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2016 ; 124
(6
): 1568-77
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The cognitive and behavioral effects of meningioma lesions involving the
ventromedial prefrontal cortex
#MMPMID26613174
Abel TJ
; Manzel K
; Bruss J
; Belfi AM
; Howard MA 3rd
; Tranel D
J Neurosurg
2016[Jun]; 124
(6
): 1568-77
PMID26613174
show ga
OBJECT Anterior skull base meningiomas are frequently associated with changes in
personality and behavior. Although such meningiomas often damage the ventromedial
prefrontal cortex (vmPFC), which is important for higher cognition, the cognitive
and behavioral effects of these meningiomas remain poorly understood. Using
detailed neuropsychological assessments in a large series of patients, this study
examined the cognitive and behavioral effects of meningioma lesions involving the
vmPFC. METHODS The authors reviewed neuropsychology and lesion mapping records of
70 patients who underwent resection of meningiomas. The patients were drawn from
the Neurological Patient Registry at the University of Iowa. Patients were sorted
into 2 groups: those with lesions involving the vmPFC and those with lesions that
did not involve the vmPFC. Neuropsychological data pertaining to a comprehensive
array of cognitive and behavioral domains were available preoperatively in 20
patients and postoperatively in all 70 patients. RESULTS No change occurred in
basic cognitive functions (e.g., attention, perception, memory, construction and
motor performance, language, or executive functions) from the preoperative to
postoperative epochs for the vmPFC and non-vmPFC groups. There was a significant
decline in the behavioral domain, specifically adaptive function, for both the
vmPFC and non-vmPFC groups, and this decline was more pronounced for the vmPFC
group. Additionally, postoperative data indicated that the vmPFC group had a
specific deficit in value-based decision making, as evidenced by poor performance
on the Iowa Gambling Task, compared with the non-vmPFC group. The vmPFC and
non-vmPFC groups did not differ postoperatively on other cognitive measures,
including intellect, memory, language, and perception. CONCLUSIONS Lesions of the
vmPFC resulting from meningiomas are associated with specific deficits in
adaptive function and value-based decision making. Meningioma patients showed a
decline in adaptive function postoperatively, and this decline was especially
notable in patients with vmPFC region meningiomas. Early detection and resection
of meningiomas of the anterior skull base (involving the gyrus rectus) may
prevent these deficits.
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