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The British Journal of Radiology 2016Our anecdotal experience from foetal neuroimaging studies suggests that there are often significant disagreements between the findings of ultrasonography (USS) and in... (Observational Study)
Observational Study
OBJECTIVE
Our anecdotal experience from foetal neuroimaging studies suggests that there are often significant disagreements between the findings of ultrasonography (USS) and in utero MR (iuMR) imaging in cases of antenatally detected supratentorial extra-axial cysts. Although this is a relatively rare clinical situation, it warrants further investigation because of the high risk of other intracranial abnormalities that are likely to cause long-term neurodevelopmental problems.
METHODS
We reviewed 957 consecutive referrals for iuMR of the foetal brain over a 3.5-year period and studied all cases where the referral from USS described supratentorial extra-axial cysts in the foetus. The iuMR imaging was reviewed, and a comparison between the results of the two examinations was made.
RESULTS
Supratentorial extra-axial cysts were an unusual referral for iuMR occurring in only 13/957 (1.4%) of cases. The findings on USS and iuMR imaging were conflicting in all 13 cases with intracranial pathology being excluded on iuMR imaging in 4 cases and more significant pathology being shown in 9 cases. Abnormalities of the corpus callosum were recognized in association with a cyst in eight cases, and this was recognized in only two cases on USS. Six of those cases also had abnormalities of cortical formation.
CONCLUSION
iuMR imaging should be used in the assessment of pregnancies in which a supratentorial extra-axial cyst has been detected on USS. This is based on the improved primary diagnosis and a high rate of associated brain abnormalities not detected on USS.
ADVANCES IN KNOWLEDGE
Our retrospective observational study examines a range of foetal intracranial abnormalities which are better defined using iuMRI. This is a previously described spectrum of neurodevelopmental anomalies which we suggest would benefit from MRI.
Topics: Adult; Brain; Female; Humans; Magnetic Resonance Imaging; Pregnancy; Prenatal Diagnosis; Retrospective Studies
PubMed: 26577541
DOI: 10.1259/bjr.20150395 -
American Journal of Obstetrics and... Aug 2022Congenital heart disease is associated with an increased risk of smaller brain volumes and structural brain damage, and impaired growth of supratentorial brain...
BACKGROUND
Congenital heart disease is associated with an increased risk of smaller brain volumes and structural brain damage, and impaired growth of supratentorial brain structures in utero has been linked to poor neurodevelopmental outcomes. However, little is known on brainstem and cerebellar volumes in fetuses with congenital heart disease. Moreover, it is not clear whether impaired infratentorial growth, if present, is associated with only certain types of fetal cardiac defects or with supratentorial brain growth, and whether altered biometry is already present before the third trimester.
OBJECTIVE
This study aimed to investigate brainstem and cerebellar volumes in fetuses with congenital heart disease and to compare them to infratentorial brain volumes in fetuses with normal hearts. Secondarily, the study aimed to identify associations between infratentorial brain biometry and the type of cardiac defects, supratentorial brain volumes, and gestational age.
STUDY DESIGN
In this retrospective case-control study, 141 magnetic resonance imaging studies of 135 fetuses with congenital heart disease and 141 magnetic resonance imaging studies of 125 controls with normal hearts at 20 to 37 gestational weeks (median, 25 weeks) were evaluated. All cases and controls had normal birthweight and no evidence of structural brain disease or genetic syndrome. Six types of congenital heart disease were included: tetralogy of Fallot (n=32); double-outlet right ventricle (n=22); transposition of the great arteries (n=27); aortic obstruction (n=24); hypoplastic left heart syndrome (n=22); and hypoplastic right heart syndrome (n=14). First, brainstem and cerebellar volumes of each fetus were segmented and compared between cases and controls. In addition, transverse cerebellar diameters, vermian areas, and supratentorial brain and cerebrospinal fluid volumes were quantified and differences assessed between cases and controls. Volumetric differences were further analyzed according to types of cardiac defects and supratentorial brain volumes. Finally, volume ratios were created for each brain structure ([volume in fetus with congenital heart disease/respective volume in control fetus] × 100) and correlated to gestational age.
RESULTS
Brainstem (cases, 2.1 cm vs controls, 2.4 cm; P<.001) and cerebellar (cases, 3.2 cm vs controls, 3.4 cm; P<.001) volumes were smaller in fetuses with congenital heart disease than in controls, whereas transverse cerebellar diameters (P=.681) and vermian areas (P=.947) did not differ between groups. Brainstem and cerebellar volumes differed between types of cardiac defects. Overall, the volume ratio of cases to controls was 80.8% for the brainstem, 90.5% for the cerebellum, and 90.1% for the supratentorial brain. Fetuses with tetralogy of Fallot and transposition of the great arteries were most severely affected by total brain volume reduction. Gestational age had no effect on volume ratios.
