with posterior fossa tumors. Preliminary results.

Psychiatric disorders are very rarely investigated in neurosurgical patients and are not considered specifically related to surgical pathology, so the hypothesis that mood disorders could be a focal symptom in patients with posterior fossa tumors seems very daring. We present preliminary results of an ongoing prospective study based on observations from various fields of neuroscience and our personal experience. We enrolled 25 consecutive cases with posterior fossa tumors over 3 months. We only excluded patients under 16 years of age. All the patients had a psychiatric evaluation to ascertain the existence and degree of depression (DSM-IV criteria and Montgomery-Asberg Depression Rating Scale-MADRS). Three groups were defined: Major Depression (n= 6), less than Major Depression (MADRS > 12, n=2), and normal (n=17). The global incidence of Major Depression in this series is 24%, higher than either in the normal population (3%) or among those hospitalized for acute illness (18%). Different levels of statistical analysis (univariate and multivariate logistic regression) were planned to determine which of the following factors are associated with depression: sex, age, personal and family history of depression, length of clinical history, Karnofsky Score, size and location of the tumor, hydrocephalus, morphology of the posterior fossa and histology. Follow-up evaluations were performed as well, to assess the role of surgical and perioperative factors in the possible development of depression. At present we can conclude that depression is unusually high in patients with posterior fossa tumors, but further analyses are required to confirm and understand these preliminary results.