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J Neurol Surg B Skull Base 2024; 85(02): 189-201
DOI: 10.1055/a-2028-6373
Original Article

Emotional Lability as a Symptom of Extra-axial Posterior Fossa Tumors: a Case–Control Review of Neuroanatomy and Patient-Reported Quality of Life

Swetha Prakash 
1   Division of Neurosurgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
2   University of Alberta Faculty of Medicine, Edmonton, Canada
,
Peter Gooderham
1   Division of Neurosurgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
,
Ryojo Akagami
1   Division of Neurosurgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
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Abstract

Introduction Emotional lability (EL), the uncontrollable and unmotivated expression of emotion, is a rare and distressing symptom of brainstem compression. In published case reports, EL from an extra-axial posterior fossa tumor was alleviated by tumor resection. The primary aim herein was to radiographically establish the degree of compression from mass lesions onto brainstem structures. Secondarily, we compared changes in patient-reported quality of life (QOL) pre- and postoperatively.

Methods A retrospective review of posterior fossa tumors treated between 2002 and 2018 at Vancouver General Hospital revealed 11 patients with confirmed EL. Each case was matched to three controls. A lateral brainstem compression scale characterized mass effect at the level of the medulla, pons, and midbrain in preoperative axial T2-weighted fluid-attenuated inversion recovery magnetic resonance imaging (FLAIR MRI) scans. Compression and clinical variables were compared between patient groups. Short Form-36 version 1 health surveys were retrospectively obtained from patient charts to compare pre- versus postoperative changes in survey scores between EL and control patients.

Results EL symptoms ceased postoperatively for all EL patients. EL tumors exert greater compression onto the pons (p = 0.03) and EL patients more commonly have cerebellar findings preoperatively (p = 0.003). Patients with EL-causing tumors experienced greater improvement postoperatively in “Health Change” (p = 0.05), which was maintained over time.

Conclusion Findings suggest that compression onto the pons inhibits control over involuntary, stereotyped expression of emotion. This adds to evidence that EL may be attributed to cerebellum deafferentation from cortical and limbic structures through the basis pontis, leading to impaired modulation of emotional response. QOL results augment benefits of offering patients EL-alleviating tumor resection surgery.

Keywords

skull base - posterior fossa - emotional lability - quality of life - brainstem compression


Publication History

Received: 11 November 2022

Accepted: 29 January 2023

Accepted Manuscript online:
04 February 2023

Article published online:
10 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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