CONCLUSION
The volume of the infratentorial brain, which contains structures considered crucial to brain function, is significantly smaller in fetuses with congenital heart disease than in controls from midgestation onward. These findings suggest that impaired growth of both supra- and infratentorial brain structures in fetuses with congenital heart disease occurs in the second trimester. Further research is needed to elucidate associations between fetal brain volumes and neurodevelopmental outcomes in congenital heart disease.
Topics: Brain; Brain Stem; Case-Control Studies; Cerebellum; Female; Fetus; Gestational Age; Heart Defects, Congenital; Humans; Magnetic Resonance Imaging; Pregnancy; Retrospective Studies; Tetralogy of Fallot; Transposition of Great Vessels
PubMed: 35305961
DOI: 10.1016/j.ajog.2022.03.030 -
Cerebellum (London, England) Dec 2023To date, cerebellar contribution to language is well established via clinical and neuroimaging studies. However, the particular functional role of the cerebellum in... (Meta-Analysis)
Meta-Analysis Review
To date, cerebellar contribution to language is well established via clinical and neuroimaging studies. However, the particular functional role of the cerebellum in language remains to be clarified. In this study, we present the first systematic review of the diverse language symptoms in spoken language after cerebellar lesion that were reported in case studies for the last 30 years (18 clinical cases from 13 papers), and meta-analysis using cluster analysis with bootstrap and symptom co-occurrence analysis. Seven clusters of patients with similar language symptoms after cerebellar lesions were found. Co-occurrence analysis revealed pairs of symptoms that tend to be comorbid. Our results imply that the "linguistic cerebellum" has a multiform contribution to language function. The most possible mechanism of such contribution is the cerebellar reciprocal connectivity with supratentorial brain regions, where the cerebellar level of the language network has a general modulation function and the supratentorial level is more functionally specified. Based on cerebellar connectivity with supratentorial components of the language network, the "linguistic cerebellum" might be further functionally segregated.
Topics: Humans; Language; Cerebellum; Language Disorders; Linguistics; Brain; Magnetic Resonance Imaging
PubMed: 36205825
DOI: 10.1007/s12311-022-01482-5 -
Journal of Clinical Neurophysiology :... Dec 2013It has been shown that aggressive removal of gliomas improves survival and the quality of life in both adults and children. Conversely, there is a strong correlation... (Review)
Review
It has been shown that aggressive removal of gliomas improves survival and the quality of life in both adults and children. Conversely, there is a strong correlation between incomplete resection of an epileptic focus and poor seizure control outcome in epilepsy surgery. Thus, it is no surprise that maximal resection of supratentorial lesions remains a priority in neurologic surgery. In many circumstances, this is difficult to achieve because of the close proximity of functionally eloquent regions. As a consequence, accurate identification of the latter is imperative to reliably identify safe boundaries for resection and to expand them as much as possible, while preserving neurologic function. Along these lines, preservation of sensorimotor function, with significant impact on postoperative outcome and quality of life, remains essential as achieving maximal resection. Although there is a wide range of methods that could be used for functional sensorimotor mapping, intraoperative neurophysiologic techniques are still considered by many to be the "gold standard." This article provides a detailed overview of these techniques, their principles, and several alternative methodologies. Although the overview directly reflects the current practice at our institution, it also shows the temporal evolution of the major motor mapping methods, relating them to all significant contributions made over the years by different experts in the field. I have tried to exemplify the relevant points of these techniques by using as many pictures and clinical examples as possible.
Topics: Brain; Brain Mapping; Humans; Intraoperative Neurophysiological Monitoring; Multimodal Imaging; Neurosurgical Procedures
PubMed: 24300982
DOI: 10.1097/01.wnp.0000436897.02502.78 -
Seminars in Fetal & Neonatal Medicine Oct 2005In the last few years magnetic resonance imaging (MRI) has expanded its diagnostic capability in the evaluation of fetal brain. Starting from the 18th to 20th... (Review)
Review
In the last few years magnetic resonance imaging (MRI) has expanded its diagnostic capability in the evaluation of fetal brain. Starting from the 18th to 20th gestational weeks, MRI can reliably depict fetal brain anatomy and locate pathology, offering a robust and reliable tool for the assessment of disorders of the fetal central nervous system. In this review quantitative and qualitative in vivo MRI data on fetal cerebellar development are presented. Our normative reference data have been obtained from a database of 580 MR fetal imaging studies. Normal cases were selected within normal MRI fetal brain studies, and all selected cases had a normal clinical evaluation and a normal cranial ultrasound or MR image after birth. Fetal cerebellar development is gradual, steady, and grossly comparable to the development of the supratentorial brain. Archicerebellar (flocculonodular lobe) and paleocerebellar (vermis) structures develop before the neocerebellum (cerebellar hemispheres) that develops more slowly and largely after birth.
