Journal of Neuro-Oncology

, Volume 140, Issue 1, pp 145–153 | Cite as

A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle

  • Simone GoebelEmail author
  • Hubertus Maximilian Mehdorn
Clinical Study



To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group.


Forty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning.


The majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients’ Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors.


Although patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.


Tumor Cerebellopontine angle Neuropsychology Cognition Affect HRQoL 



The authors are grateful to Maren Hinck for valuable support during manuscript preparation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Tos M, Charabi S, Thomsen J (1998) Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results. Eur Arch Otorhinolaryngol 255:1–6. CrossRefGoogle Scholar
  2. 2.
    Foley RW, Shirazi S, Maweni RM et al (2017) Signs and symptoms of acoustic neuroma at initial presentation: an exploratory analysis. Cureus 9:e1846. Google Scholar
  3. 3.
    Carlson ML, Tveiten ØV, Driscoll CL et al (2015) What drives quality of life in patients with sporadic vestibular schwannoma? Laryngoscope 125:1697–1702. CrossRefGoogle Scholar
  4. 4.
    McLaughlin EJ, Bigelow DC, Lee JYK et al (2015) Quality of life in acoustic neuroma patients. Otol Neurotol 36:653–656. CrossRefGoogle Scholar
  5. 5.
    Bateman N, Nikolopoulos TP, Robinson K et al (2000) Impairments, disabilities, and handicaps after acoustic neuroma surgery. Clin Otolaryngol 25:62–65. CrossRefGoogle Scholar
  6. 6.
    Ribeyre L, Frère J, Gauchard G et al (2015) Preoperative balance control compensation in patients with a vestibular schwannoma: does tumor size matter? Clin Neurophysiol 126:787–793. CrossRefGoogle Scholar
  7. 7.
    Sandooram D, Grunfeld EA, McKinney C et al (2004) Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma. Clin Otolaryngol 29:621–627. CrossRefGoogle Scholar
  8. 8.
    Martin HC, Sethi J, Lang D et al (2001) Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. J Neurosurg 94:211–216. CrossRefGoogle Scholar
  9. 9.
    British Association of Otolaryngologists – Head & Neck Surgeons (ed) (2002) Clinical effectiveness guidelines on acoustic neuroma (vestibular schwannoma).
  10. 10.
    Tucha O, Smely C, Preier M et al (2000) Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47:324–334. CrossRefGoogle Scholar
  11. 11.
    Goebel S, Stark AM, Kaup L et al (2011) Distress in patients with newly diagnosed brain tumours. Psychooncology 20:623–630. CrossRefGoogle Scholar
  12. 12.
    Pringle A-M, Taylor R, Whittle IR (1999) Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. Br J Neurosurg 13:46–51. CrossRefGoogle Scholar
  13. 13.
    Taphoorn MJB, Sizoo EM, Bottomley A (2010) Review on quality of life issues in patients with primary brain tumors. Oncologist 15(6):618–626. CrossRefGoogle Scholar
  14. 14.
    Hio S, Kitahara T, Uno A et al (2013) Psychological condition in patients with an acoustic tumor. Acta Otolaryngol 133:42–46. CrossRefGoogle Scholar
  15. 15.
    Kolb B, Whishaw IQ (2015) Fundamentals of human neuropsychology, 7th edn. Worth Publ, New YorkGoogle Scholar
  16. 16.
    Schmahmann J (1998) The cerebellar cognitive affective syndrome. Brain 121:561–579. CrossRefGoogle Scholar
  17. 17.
    Mariën P, D’aes T (2015) “Brainstem cognitive affective syndrome” following disruption of the cerebrocerebellar network. Cerebellum 14:221–225. CrossRefGoogle Scholar
  18. 18.
    Garrard P (2002) Cognitive dysfunction after isolated brain stem insult. An underdiagnosed cause of long term morbidity. J Neurol Neurosurg Psychiatry 73:191–194. CrossRefGoogle Scholar
  19. 19.
    Kim TW, Kim Y-H, Kim KH et al (2014) White matter hyperintensities and cognitive dysfunction in patients with infratentorial stroke. Ann Rehabil Med 38:620–627. CrossRefGoogle Scholar
  20. 20.
    Meskal I, Gehring K, van der Linden SD et al (2015) Cognitive improvement in meningioma patients after surgery: clinical relevance of computerized testing. J Neurooncol 121:617–625. CrossRefGoogle Scholar
  21. 21.
    Lezak MD, Howieson DB, Bigler ED, Tranel D (2012) Neuropsychological Assessment, 5th edn. University Press, OxfordGoogle Scholar
  22. 22.
    Armstrong CL, Goldstein B, Shera D et al (2003) The predictive value of longitudinal neuropsychologic assessment in the early detection of brain tumor recurrence. Cancer 97(3):649–656. CrossRefGoogle Scholar
  23. 23.
    Talacchi A, d’Avella D, Denaro L et al (2012) Cognitive outcome as part and parcel of clinical outcome in brain tumor surgery. J Neurooncol 108(2):327–332. CrossRefGoogle Scholar
  24. 24.
    Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 191–205Google Scholar
  25. 25.
    Taphoorn MJB, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3:159–168. CrossRefGoogle Scholar
  26. 26.
    Barona ACRL (1986) An improved estimate of premorbid IQ for blacks and whites on the WAIS-R. Int J Clin Neuropsychol 8:169–173Google Scholar
