Mentalizing can be Impaired in Patients with Meningiomas Originating in the Anterior Skull Base

Munehiro Demura; Riho Nakajima; Shingo Tanaka; Masashi Kinoshita; Mitsutoshi Nakada

doi:10.1016/j.wneu.2023.12.067

Mentalizing can be Impaired in Patients with Meningiomas Originating in the Anterior Skull Base

World Neurosurg. 2023 Dec 16:S1878-8750(23)01790-4. doi: 10.1016/j.wneu.2023.12.067. Online ahead of print.

Authors

Munehiro Demura¹, Riho Nakajima², Shingo Tanaka¹, Masashi Kinoshita¹, Mitsutoshi Nakada³

Affiliations

¹ Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
² Department of Occupational Therapy, Faculty of Health Science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
³ Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan. Electronic address: mnakada@med.kanazawa-u.ac.jp.

PMID: 38110151
DOI: 10.1016/j.wneu.2023.12.067

Abstract

Objective: Mentalizing is an essential function of our social lives. Impairment of mentalizing due to meningiomas has not received attention because most patients return to their social lives after surgical treatment. We investigated the influence of meningiomas and their surgical resection on mentalizing.

Methods: Low- and high-level mentalizing were retrospectively examined in 61 patients with meningiomas and 14 healthy volunteers. Mentalizing was assessed using the facial expression recognition test and picture arrangement test of the Wechsler Adult Intelligence Scale, third edition, before and after surgery. We examined the influence of tumor localization on mentalizing and recovery from mentalizing disorders after tumor resection. Voxel-based lesion-symptom mapping was performed to investigate the relationship between impairments in mentalizing and tumor location.

Results: Before surgery, mentalizing was impaired significantly in patients with meningiomas compared to those in the control group (low-level: P = 0.015, high-level: P = 0.011). This impairment was associated with contact between the tumor and frontal lobe (low-level: P = 0.036, high-level: P = 0.047) and was severe in patients with tumors arising in the anterior skull base (low-level: P = 0.0045, high-level: P = 0.043). Voxel-based lesion-symptom mapping revealed that when the basal cortex of the frontal lobe was compressed by the tumor, the risk of impaired mentalizing was high. The region responsible for high-level mentalizing was located deeper than that responsible for low-level mentalizing. After the surgical removal of the tumor, the test scores significantly improved (low-level: P = 0.035, high-level: P = 0.045).

Conclusions: Mentalizing was impaired by meningiomas arising from the anterior skull base, but it can improve after surgical resection of the tumors.

Keywords: Emotion recognition; Meningioma; Mentalizing; Skull base; Social cognition.