Topics: Cerebellum; Female; Gestational Age; Humans; Infant, Newborn; Magnetic Resonance Imaging; Pregnancy; Reference Values
PubMed: 15985392
DOI: 10.1016/j.siny.2005.05.004 -
Minerva Anestesiologica 2008The awake craniotomy technique was originally introduced for the surgical treatment of epilepsy and has subsequently been used in patients undergoing surgical management... (Review)
Review
UNLABELLED
The awake craniotomy technique was originally introduced for the surgical treatment of epilepsy and has subsequently been used in patients undergoing surgical management of supratentorial tumors, arteriovenous malformation, deep brain stimulation, and mycotic aneurysms near critical brain regions. This surgical approach aims to maximize lesion resection while sparing important areas of the brain (motor, somatosensory, and language areas). Awake craniotomy offers great advantages with respect to patient outcome. In this type of procedure, the anesthetist's goal is to make the operation safe and effective and reduce the psychophysical distress of the patient. Many authors have described different anesthetic care protocols for awake craniotomy based on monitored or general anesthesia; however, there is still no consensus as to the best anesthetic technique. The most commonly used drugs for awake craniotomies are propofol and remifentanil, but dexmedetomidine is beginning to be used more commonly outside of Europe. Personal experience, careful planning, and attention to detail are the basis for obtaining good awake craniotomy
RESULTS
Additional studies are necessary in order to optimize the procedure, reduce complications, and improve patient tolerance. The aim of this review is to present a thorough report of the literature, with particular attention to neuro-oncology surgery.
Topics: Anesthesia; Awareness; Brain; Craniotomy; Forecasting; Humans
PubMed: 18612268
DOI: No ID Found -
Patterns of brain infiltration and secondary structure formation in supratentorial ependymal tumors.Journal of Neuropathology and... Sep 2008Ependymomas are generally considered to be noninfiltrative tumors that have discrete borders with adjacent brain tissue. Most occur in the posterior fossa or spinal...
Ependymomas are generally considered to be noninfiltrative tumors that have discrete borders with adjacent brain tissue. Most occur in the posterior fossa or spinal cord. Supratentorial ependymal tumors arise near the ventricular system or, more rarely, within the cerebral white matter or cortex. Presented here are 6 supratentorial ependymal tumors, 3 that primarily involve the cerebral cortex and 3 that extend into the cortex from the underlying white matter. By microscopy, all of these tumors locally infiltrate the cortex and/or white matter along small blood vessels and axonal fiber tracts. They also form other glioma secondary structures including perineuronal tumor cell satellitosis and subpial tumor cell mounds. The 3 cortical ependymal tumors show a spectrum of features ranging from conventional and clear-cell ependymoma-like patterns to more angiocentric glioma-like histology. Because ependymal tumors generally have a significantly better prognosis than other infiltrating gliomas, recognition of their capacity to infiltrate adjacent cortex and white matter is important to prevent the misdiagnosis of oligodendroglioma, astrocytoma, or infiltrating glioma, not otherwise specified. Cortical ependymomas and angiocentric gliomas may comprise a group of locally infiltrative ependymal tumors that are associated with an excellent prognosis after gross total surgical resection.
Topics: Adult; Brain; Child; Child, Preschool; Ependymoma; Female; Humans; Immunohistochemistry; Infant; Male; Supratentorial Neoplasms
PubMed: 18716554
DOI: 10.1097/NEN.0b013e31818521cd -
Child's Nervous System : ChNS :... Oct 2009Supratentorial ependymomas are rare neoplasms accounting for just ten to 15 new cases in the UK per year. This article discusses the surgical management of these tumours. (Review)
Review
INTRODUCTION
Supratentorial ependymomas are rare neoplasms accounting for just ten to 15 new cases in the UK per year. This article discusses the surgical management of these tumours.
MATERIALS AND METHODS
We present our experience over the past 12 years looking, in particular, at the location, histological grading, postoperative complications, survival and progression-free survival. A literature review of publications discussing the surgical management of ependymoma over the past 10 years is then presented.
