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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Major depression caused by the unrupted right temporo-mesial arteriovenous malformation

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  • Mykhailo Salobaiev - Sana Klinikum Offenbach, Neurochirurgie, Offenbach am Main, Deutschland
  • Pavel Timofeev - Sana Klinikum Offenbach, Neurochirurgie, Offenbach, Deutschland
  • Ansgar Schütz - Nordwest Krankenhaus, Neuroradiologie, Frankfurt am Main , Deutschland
  • Alexander Ludolph - Sana Klinikum Offenbach, Radiologie, Offenbach, Deutschland
  • Ulrich Hartmann - Klinikum Hanau, Psychiatrie und Psychotherapie, Hanau, Deutschland
  • Peter Ulrich - Sana Klinikum Offenbach, Neurochirurgie, Offenbach, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 210

doi: 10.3205/17dgnc773, urn:nbn:de:0183-17dgnc7738

Published: June 9, 2017

© 2017 Salobaiev et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective, Methods: Temporal lobe arteriovenous-malformations (AVMs) account for 12-16 % of intracranial AVMs and most commonly present with seizures and headache. An isolated major depression as a main symptom of temporal AVM was not reported until now.

We present the case of a temporo-mesially located unruptured AVM with an isolated major depression and the results of its successful multidisciplinary treatment.

A 19-year-old man was referred to our clinic for evaluation of a severe depression refractory to conservative treatment ongoing for the past 3 years. The patient had to quit school due to the depression and was unable to feel any emotions at all. There was no history of seizures or headaches. Neurological examination was normal.

A magnetic resonance imaging (MRI) scan showed a right temporo-mesial AVM with a nidus of 3,2 cm × 2,5 cm x 1,7 cm with shifting of hippocampus without any signs of previous bleeding. The AVM was classified into grade IV of the Spetzler-Martin grading system.

Due to the highly probable steal syndrome from the limbic system, the decision was made to treat the AVM surgically via open surgical removal and by preoperative transarterial transfemoral embolisation.

Results: Immediately after the 75% embolisation of the AVM the patient already experienced improvement in his depressive symptoms. There were no neurological deficits. One week later microsurgical total resection of the AVM was performed.There were no postoperative complications.

Patient mental status was evaluated in preoperative and postoperative period using Hamilton Depression Rating Scale (HDRS), Frankfurt Complaint Questionnaire (FCQ), Beck-Depressions-Inventar (BDI) and SLC-90-R. At postoperative evaluation functioning was improving with resolvement of the depressive symptoms.

Conclusion:

1.
Temporo-mesial brain AVM can cause a depression and total surgical removal of such AVM may potentially lead to full recovery.
2.
Treatment of unruptured brain AVMs is highly debated since the ARUBA study had to be stopped. Nevertheless, such a major depression as reported with such a heavy impact on patients life should be considered as an appropriate treatment indication.
3.
A multidisciplinary approach for the management of the patients with brain AVMs should be used.