The pre-interventional psychiatric history – An underestimated confounder in benign intracranial lesions studies

• We analyzed the quality of life after successful meningioma and aneurysm treatment.
• We included only patients with an uneventful and successful treatment process and an objectively unaffected health status.
• The pre-interventional psychiatric history was identified as a significant and independent confounder.
• None of the previous studies took this aspect adequately into account.
• Ignoring this aspect, might easily lead to serious selection bias in small study populations.

ObjectivesThe current study was designed to analyze the influence of a positive pre-interventional psychiatric history on the quality of life (QOL) after successful treatment of benign intracranial extra-cerebral lesions.MethodsPatients treated due to meningioma WHO I or unruptured intracranial aneurysms in two German neurosurgical centers between 2007 and 2013 were screened for exclusion criteria including malignant/chronic diseases, recurrence of the tumor/aneurysm and neurological deficits among others. 131 patients who met the criteria of an objectively unaffected health status were included. The pre-interventional psychiatric histories and the rates of post-interventional headaches, sleeping disorders, symptoms of chronic fatigue syndrome (CFS), post-traumatic stress disorder (PTSD) and QOL were determined by questionnaires which were mailed to the patients.Results103 patients returned the questionnaires. Despite the objectively unaffected health status, the patients with a positive pre-interventional psychiatric history demonstrated a post-interventionally significantly lower QOL (p = 0.002), a significantly higher Pittsburgh Sleep Quality Index sum score (p = 0.009), as well as significantly higher rates of symptoms of a chronic fatigue syndrome (p = 0.003) and PTSD (p = 0.024), compared to the patient collective with a negative pre-interventional psychiatric status.ConclusionThe results of the current study demonstrate the importance of taking the pre-interventional psychiatric history as a significant and independent confounder into consideration when evaluating the outcome after treatment of benign intracranial extra-cerebral lesions. A pre-interventional psychiatric screening and an early psychological intervention might help to improve the overall outcome after successful treatment of such lesions.