Cortical and Subcortical Anatomy of the Orbitofrontal Cortex: A White Matter Microfiberdissection Study and Case Series

2021 ◽  
Author(s):  
Philip Rauch ◽  
Carlo Serra ◽  
Luca Regli ◽  
Andreas Gruber ◽  
Martin Aichholzer ◽  
...  
Keyword(s):  
White Matter ◽  
Orbitofrontal Cortex ◽  
Case Series ◽  
Glioma Surgery ◽  
Lentiform Nucleus ◽  
External Capsule ◽  
Radiological Data ◽  
Frontal Horn ◽  
Secondary Objective ◽  
Glioma Resection

ABSTRACT BACKGROUND The literature on white matter anatomy underlying the human orbitofrontal cortex (OFC) is scarce in spite of its relevance for glioma surgery. OBJECTIVE To describe the anatomy of the OFC and of the underlying white matter fiber anatomy, with a particular focus on the surgical structures relevant for a safe and efficient orbitofrontal glioma resection. Based on anatomical and radiological data, the secondary objective was to describe the growth pattern of OFC gliomas. METHODS The study was performed on 10 brain specimens prepared according to Klingler's protocol and dissected using the fiber microdissection technique modified according to U.T., under the microscope at high magnification. RESULTS A detailed stratigraphy of the OFC was performed, from the cortex up to the frontal horn of the lateral ventricle. The interposed neural structures are described together with relevant neighboring topographic areas and nuclei. Combining anatomical and radiological data, it appears that the anatomical boundaries delimiting and guiding the macroscopical growth of OFC gliomas are as follows: the corpus callosum superiorly, the external capsule laterally, the basal forebrain and lentiform nucleus posteriorly, and the gyrus rectus medially. Thus, OFC gliomas seem to grow ventriculopetally, avoiding the laterally located neocortex. CONCLUSION The findings in our study supplement available anatomical knowledge of the OFC, providing reliable landmarks for a precise topographical diagnosis of OFC lesions and for perioperative orientation. The relationships between deep anatomic structures and glioma formations described in this study are relevant for surgery in this highly interconnected area.

scholarly journals Tractography and the connectome in neurosurgical treatment of gliomas: the premise, the progress, and the potential

2020 ◽  
Vol 48 (2) ◽  
pp. E6 ◽  
Author(s):  
Fraser Henderson ◽  
Kalil G. Abdullah ◽  
Ragini Verma ◽  
Steven Brem
Keyword(s):  
White Matter ◽  
Diffusion Tensor ◽  
Cerebral White Matter ◽  
Neural Pathways ◽  
Glioma Surgery ◽  
Preferential Diffusion ◽  
Neurosurgical Treatment ◽  
Glioma Resection ◽  
Relationship Of ◽  
The Relationship

The ability of diffusion tensor MRI to detect the preferential diffusion of water in cerebral white matter tracts enables neurosurgeons to noninvasively visualize the relationship of lesions to functional neural pathways. Although viewed as a research tool in its infancy, diffusion tractography has evolved into a neurosurgical tool with applications in glioma surgery that are enhanced by evolutions in crossing fiber visualization, edema correction, and automated tract identification. In this paper the current literature supporting the use of tractography in brain tumor surgery is summarized, highlighting important clinical studies on the application of diffusion tensor imaging (DTI) for preoperative planning of glioma resection, and risk assessment to analyze postoperative outcomes. The key methods of tractography in current practice and crucial white matter fiber bundles are summarized. After a review of the physical basis of DTI and post-DTI tractography, the authors discuss the methodologies with which to adapt DT image processing for surgical planning, as well as the potential of connectomic imaging to facilitate a network approach to oncofunctional optimization in glioma surgery.

Electrically induced verbal perseveration

Neurology ◽  
2019 ◽  
Vol 92 (6) ◽  
pp. e613-e621 ◽  
Author(s):  
Emmanuel Mandonnet ◽  
Guillaume Herbet ◽  
Sylvie Moritz-Gasser ◽  
Isabelle Poisson ◽  
François Rheault ◽  
...  
Keyword(s):  
White Matter ◽  
Cognitive Model ◽  
Neural Correlates ◽  
Tunable Filter ◽  
Montreal Neurological Institute ◽  
Glioma Surgery ◽  
Semantic System ◽  
Postoperative Mri ◽  
External Capsule ◽  
Temporal Horn

ObjectiveThe present study aimed to elucidate the neural correlates of the deafferentation cognitive model of verbal perseveration (VP) by analyzing the connectomics of the sites where electric stimulation elicited VP during awake left glioma surgery.MethodsWe retrospectively reviewed the anatomic sites that generated VP when electrically stimulated in a series of 21 patients operated on while awake for a left glioma. Each stimulation point was manually located on the postoperative MRI and then registered to the Montreal Neurological Institute template. Connectomics of these sites were further analyzed with Tractotron and disconnectome maps.ResultsVP stimulation sites were located within the white matter surrounding the posterosuperior head of the caudate nucleus, as well as within the white matter of the external capsule and the superolateral wall of the temporal horn of the ventricle. Furthermore, Tractotron and disconnectome maps revealed the connectome of these stimulation sites: the inferior fronto-occipital fasciculus, frontostriatal tract, and anterior thalamic radiations.ConclusionOn the basis of these results and other data, we propose the following anatomic implementation of the deafferentation cognitive model: the lexico-semantic system, comprising different areas linked together through direct cortico-cortical connections, sends information to the striatum; the striato-thalamic system acts as a tunable filter of this lexico-semantic input; and the thalamus projects back to the lexico-semantic system, amplifying the targeted response and inhibiting its competitors.

