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Journal of Clinical Neuroscience :... Oct 2011Between March 2009 and January 2010, 36 patients with 38 supratentorial cavernous malformations in eloquent brain areas underwent surgery with the aid of intraoperative... (Comparative Study)
Comparative Study
Between March 2009 and January 2010, 36 patients with 38 supratentorial cavernous malformations in eloquent brain areas underwent surgery with the aid of intraoperative MRI (iMRI), functional neuronavigation, and electrocorticography (ECoG). To optimize outcomes, the hemosiderin-stained tissue surrounding the lesion in addition to the cavernous malformation itself (lesion) was microsurgically removed, leaving behind only small areas adjacent to, or overlapping with, functional areas. According to the Zabramski classification, there were 13 type I lesions, which all underwent total resection. There were 25 type II or III lesions with a surrounding hypointense rim, and all of these lesions were completely removed; the surrounding hypointense rims were completely removed in 15 patients and partially removed in 10. No new neurologic disorders occurred postoperatively. Twenty patients had preoperative epileptic seizures, nine of whom were refractory to treatment. During follow-up, seizure outcome was assessed using the Engel classification, and 11 patients with non-refractory epilepsy had a class I outcome. Of the nine patients with refractory epilepsy, seven (77.8%) had a class I outcome, one (11.1%) had a class II outcome, and one (11.1%) had a class III outcome.
Topics: Adolescent; Adult; Brain; Cavernous Sinus; Child; Female; Humans; Intracranial Arteriovenous Malformations; Magnetic Resonance Imaging; Male; Middle Aged; Monitoring, Intraoperative; Neuronavigation; Young Adult
PubMed: 21719294
DOI: 10.1016/j.jocn.2011.01.025 -
Journal of Neurosurgery Jul 2020Connectomics is the production and study of detailed "connection" maps within the nervous system. With unprecedented advances in imaging and high-performance computing,... (Review)
Review
Connectomics is the production and study of detailed "connection" maps within the nervous system. With unprecedented advances in imaging and high-performance computing, the construction of individualized connectomes for routine neurosurgical use is on the horizon. Multiple projects, including the Human Connectome Project (HCP), have unraveled new and exciting data describing the functional and structural connectivity of the brain. However, the abstraction from much of these data to clinical relevance remains elusive. In the context of preserving neurological function after supratentorial surgery, abstracting surgically salient points from the vast computational data in connectomics is of paramount importance. Herein, the authors discuss four interesting observations from the HCP data that have surgical relevance, with an emphasis on the cortical organization of language: 1) the existence of a motor speech area outside of Broca's area, 2) the eloquence of the frontal aslant tract, 3) the explanation of the medial frontal cognitive control networks, and 4) the establishment of the second ventral stream of language processing. From these connectome observations, the authors discuss the anatomical basis of their insights as well as relevant clinical applications. Together, these observations provide a firm platform for neurosurgeons to advance their knowledge of the cortical networks involved in language and to ultimately improve surgical outcomes. It is hoped that this report encourages neurosurgeons to explore new vistas in connectome-based neurosurgery.
Topics: Broca Area; Connectome; Frontal Lobe; Humans; Language; Nerve Net; Neurosurgical Procedures
PubMed: 32736348
DOI: 10.3171/2020.5.JNS191281 -
Cerebellum (London, England) 2006In the last few years fetal magnetic resonance imaging (MRI) has been proposed as a second level technique in the evaluation of fetal brain anomalies. It has been... (Review)
Review
In the last few years fetal magnetic resonance imaging (MRI) has been proposed as a second level technique in the evaluation of fetal brain anomalies. It has been demonstrated that MRI is highly accurate in illustrating the morphologic changes of developing brain and fetal brain abnormalities being a useful procedure when ultrasonography is inconclusive or doubtful. Starting from the 19-20 weeks gestational age (GA), MRI can reliably depict fetal brain anatomy and locating pathology, offering a robust and reliable tool in the assessment of fetal CNS diseases. In this review both in vivo MRI quantitative and qualitative data about fetal cerebellar development are presented and compared with ultrasonography data. Fetal cerebellar development is gradual, steady, and largely comparable to the development of the supratentorial brain. Archicerebellar (flocculo-nodular lobe) and paleocerebellar (vermis) structures develop first, whereas neocerebellum (cerebellar hemispheres) develop slowly and largely after birth.
Topics: Cerebellum; Embryo, Mammalian; Gestational Age; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Ultrasonography
PubMed: 16997751
DOI: 10.1080/14734220600589210 -
AJNR. American Journal of Neuroradiology Sep 1997To assess the in vitro MR signal of the developing brain through histologic comparisons.