RESULTS
The data shows that complete surgical resection confers a significant survival advantage. There appears to be conflicting data with respect to prognosis when comparing supratentorial to infratentorial ependymoma.
CONCLUSION
The authors suggest complete excision and advocate, where appropriate, the use of pre and intra-operative functional mapping and second-look surgery. The trade off neurological deficit in the pursuit of complete surgical excision in some instances should be considered.
Topics: Adolescent; Brain; Child; Child, Preschool; Ependymoma; Female; Follow-Up Studies; Humans; Infant; Infratentorial Neoplasms; Male; Neoplasm Staging; Prognosis; Supratentorial Neoplasms; Treatment Outcome
PubMed: 19357853
DOI: 10.1007/s00381-009-0881-z -
British Journal of Anaesthesia Nov 2017The optimal volume status for neurosurgery has yet to be determined. We compared two fluid protocols based on different stroke volume variation (SVV) cut-offs for... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
The optimal volume status for neurosurgery has yet to be determined. We compared two fluid protocols based on different stroke volume variation (SVV) cut-offs for goal-directed fluid therapy (GDFT) during supratentorial brain tumour resection.
METHODS
A randomized, single-blind, open-label trial was conducted. Eighty adult patients undergoing elective supratentorial brain tumour resection were randomly divided into a low SVV and a high SVV group. The SVV cut-offs were used to determine when to initiate colloid infusion. Clinical outcomes and perioperative changes in serum neuronal biomarkers, including S100β, neurone-specific enolase (NSE) and glial fibrillary acidic protein (GFAP), were compared.
RESULTS
Patients in the low SVV group received a higher volume of colloid [869 (SD 404) vs 569 (453) ml; P=0.0025], had a higher urine output [3.4 (2.4) vs 2.5 (1.7) ml kg-1 h-1; P=0.0416] and a higher average cardiac index [3.2 (0.7) vs 2.8 (0.6) litres min-1 m-2; P=0.0204]. Patients in the low SVV group also had a shorter intensive care unit stay [1.4 (0.7) vs 2.6 (3.3) days, P=0.0326], fewer postoperative neurological events (17.5 vs 40%, P=0.0469), attenuated changes in the NSE and GFAP levels, lower intraoperative serum lactate and a higher Barthel index at discharge (all P<0.05).
CONCLUSIONS
During GDFT for supratentorial brain tumour resection, fluid boluses targeting a lower SVV are more beneficial than a restrictive protocol.
CLINICAL TRIAL REGISTRATION
NCT02113358.
Topics: Brain; Female; Fluid Therapy; Humans; Intraoperative Care; Male; Middle Aged; Single-Blind Method; Stroke Volume; Supratentorial Neoplasms; Treatment Outcome
PubMed: 28981592
DOI: 10.1093/bja/aex189 -
AJNR. American Journal of Neuroradiology Aug 1997To determine the prevalence of MR white matter abnormalities in patients with chronic fatigue syndrome (CFS).
PURPOSE
To determine the prevalence of MR white matter abnormalities in patients with chronic fatigue syndrome (CFS).
METHODS
Brain MR studies of 43 patients (29 women and 14 men, 22 to 78 years old) with a clinical diagnosis of CFS (n = 15), CFS with associated depression (n = 14), and CFS with associated other psychiatric disorders, namely, anxiety and somatization disorder (n = 14), were compared with brain MR studies in 43 age- and sex-matched control subjects.
RESULTS
MR findings were abnormal in 13 (32%) of the patients in the study group (ages 34 to 78 years) and in 12 (28%) of the control subjects (ages 26 to 73 years). One patient with CFS had multiple areas of demyelination in the supratentorial periventricular white matter. Another patient with CFS and associated depression had a single focus of probable demyelination in the supratentorial periventricular white matter. In four patients with CFS (ages 34 to 48 years) MR abnormalities consisted of one or several punctate hyperintense foci in the corona radiata, centrum ovale, and frontal white matter. The remaining seven patients (ages 50 to 78 years) had frontoparietal subcortical white matter foci of high T2 signal. The prevalence of white matter hyperintensities was not different between the patients and the control subjects.
CONCLUSIONS
Our findings suggest that no MR pattern of white matter abnormalities is specific to CFS.
Topics: Adult; Aged; Anxiety Disorders; Brain; Brain Diseases; Cerebral Cortex; Demyelinating Diseases; Depressive Disorder; Fatigue Syndrome, Chronic; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurocognitive Disorders; Reference Values; Somatoform Disorders
PubMed: 9282853
DOI: No ID Found