Following the light in glioma surgery: a comparison of sodium fluorescein and 5-aminolevulinic acid as surgical adjuncts in glioma resection

2020 ◽  
Vol 63 (6) ◽  
Author(s):  
Jorge Navarro-Bonnet ◽  
Paola Suarez-Meade ◽  
Desmond A. Brown ◽  
Kaisorn L. Chaichana ◽  
Alfredo Quinones-Hinojosa
Keyword(s):  
Aminolevulinic Acid ◽  
Sodium Fluorescein ◽  
Glioma Surgery ◽  
Glioma Resection

scholarly journals Magnetic resonance imaging findings in children with Parry-Romberg syndrome and en coup de sabre

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Harry Knights ◽  
Elizabeth Minas ◽  
Faraan Khan ◽  
Lindsay Shaw ◽  
Muthana Al Obaidi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
Brain Imaging ◽  
Case Series ◽  
Dystrophic Calcification ◽  
Resonance Imaging ◽  
Cutaneous Manifestations ◽  
Street Hospital ◽  
Parry Romberg Syndrome

Abstract Background The aim of this study was to: (i) describe the abnormalities seen on brain imaging in a group of children with en coup de sabre (EDCS) with/without Parry-Romberg syndrome (PRS); and (ii) identify clinical predictors of brain imaging abnormalities. Methods This was a single centre (Great Ormond Street Hospital, London) retrospective case series of patients with ECDS/PRS seen from 2000 to 2018. We identified patients with cutaneous manifestations consistent with the clinical descriptions of ECDS/PRS. Presenting clinical, laboratory, and radiological brain findings are described. Results are expressed as medians and ranges or frequencies and percentages. Fisher’s exact test was used to identify clinical associations with magnetic resonance imaging (MRI) abnormalities. Results Fourteen patients were studied: 6 males and 8 females; median age 14 years (range 3–20). We observed neuroimaging abnormalities in 2/6 ECDS and 5/8 ECDS/PRS patients. White matter signal abnormality, dystrophic calcification, leptomeningeal enhancement, and sulcal crowding were the typical findings on brain imaging. A total of 50% of patients had no MRI abnormality despite some of these patients having neurological symptoms. The presence of seizures was significantly associated with ipsilateral enhanced white matter signalling on MRI (p < 0.05). Conclusions In summary, we observed several distinct radiographic patterns associated with ECDS/PRS. Seizure disorder was strongly associated with the presence of ipsilateral enhanced white matter signalling. Improved neuroimaging techniques that combine morphological with functional imaging may improve the detection rate of brain involvement in children with ECDS/PRS in the future.

All-Arthroscopic Autologous Matrix-Induced Chondrogenesis-Aided Repair of a Patellar Cartilage Defect Using Dry Arthroscopy and a Retraction System

2017 ◽  
Vol 30 (09) ◽  
pp. 925-929 ◽  
Author(s):  
Mariusz Puszkarz ◽  
Lidia Kosmalska ◽  
Martin Wiewiorski ◽  
Boguslaw Sadlik
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Case Series ◽  
Collagen Matrix ◽  
International Knee Documentation Committee ◽  
Level Of Evidence ◽  
Patellar Cartilage ◽  
Radiological Data ◽  
Implantation Techniques

AbstractThe technique of all-arthroscopic autologous matrix-induced chondrogenesis (AMIC)-aided repair of patellar cartilage lesions using a retraction system and dry arthroscopy has been recently described. We report the first clinical and radiological data at a short-term follow-up. Twelve patients underwent AMIC-aided cartilage repair for a patellar lesion. All steps of the procedure were performed arthroscopically, which include the use of an intra-articularly placed retraction plate for distraction of the patellofemoral joint and evacuation of saline solution for collagen matrix insertion and fixation. Clinical assessment performed before surgery and at a mean follow-up time of 38 months (range: 24–70) included the following scores: Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and visual analog scale (VAS). Magnetic resonance imaging was performed at the follow-up examination, including the magnetic resonance observation of cartilage repair tissue (MOCART) score. The mean KOOS and IKDC scores increased significantly (p < 0.01) from 50.3 and 37.4 points preoperatively to 90.1 and 79.4 postoperatively. The VAS score decreased from 7.8 to 2.3 points. Mean MOCART score at follow-up was 58.3 points. Cartilage repair of patellar lesions aided by a retraction system in a dry arthroscopy setup is a promising approach. Further studies are needed to evaluate this procedure and compare it to existing matrix implantation techniques. The level of evidence for the study is 4 (case series).