PURPOSE
To assess the in vitro MR signal of the developing brain through histologic comparisons.
METHODS
Five healthy fetal specimens aged 16, 19, 22, 27, and 34 gestational weeks were studied in vitro using T1- and T2-weighted sequences in frontal and axial planes. Neuropathologic studies included sections in the same frontal plane. Comparison of histologic sections with measurements of the relative widths of the layers of different signal intensities enabled us to assign cellular correspondence to each MR layer.
RESULTS
In the cerebral mantle, a layered pattern was observed on both T1- and T2-weighted images. In the basal ganglia, signal from the pallidum and thalamus was isointense with white matter from 16 to 22 weeks' gestation; then, from 27 and 34 weeks' gestation, the signal was relatively high on T1-weighted images and low on T2-weighted images. The neostriatum had a relatively low signal on T1-weighted images and a high signal on T2-weighted images from 16 to 27 weeks' gestation: then, at 34 weeks' gestation, the signal was relatively high on T1-weighted images and low on T2-weighted images.
CONCLUSION
MR imaging can clearly show specific patterns of growing fetal brain in vitro.
Topics: Basal Ganglia; Brain; Cerebral Cortex; Female; Gestational Age; Humans; In Vitro Techniques; Infant, Newborn; Magnetic Resonance Imaging; Pregnancy; Reference Values
PubMed: 9296190
DOI: No ID Found -
Child's Nervous System : ChNS :... Oct 2016The objective of the present study was to retrospectively evaluate the relationship between tumor grading and a selective evaluation of neurocognitive and behavioral...
OBJECTIVE
The objective of the present study was to retrospectively evaluate the relationship between tumor grading and a selective evaluation of neurocognitive and behavioral functions in children with supratentorial hemispheric brain tumors.
METHODS
Children admitted with a diagnosis of supratentorial hemispheric tumors involving the cerebral hemispheres or the thalamus at the Pediatric Neurosurgery Unit of the Catholic University of Rome between January 2008 and January 2014 were considered for the present study. Exclusion criteria were represented by age less than 2 years, severe neurological deficits, seizures, and a metastatic disease. A selective neurocognitive and behavioral workout was used for children aged less and more than 5 years.
RESULTS
Global cognitive functions as well as selective neurocognitive and behavioral profiles were found to be significantly worse in children with low-grade tumors, compared with those affected by higher-grades histotypes. Frontal locations for cortical tumors and thalamic lesions were significantly related with worse results, with a clear contribution of dominant vs. nondominant hemisphere involvement and an age higher than 5 years.
CONCLUSIONS
Preoperative global and selective neurocognitive evaluation might contribute to the prediction of the tumor aggressiveness. Due to a longer clinical history, more benign tumors more frequently arrive to the diagnosis with a neurocognitive compromise in spite of an apparently mild presence of neurological symptoms and signs.
Topics: Age Factors; Brain; Child; Child, Preschool; Cognition Disorders; Female; Humans; Male; Neuropsychological Tests; Neurosurgical Procedures; Preoperative Care; Retrospective Studies; Statistics as Topic; Statistics, Nonparametric; Supratentorial Neoplasms
PubMed: 27659835
DOI: 10.1007/s00381-016-3170-7 -
Cancer Reports (Hoboken, N.J.) Aug 2018The cortico-ponto-cerebellar tract (CPCT) is the largest projection pathway, which synapses at the pons. Remote effects of supratentorial brain tumors have not been...
Quantitative assessment of changes in diffusion tensor imaging (DTI) metrics along the courses of the cortico-ponto-cerebellar tracts secondary to supratentorial human brain glial tumors.
BACKGROUND
The cortico-ponto-cerebellar tract (CPCT) is the largest projection pathway, which synapses at the pons. Remote effects of supratentorial brain tumors have not been evaluated along the infratentorial course of the CPCT.
AIM
The purpose of this study is to evaluate the possible lateralization of the diffusion tensor metrics of the affected CPCT in patients with supratentorial brain tumor.
