P09.09.a resection cavity locations associated with changes in depressive symptoms after surgery in patients with diffuse glioma

Abstract BACKGROUND The aim of glioma resections is to maximize tumor removal while preserving functional integrity. Functional outcome usually focuses on neurological and neurocognitive functions. However, emotions may also be affected by surgery. Therefore, we determined the occurrence of depressive symptoms after surgery and investigated factors associated with changes in depressive symptoms after surgery, specifically focusing on the location of the resection cavity. MATERIAL AND METHODS This study included a single center retrospective cohort of patients with a diffuse glioma who underwent a surgical resection between 2009 and 2021. Patients completed the Center for Epidemiologic Studies Depression Scale (CES-D) before and after surgery, with cut-offs for no depressive symptoms (CES-D <16), mild depressive symptoms (CES-D 16-20) or moderate to severe depressive symptoms (CES-D >20). We calculated a change score with a minimum clinically important difference defined as 6 points. Surgical cavities were semi-automatically segmented based on postoperative MRIs. Patient characteristics, i.e. age, sex, education, epilepsy, and tumor characteristics, including tumor grade, and segmented cavity locations, were related to change in depression scores in a multivariable regression analysis and sparse canonical correlation analysis. RESULTS We included 83 patients with a mean age of 42 years (SD 11.8), consisting of 61% males, 49% with high education, 86% with epilepsy and 61% with a WHO grade 2 glioma, 27% grade 3 and 12% grade 4 glioma. Median change in depressive scores was 1, with a range from -25 to 30. Before surgery, 26% had at least mild depressive symptoms, after surgery, 33% had at least mild depressive symptoms. A clinically important increase (≥6) in depressive symptoms was seen in 25% of patients, whereas 15% had a clinically important decrease in depressive symptoms. Patient characteristics and tumor grade were not associated with change in depressive symptoms. Eight clusters of cavity locations were associated with change in depressive symptoms (CV corr = 0.224, p = 0.0419), including in the left and right frontal, temporal, and anterior cingulate regions. CONCLUSION Resection cavity locations are associated with changes in depressive symptoms in patients with diffuse glioma. This may be important for patient counseling and of potential use for neurosurgical decision making. * These authors contributed equally