Postoperative Psychoses in Patients with Brain Gliomas

Abstract

Background: despite the widespread opinion that psychoses are common after surgery in neurosurgical patients, they remain practically unexplored to date.  Objective: based on the analysis of scientific literature to get an idea of the state and prospects of studying the problem of psychoses arising after operations for brain gliomas.  Materials and methods: the work is a scoping review; the main method used was the search for publications by the keywords “postoperative psychosis”, “postoperative delirium ”, “brain gliomas”, “neurosurgery”, “craniotomy” conducted in the Medline/PubMed, Scopus, Web of Science, RISC and other sources over the past 20 years.  Conclusion: studies of postoperative psychoses in patients with brain gliomas and comparison of results in neurosurgery and general surgical practice are hindered by terminological dissonance and shortcomings of various types of verification of postoperative psychotic disorders. This manifests itself both at the epidemiological data (the probability of occurrence ranges from 4 to 29%), and in determining the risk factors necessary and sufficient to predict the onset of psychosis: according to literature data. About 80 indicators claim this role (gender, age, premorbid diseases, preoperative mental state,  tumor malignancy, options for neurosurgical interventions, etc.) while the list does not contain conceptually important features, such as the profile of individual brain asymmetr y, tumor lateralization, etc. These problems lead to controversy in approaches to treatment and prevention of postoperative psychotic disorders. Before evaluating the effectiveness of the main drugs (dexmedetomidine, GABA-ergics, antipsychotics, etc.) and non-drugs influences, one must understand the phenomenon clearly with all the individual characteristics and variants of disease manifestations.