scholarly journals Brain Injury and Mental Health Among the Victims of Intimate Partner Violence: A Case-Series Exploratory Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Gunnur Karakurt ◽  
Kathleen Whiting ◽  
Stephen E. Jones ◽  
Mark J. Lowe ◽  
Stephen M. Rao
Keyword(s):  
Mental Health ◽  
Intimate Partner Violence ◽  
White Matter ◽  
Partner Violence ◽  
Exploratory Study ◽  
Case Series ◽  
Intimate Partner ◽  
Self Report ◽  
Case Series Study ◽  
History Of

Intimate partner violence (IPV) survivors frequently report face, head, and neck as their injury site. Many mild traumatic brain injuries (TBIs) are undiagnosed or underreported among IPV survivors while these injuries may be linked to changes in brain function or pathology. TBI sustained due to IPV often occurs over time and ranges in severity. The aim of this case-series study was to explore risk factors, symptoms, and brain changes unique to survivors of intimate partner violence with suspicion of TBI. This case-series exploratory study examines the potential relationships among IPV, mental health issues, and TBI. Participants of this study included six women: 3 women with a history of IPV without any experience of concussive blunt force to the head, and 3 women with a history of IPV with concussive head trauma. Participants completed 7T MRI of the brain, self-report psychological questionnaires regarding their mental health, relationships, and IPV, and the Structured Clinical Interview. MRI scans were analyzed for cerebral hemorrhage, white matter disturbance, and cortical thinning. Results indicated significant differences in resting-state connectivity among survivors of partner violence as well as differences in relationship dynamics and mental health symptoms. White matter hyperintensities are also observed among the survivors. Developing guidelines and recommendations for TBI-risk screening, referrals, and appropriate service provision is crucial for the effective treatment of TBI-associated IPV. Early and accurate characterization of TBI in survivors of IPV may relieve certain neuropsychological consequences.

scholarly journals High-definition fiber tractography for the evaluation of perilesional white matter tracts in high-grade glioma surgery

2015 ◽  
pp. nov113 ◽  
Author(s):  
Kumar Abhinav ◽  
Fang-Cheng Yeh ◽  
Alireza Mansouri ◽  
Gelareh Zadeh ◽  
Juan C. Fernandez-Miranda
Keyword(s):  
White Matter ◽  
High Grade Glioma ◽  
High Grade ◽  
Fiber Tractography ◽  
High Definition ◽  
Glioma Surgery ◽  
White Matter Tracts

scholarly journals Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) presenting with stroke in a young man

2019 ◽  
Vol 12 (7) ◽  
pp. e229609
Author(s):  
Louise Dunphy ◽  
Amir Rani ◽  
Yaw Duodu ◽  
Yousef Behnam
Keyword(s):  
White Matter ◽  
Autosomal Dominant ◽  
Age Of Onset ◽  
Cerebral Atrophy ◽  
Microvascular Disease ◽  
Lower Limbs ◽  
Receptor Protein ◽  
External Capsule ◽  
Ct Head ◽  
Epidermal Growth

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is caused by mutations in the NOTCH3 gene which maps to the short arm of chromosome 19 and encodes the NOTCH3 receptor protein, predominantly expressed in adults by vascular smooth muscle cells and pericytes. The receptor has a large extracellular domain with 34 epidermal growth factor-like repeats encoded by exons 2–24, the site at which CADASIL mutations are most commonly found. Migraine with aura is often the earliest feature of the disease, with an increased susceptibility to cortical spreading depression suggested as a possible aetiological mechanism. Stroke, acute encephalopathy and cognitive impairment can also occur. Hypertension and smoking are associated with early age of onset of stroke. It diffusely affects white matter, with distinct findings on T2- weighted MRI, involving the external capsule, anterior poles of the temporal lobe and superior frontal gyri, displaying a characteristic pattern of leucoencephalopathy. Affected individuals have a reduced life expectancy. An effective treatment for CADASIL is not available. The authors describe a 35-year-old manwith an unremarkable medical history, presenting to the emergency department with slurred speech and increased confusion 3 days following a fall. He was a smoker and consumed 16 units of alcohol weekly. He was hypertensive and tachycardic. Physical examination confirmed increased tone in his lower limbs and dysarthria. His CT head showed severe cerebral atrophy, multiple small old infarcts and moderate background microvascular disease. Further investigation with an MRI head confirmed multiple white matter abnormalities with microhaemorrhages. The possibility of a hereditary vasculopathy was rendered as the appearances were thought consistent with a diagnosis of CADASIL. Genetic testing identified the NOTCH3 gene thus confirming the diagnosis. This paper provides an overview of the aetiology, clinical presentation, pathogenesis, investigations and management of CADASIL.

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