METHODS AND RESULTS
We included 39 patients with 29 left-sided tumors (LST) and 10 right-sided tumors, retrospectively. We measured the magnitude of changes of the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the CPCT prior to the brain surgery at the level of crus cerebri and middle cerebellar peduncle. Regions of interest (ROIs) were placed on the lateral side of crus cerebri, and ROI-1 (anterior 1/3), ROI-2 (middle 1/3), ROI-3 (posterior 1/3), and ROI-4 were placed at the level of middle cerebellar peduncle. We hypothesized that there would be decreased FA and increased ADC values of the ipsilesional CPCT compared with contralesional CPCT. Ipsilesional FA values were decreased with simultaneous increased ADC value along the CPCT compared with contralesional CPCT in following ROIs, ROI-1 (LST FA: P = .005, ADC: P = .037) and ROI-3 (LST FA: P = .049, ADC: P = .049), respectively. Affected ROI-4 in LST cases also showed lower FA values, although not statistically significant.
CONCLUSION
We observed a statistically significant FA value decrease and ADC increase along the left ROI-1 and ROI-3 as well as the nonstatistically significant FA decrease of the left ROI-4 at the second neuron level when there was a related supratentorial tumor. These findings are suggestive of presynaptic and postsynaptic microstructural changes of these tracts following the presynaptic involvement by a primary supratentorial brain tumor.
Topics: Adolescent; Adult; Aged; Cerebellum; Cerebral Cortex; Diffusion Tensor Imaging; Female; Glioma; Humans; Male; Middle Aged; Neoplasm Grading; Neural Pathways; Pons; Retrospective Studies; Supratentorial Neoplasms; Young Adult
PubMed: 32721087
DOI: 10.1002/cnr2.1108 -
AJNR. American Journal of Neuroradiology Jun 2018Neuroimaging features in neonates with RASopathies are rarely reported, and to date, there are no neuroimaging studies conducted in this population. Our aim was to... (Observational Study)
Observational Study
BACKGROUND AND PURPOSE
Neuroimaging features in neonates with RASopathies are rarely reported, and to date, there are no neuroimaging studies conducted in this population. Our aim was to investigate the occurrence of supratentorial and posterior fossa abnormalities on brain MRIs of neonates with a RASopathy.
MATERIALS AND METHODS
An observational case-control study of neonates with a confirmed RASopathy was conducted. The presence of an intraventricular and/or parenchymal hemorrhage and punctate white matter lesions and assessments of the splenium of the corpus callosum, gyrification of the cortical gray matter, and enlargement of the extracerebral space were noted. The vermis height, transverse cerebellar diameter, cranial base angle, tentorial angle, and infratentorial angle were measured.
RESULTS
We reviewed 48 brain MR studies performed at 3 academic centers in 3 countries between 2009 and 2017. Sixteen of these infants had a genetically confirmed RASopathy (group 1), and 32 healthy infants were enrolled as the control group (group 2). An increased rate of white matter lesions, extracerebral space enlargement, simplification of the cortical gyrification, and white matter abnormalities were seen in group 1 ( < .001, for each). The vermis height of patients was significantly lower, and tentorial and infratentorial angles were significantly higher in group 1 ( = .01, < .001, and = .001, respectively).
CONCLUSIONS
Neonates with a RASopathy had characteristic structural and acquired abnormalities in the cortical gray matter, white matter, corpus callosum, cerebellum, and posterior fossa. This study provides novel neuroimaging findings on supratentorial and posterior fossa abnormalities in neonates with a RASopathy.
Topics: Brain; Case-Control Studies; Female; Germ-Line Mutation; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Magnetic Resonance Imaging; Male; Neuroimaging; White Matter; ras Proteins
PubMed: 29622558
DOI: 10.3174/ajnr.A5611 -
Journal of Neurosurgical Anesthesiology Apr 1996Neurosurgery can be complicated by the clinical situation commonly referred to as "tight brain," in which the brain presses against the inner table of the skull or... (Clinical Trial)
Clinical Trial
Neurosurgery can be complicated by the clinical situation commonly referred to as "tight brain," in which the brain presses against the inner table of the skull or protrudes through the craniotomy site. We report here a retrospective study of 32 patients who had undergone elective craniotomy for resection of supratentorial mass lesions. We determined the relationship between lumbar cerebrospinal fluid pressure (CSFP) and brain relaxation and whether brain relaxation varies with anesthetic technique. Patients had received one of four anesthetic techniques: 1 MAC isoflurane (ISO), 1 MAC desflurane (DES), 50% N2O with 0.5 MAC ISO, or 50% N2O with 0.5 MAC DES. Lumbar CSFP had been recorded before the induction of anesthesia (baseline) and immediately prior to dural incision. Charts were retrospectively reviewed for evidence of tight brain, which was considered present if mannitol had been administered, CSF had been drained via the lumbar needle, or the surgical dictation noted the brain was tight at the time of dural incision. Tight brain occurred in 10 of 32 patients. CSFP (mean +/- SD) was significantly greater in the tight than in the nontight group both at baseline (11 +/- 5 vs. 8 +/- 3 mm Hg, p < 0.05) and immediately prior to dural incision (13 +/- 7 vs. 9 +/- 4 mm Hg, p < 0.05). Tight brain did not occur in any patient with CSFP < 6 mm Hg, but it did occur in all patients with CSFP > 17 mm Hg. Within the range of 6-17 mm Hg, CSFP was not predictive of brain relaxation. Tight brain was more common in patients receiving 1 MAC ISO or DES (9 of 20 patients; 45%) than in patients receiving 0.5 MAC ISO or DES with 50% N2O (1 of 12 patients; 8%, p < 0.05). We conclude that in patients undergoing elective craniotomy for resection of a supratentorial mass lesion, brain relaxation is not predictive of CSFP. Although CSFP values at the extremes of the observed distribution ( > 17 mm Hg or < 6 mm Hg) did correlate with brain relaxation, within the range of 6-17 mm Hg, CSFP did not predict brain relaxation. Additionally, the data from this study suggest that in patients undergoing elective craniotomy for resection of a supratentorial mass lesion, tight brain may occur with a lower frequency in patients receiving 0.5 MAC ISO or DES with 50% N2O than in patients receiving 1 MAC ISO or DES.
