Citation

Sade B, Budur K, Lee DK, Franco K, Lee JH. Surg. Neurol. 2006; 65(3): 290-292; discussion 292.

Copyright

(Copyright © 2006, Elsevier Publishing)

DOI

10.1016/j.surneu.2005.06.041

PMID

16488253

Abstract

BACKGROUND: Postoperative onset of acute major depression in a patient with no previous history of psychiatric disorder is highly unexpected after skull base surgery.
CASE DESCRIPTION: A 38-year-old woman with no previous physical or mental illness presented with a 3-month history of left ear pain, short-term memory disturbance, and motor dysphasia. Magnetic resonance imaging revealed a large extraaxial tumor in the left middle fossa. Left temporal craniotomy was performed, achieving complete tumor resection. The patient showed signs of confusion, disorientation, and severe depression 3 days after the surgery. She developed insomnia and auditory hallucinations along with expressed suicidal ideation, then deteriorated rapidly, necessitating a transfer to a psychiatric unit. In spite of the intensive treatment with antidepressive and antipsychotic medications, she continued to have prolonged psychotic symptoms and depression for several months after surgery.
CONCLUSION: Although the incidence is rare, psychiatric complications should be anticipated in patients undergoing resection of a large skull base tumor affecting the temporal lobe. The exact mechanism in this process is not clear; however, it is important to clinically differentiate treatable etiologies such as steroid-induced psychosis and postoperative delirium.

Language: en

Keywords

Affective Disorders, Psychotic; Antidepressive Agents; Antipsychotic Agents; Cranial Fossa, Middle; Depressive Disorder, Major; Follow-Up Studies; Hemangiopericytoma; Humans; Image Enhancement; Magnetic Resonance Imaging; Neurologic Examination; Patient Admission; Postoperative Complications; Referral and Consultation; Skull Base Neoplasms; Suicide, Attempted