Evaluation of sexual activity after low-grade tumor surgery affecting the limbic system and epilepsy surgery

Background: Although sexual health is one of the important elements of quality of life, patients often do not express their complaints about this issue and do not open this topic unless the doctor asks. In this study, it was aimed to compare the changes in sexual activity before and after surgery in patients who underwent craniotomy due to low-grade glial tumor and epilepsy. Materials and Method: 47 patients who underwent low-grade glial tumor excision and epilepsy surgery affecting the limbic system at Yeditepe University Hospital, Department of Neurosurgery. The age, gender, initial complaints, tumor localization, surgery date, surgical approach and technique, postoperative pathology results, pre- and postoperative neurological examinations, postoperative chemotherapy and duration, usage and the number of pre- and postoperative antiepileptic drugs, pre- and postoperative SCL-90-R and ASEX test results of these patients were recorded. The ASEX and SCL-90-R test results were evaluated statistically and the effect of surgical approach, excision area, and location on sexual activity was investigated. Results: While the mean age of the patients was found to be 31.81±7.94 (December: 18-52) years, 59.6% of the patients were male and 40.4% were female. Surgical excision was applied to 68.1% of the patients from the left and 31.9% from the right location. Epilepsy was diagnosed in 40.4% of the patients and tumoral mass/cavernoma (insula tumor, 23.4%; MTR tumor, 27.7%, and subcallosal region tumor, 8.5%) was diagnosed in 59.6% of the patients and surgical procedure was performed. It was found that the preoperative ASEX sexual arousal subscale score of women increased at a statistically significant level in the postoperative period(p=0.038). It was found that the preoperative ASEX sexual arousal (arousal) and lubrication/erection subscale scores of patients who underwent left localization surgery increased at a statistically significant level in the postoperative period (p=0.018 and p=0.013). Preoperative ASEX orgasm (p=0.004) and satisfaction from orgasm (p=0.011) subscale scores were found to increase statistically significantly in the postoperative period in patients undergoing temporal lobectomy/polectomy and amygdalohypocampectomy (AH) surgery (p<0.05). In patients undergoing selective amygdalohypocampectomy (SAH), it was found that the scores of ASEX orgasm (p=0.021) and satisfaction from orgasm (p=0.013) of patients undergoing paramedian supracerebellar transtentorial (PST) approach were statistically significantly lower compared to the pterional transsylvian surgical approach in the postoperative period (p<0.05). Conclusion: Improvement in sexual satisfaction and orgasm functions was observed in the postoperative period compared to the preoperative period of patients who underwent the Paramedian supracerebellar transtentorial approach. These results suggest that this method could potentially provide greater protection for sexual function.