  27. 27.
    Osterrieth PA (1944) Le test de copie d’une figure complexe; contribution à l’étude de la perception et de la mémoire. Arch Psychol 30:206–356Google Scholar
  28. 28.
    Warrington EK, James M (1992) Testbatterie für visuelle 584Objekt- und Raumwahrnehmung (VOSP). 585Thames Valley Test Company, Burry St EdmundsGoogle Scholar
  29. 29.
    Schenkenberg T, Bradford DC, Ajax ET (1980) Line bisection and unilateral visual neglect in patients with neurologic impairment. Neurology 30(5):509. CrossRefGoogle Scholar
  30. 30.
    Härting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J (eds) (2000) Wechsler Gedächtnistest - Revidierte Fassung (WMS-R). Huber, BernGoogle Scholar
  31. 31.
    Tombaugh T (2004) Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol 19(2):203–214. CrossRefGoogle Scholar
  32. 32.
    Zimmermann P, Fimm B (1994) Testbatterie zur Aufmerksamkeitsprüfung. PSYTEST, HerzogenrathGoogle Scholar
  33. 33.
    Benton AL, Hamsher Kd (1989) Multilingual Aphasia Examination. AJA Associates, Iowa CityGoogle Scholar
  34. 34.
    Goebel S, Fischer R, Ferstl R et al (2009) Normative data and psychometric properties for qualitative and quantitative scoring criteria of the Five-point Test. Clin Neuropsychol 23(4):675–690. CrossRefGoogle Scholar
  35. 35.
    Helmstaedter C, Durwen HF (1990) VLMT: a useful tool to assess and differentiate verbal memory performance. Schweizer Archiv für Neurologie Neurochirurgie Psychiatrie 14(1):21–30Google Scholar
  36. 36.
    Hubert W, Poeck K, Willmes-von-Hinckeldey K et al (1983) Aachener aphasie test. Hogrefe Verlag GmbH & Co., GöttingenGoogle Scholar
  37. 37.
    Hermann-Lingen C, Buss U, Snaith RP (2011) HADS-D Hospital Anxiety and Depression Scale-German Version: Deutsche Adaptation der Hospital Anxiety and Depression Scale (HADS) von R. P. Snaith und A. S. ZigmondGoogle Scholar
  38. 38.
    Grulke N, Bailer H, Schmutzer G et al (2006) Standardization of the German short version of “profile of mood states” (POMS) in a representative sample—short communication. Psychother Psychosom Med Psychol 56(9–10):403–405. Google Scholar
  39. 39.
    Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI J Natl Cancer Inst 85(5):365–376. CrossRefGoogle Scholar
  40. 40.
    Smet HJ de, Paquier P, Verhoeven J et al (2013) The cerebellum: its role in language and related cognitive and affective functions. Brain Lang 127(3):334–342. CrossRefGoogle Scholar
  41. 41.
    Bodranghien F, Bastian A, Casali C et al (2016) Consensus paper: revisiting the symptoms and signs of cerebellar syndrome. Cerebellum 15(3):369–391. CrossRefGoogle Scholar
  42. 42.
    Kansal K, Yang Z, Fishman AM et al (2017) Structural cerebellar correlates of cognitive and motor dysfunctions in cerebellar degeneration. Brain 140(3):707–720. Google Scholar
  43. 43.
    Kopelman MD (2002) Disorders of memory. Brain 125(10):2152–2190. CrossRefGoogle Scholar
  44. 44.
    Jacobson S, Marcus EM, Pugsley S (2018) Brain stem functional localization. In: Jacobson S, Marcus EM, Pugsley S (eds) Neuroanatomy for the neuroscientist, vol 5. Springer, Cham, pp 169–204CrossRefGoogle Scholar
  45. 45.
    Perciavalle V, Apps R, Bracha V et al (2013) Consensus paper: current views on the role of cerebellar interpositus nucleus in movement control and emotion. Cerebellum 12(5):738–757. CrossRefGoogle Scholar
  46. 46.
    Cronin T, Arshad Q, Seemungal BM (2017) Vestibular deficits in neurodegenerative disorders: balance, dizziness, and spatial disorientation. Front Neurol 8:538. CrossRefGoogle Scholar
  47. 47.
    Karnath H-O, Dieterich M (2006) Spatial neglect—a vestibular disorder? Brain 129(Pt 2):293–305. CrossRefGoogle Scholar
  48. 48.
    Kralj-Hans I, Baizer JS, Swales C et al (2007) Independent roles for the dorsal paraflocculus and vermal lobule VII of the cerebellum in visuomotor coordination. Exp Brain Res 177(2):209–222. CrossRefGoogle Scholar
  49. 49.
    Carrera E, Tononi G (2014) Diaschisis: past, present, future. Brain 137(Pt 9):2408–2422. CrossRefGoogle Scholar
  50. 50.
    Obrador S (1975) Brain stem vascular lesions affecting alertness and responsiveness. J Neurosurg Sci 19(4):211–214Google Scholar
  51. 51.
    Sturm W, Willmes K (2001) On the functional neuroanatomy of intrinsic and phasic alertness. Neuroimage 14(1 Pt 2):S76–S84. CrossRefGoogle Scholar
  52. 52.
    Rooney AG, Carson A, Grant R (2011) Depression in cerebral glioma patients: a systematic review of observational studies. J Natl Cancer Inst 103(1):61–76. CrossRefGoogle Scholar
  53. 53.
    Bunevicius A, Tamasauskas S, Deltuva V et al (2014) Predictors of health-related quality of life in neurosurgical brain tumor patients: Focus on patient-centered perspective. Acta Neurochir (Wien) 156(2):367–374. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical Psychology and Psychotherapy, Institute of PsychologyChristian-Albrechts UniversityKielGermany
  2. 2.Mehdorn ConsiliumKielGermany

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