The observation of patients, treated neurosurgically for expansive posterior cranial fossa lesions, presenting signs of depression at admission or during the post-operative period suggests a possible role of the brainstem and cerebellum in mood regulation. Observations in various neuroscience areas including neurochemistry, neuroanatomy, neuroradiology, and neurology seem to support this hypothesis. Due to insufficient literature on the subject and the considerable number of patients treated for expansive posterior cranial fossa lesion at the Neurosurgery Section in the Department of Neurological Sciences and Vision at the University of Verona Hospital, a prospective study was performed on all patients treated for subtentorial intracranial lesions, beginning from July 1997, to determine the incidence of Major Depression (DSM-IV) in this population and the possible correlation between clinical and radiological factors including: age, sex, psychiatric history, length of clinical history, neurological condition prior to surgery, site and dimension of lesion, presence of hydrocephalus, and histology. During July '97-Nov '97, 29 patients underwent neurological and psychiatric evaluation (interview and Montgomery-Asberg Depression Scale); pre-operative MRI evaluation was performed in 19 cases. The incidence of Major Depression was 18%; 10% of patients presented a degree of minor depression, although insufficient to satisfy the DSM-IV criteria for Major Depression. Seventy-two percent of the patients resulted not depressed. Statistical analysis did not demonstrate any significant correlation between depression and the clinico-radiological factors analyzed. A review of literature is also presented with an emphasis on the epidemiology of Major Depression.
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