This 74 year old lady presented with progressive depression. She had been treated medically for months but her symptoms did not improve. She then developed headaches and cognitive deficits such as poor short term memory became increasingly obvious.
An MRI scan of the brain was eventually done, revealing a very large lesion of the anterior cranial fossa.
Fig 1. Preoperative MRI T1+GAD. A. Axial, B. Sagittal, C. Coronal
Surgery proceeded on a semi-urgent basis, given the degree of mass effect from the tumour.
A coronal incision was made and a bifrontal craniotomy performed. The tumour was moderately vascular, but a complete resection was achieved, without damage to nearby important structures, such as the optic nerves/chiasm/tracts, or the anterior cerebral arteries and branches.
The patient made an astounding recovery, with rapid improvement in her mental state. Within 2 months she had returned to normal activities including golf.
An MRI scan at 8 months postoperatively showed no evidence of tumour recurrence. Further annual check-ups were planned.
Figure 2. 8 months postop MRI T1+GAD. A. Axial, B. Sagittal, C. Coronal.
This case serves to illustrate a number of key points:
- Depression and other mental health problems can be caused by structural pathology within or affecting the brain. Appropriate imaging (CT and/or MRI scans) should be considered.
- Despite technical challenges, even very large brain tumours can be treated successfully if performed in specialized centres by appropriately trained and skilled neurosurgeons.
– By Prof. David Walker, Neurosurgeon and Spinal Surgeon