Impact of resection location on depressive symptoms following glioma surgery

Abstract

Background: Glioma surgery aims to maximize tumor removal while preserving functional integrity. Functional outcome usually focuses on neurological and neurocognitive functions, but surgery may also affect mood regulation. We determined the occurrence of depressive symptoms after surgery and investigated associated factors, including preoperative depressive symptoms and the location of the resection.

Methods: We included a single-center retrospective cohort of patients with supratentorial diffuse glioma (WHO grade 2-4) who underwent first-time surgical resection between 2009 and 2021 and who completed the Center for Epidemiologic Studies Depression Scale (CES-D) before and one year after surgery. Resection cavities were segmented on postoperative MRI scans. White matter disconnections were computed, the so-called disconnectome, to examine distant effects. Multivariable regression analysis was used to relate patient, tumor, and treatment characteristics to postoperative depression scores and changes after surgery. Lesion-symptom mapping was used to relate resection and disconnectome locations to these scores and changes.

Results: The study included 83 patients. Before surgery, 25% of patients had depressive symptoms and one year after surgery 34%, which was not statistically different. Resections of gliomas in the right hemisphere were significantly associated with increased depression scores after surgery. A resection involving the left anterior temporal region was significantly associated with low postoperative depression scores. Disconnectome locations were not associated with either postoperative or change in depression scores.

Conclusions: Resection locations affect depressive symptoms in glioma patients. This information may be useful for patient counseling.

Keywords: Lesion-symptom mapping; brain neoplasms; connectome; depression; mood disorders.

Figure 1.

Depressive symptoms scores. (A) Depressive symptoms before and after surgery and the flow of changes in depressive symptoms. (B) Depression scores before and after surgery. (C) Histogram of depression scores after surgery minus depression scores before surgery.

Figure 2.

Resection location maps. (A) Distribution map of resection locations for all patients (B) Resection location distributions for patients without and with risk of depression after surgery. (C) T-statistic map of the relation between cavity location and postoperative depression score. Blue colors indicate voxels where a cavity is more likely to be related to low postoperative depression scores and red colors indicate voxels where a cavity is more likely to be related to high depression scores. Color intensity shows relationship strength. The lowest FWE P is .046 (significant). (D) Resection location distributions for patients with a decrease and increase in depression score change. For three patients, the depression scores did not change and were omitted from visualization. (E) T-statistic of the relation between cavity location and change in depression scores. Blue colors indicate voxels where a cavity is more likely to be related to a decrease in depression score and red colors indicate voxels where a cavity is more likely to be related to an increase in depression score. Color intensity shows relationship strength. The lowest FWE P is .037 (significant). The plotted numbers below represent z-axis slices in standard space.

Figure 3.

(A) Map of intersecting resection locations significantly associated with lower postoperative depression score and a larger decrease in depression score (FWE P < .05). (B) Preoperative and postoperative depression scores of patients with and without resection that overlap with the region depicted in panel A. Lower depression scores reflect less depressive symptoms.