Topics: Aged; Anesthesia; Anesthetics; Brain; Cerebrospinal Fluid Pressure; Craniotomy; Female; Humans; Intraoperative Complications; Male; Middle Aged; Retrospective Studies; Supratentorial Neoplasms
PubMed: 8829559
DOI: 10.1097/00008506-199604000-00005 -
Neurological Research Mar 2002There is little knowledge on the morphology of the brain stem in survivors of head injury, as CT fails to shown brain stem lesions, and neuropathological data is only... (Comparative Study)
Comparative Study
There is little knowledge on the morphology of the brain stem in survivors of head injury, as CT fails to shown brain stem lesions, and neuropathological data is only available from autopsies. As magnetic resonance imaging (MRI) sheds new light on morphological lesions of the brain, the authors investigated 100 patients with a severe head injury. MRI was performed in a prospective study within the first seven days after head injury while the patients were still in coma and on ventilation. Relating the location of the lesions as depicted by MRI with the initial CT scan and outcome, death appeared to be closely linked to the phenomenon of bilateral pontine lesions. The extent of supratentorial lesions had no bearing on survival at all in the absence of brain stem lesions. Altogether the brain stem was affected in 52%. Obviously the occurrence of bilateral upper pontine lesions is of highest predictive value for a fatal outcome. Severe destruction of supratentorial white matter as demonstrated by MRI is not related to increased mortality, as long as the brain stem is spared.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brain Injuries; Brain Stem; Child; Child, Preschool; Coma; Diffuse Axonal Injury; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pons; Predictive Value of Tests; Prognosis; Prosencephalon; Prospective Studies; Survival Rate; Tomography, X-Ray Computed
PubMed: 11877897
DOI: 10.1179/016164102101199684 -
Dementia (Basel, Switzerland) 1996Regional cerebral glucose metabolism was surveyed in 37 Alzheimer's disease (AD) patients and 21 normal controls using positron emission tomography. Where possible,... (Review)
Review
Regional cerebral glucose metabolism was surveyed in 37 Alzheimer's disease (AD) patients and 21 normal controls using positron emission tomography. Where possible, brain regions were specified according to their neurobehavioral function rather than as anatomically demarcated structures. Absolute metabolic values revealed significant differences (p < 0.05) between AD patients and controls for whole brain and the more superior supratentorial brain slices. Normalized values (region/brain stem) showed the most striking declines (p < 0.001) in the association cortex (heteromodal region -21%; unimodal region -19%) and the primary sensory-motor cortex (-13%), with motor, auditory, and visual areas more affected than somatosensory areas. Limbic and paralimbic systems were equally affected (-14%; -11%; p < 0.001). Thalamus, striatum, cerebellum and brain stem were minimally or not affected. Neurobehaviorally defined hypometabolic regions largely parallel affected areas noted in anatomic and previous metabolic studies, with the possible exception of metabolic deficits in the primary sensory-motor complex. Conceivably, brain areas unaffected morphologically by the pathophysiological processes of AD may become dysfunctional due to a disruption of connectivity between regions.
Topics: Adult; Aged; Aged, 80 and over; Alzheimer Disease; Behavior; Brain; Female; Humans; Male; Middle Aged; Tomography, Emission-Computed
PubMed: 8872413
DOI: 10.1159/000106886