More than just a urinary catheter: achieving hemostasis using Foley catheter in deep cerebral cavities—technical nuances

Abstract Background Achieving hemostasis during neurosurgical procedures within deep seated tumors is of paramount importance. Chemical methods like using ORC and gel foam are preferred to bipolar cautery as bipolar cautery causes thermal injury to the normal eloquent surrounding white matter fibers, thereby causing significant morbidities. In addition to the chemical methods, we advocate a new relatively simple mechanical method by using small size Foley catheter inflated with saline can achieve hemostasis in case of deep locating brain tumor surgery with diffuse oozing from the tumor bed and surrounding white matter tissues are of concern. The balloon tamponade effect of the inflated Foley catheter helps in achieving complete hemostasis without damaging the surrounding normal white matter parenchyma. Case presentation A 52-years-old female admitted with history of progressive drowsiness and altered sensorium. Brain MRI was done showing large right-sided trigonal meningioma. Right parieto-occipital craniotomy was done, through the superior parietal lobe, corticotomy was done, and tumor was reached. Gentle retraction was done using curved blades in between the tumor and normal brain parenchyma. During surgery, following tumor removal, there was a diffuse oozing from tumor bed and the surrounding stretched white matter fibers. Hemostasis was attempted with chemical methods like ORC and gel foam. We avoided bipolar cautery to prevent thermal injury to the normal stretched eloquent white matter, as bleeding was not settled over the period of 45 min using chemical methods. Then, we placed a 10 F size Foley catheter in the tumor cavity and inflated with 6 ml of saline over the period of 10 min. Prior to Foley placement, we coated ORC over the tumor bed and the surrounding white matter. This achieved hemostasis to a significant extent and the same was repeated for another 10 min, and finally, complete hemostasis was achieved. Postoperative period went uneventful. Patient was discharged with good neurological recovery. Conclusion Inflatable Foley catheter balloon is a simple, cost-effective technique for achieving hemostasis in deep white matter tumors in addition to the routinely available hemostatic techniques.

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Abstract T P234: Multiparametric Assessment of Longitudinal Changes in Tissue Microstructure in Normal and Abnormal Brain Tissue in Patients with Small Vessel Disease

Stroke ◽

10.1161/str.46.suppl_1.tp234 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Maria D Valdes-Hernandez ◽

Paul A Armitage ◽

Eleni Sakka ◽

Susana Munoz Maniega ◽

Natalie A Royle ◽

...

Keyword(s):

White Matter ◽

Brain Tissue ◽

Small Vessel Disease ◽

Brain Mri ◽

Mean Diffusivity ◽

Tissue Loss ◽

Minor Stroke ◽

Normal Brain ◽

Limited Information ◽

Time Points

Background: Volume measures of normal brain tissue and white matter hyperintensities (WMH) between two time points gives limited information about the complex dynamics of tissue change. We evaluated two quantitative parameters that characterise the microstructure of normal-appearing white matter (NAWM), deep grey matter (DGM) and WMH on brain images obtained at presentation with minor stroke and at 1 year to investigate the microstructural changes. Methods: From 182 brain MRI datasets of patients with minor stroke obtained at baseline and 1 year, we extracted the WMH, DGM and NAWM, and separated WMH into less-intense and intense WMH, using validated semi-automatic methods and validated criteria. We registered the binary structural masks to diffusion space and performed a voxel-wise subtraction of the combined masks at both time points. Then we measured fractional anisotropy (FA) and mean diffusivity (MD)(valuex10 -9 m 2 /s) in each tissue mask at baseline and 1 year. Results: WMH volume median increase was 1.4ml (IQR 6.98) mainly due to changes in less-intense WMH: 0.94ml (7.13). WMH that were visible at both time points, ie damage that remained after a year, had the lowest FA= 0.21(0.06) and highest MD=1.05(0.12) at baseline, and were mainly intense WMH at baseline (FA=0.12(0.03), MD=1.55(0.27)). WMH seen only at follow-up, ie that were NAWM at baseline, had the highest FA=0.30(0.06) and lowest MD=0.85 (0.06) at baseline. WMH that were observed only at baseline had intermediate FA=0.26(0.08) and MD=0.90(0.10). NAWM FA=0.26(0.03), MD=0.78(0.04) and DGM FA=0.23(0.03), MD=0.79(0.06) did not change between time points. Conclusions: WMH at baseline can partially evolve to normal-appearing tissues, remain or precede tissue loss. Differentiation between severe and subtle damage and spatial analysis are necessary to characterise the dynamic of WMH evolution.

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Cobblestone Malformation in LAMA2 Congenital Muscular Dystrophy (MDC1A)

Journal of Neuropathology & Experimental Neurology ◽

10.1093/jnen/nlaa062 ◽

2020 ◽

Vol 79 (9) ◽

pp. 998-1010

Author(s):

Himali Jayakody ◽

Sanam Zarei ◽

Huy Nguyen ◽

Joline Dalton ◽

Kelly Chen ◽

...

Keyword(s):

White Matter ◽

Muscular Dystrophy ◽

Brain Mri ◽

Congenital Muscular Dystrophy ◽

Normal Brain ◽

Mild Degree ◽

Nodular Heterotopia ◽

Magnetic Resonance Imaging Mri ◽

Occipital Lobes ◽

Gross Examination

Abstract Congenital muscular dystrophy type 1A (MDC1A) is caused by recessive variants in laminin α2 (LAMA2). Patients have been found to have white matter signal abnormalities on magnetic resonance imaging (MRI) but rarely structural brain abnormalities. We describe the autopsy neuropathology in a 17-year-old with white matter signal abnormalities on brain MRI. Dystrophic pathology was observed in skeletal muscle, and the sural nerve manifested a mild degree of segmental demyelination and remyelination. A diffuse, bilateral cobblestone appearance, and numerous points of fusion between adjacent gyri were apparent on gross examination of the cerebrum. Brain histopathology included focal disruptions of the glia limitans associated with abnormal cerebral cortical lamination or arrested cerebellar granule cell migration. Subcortical nodular heterotopia was present within the cerebellar hemispheres. Sampling of the centrum semiovale revealed no light microscopic evidence of leukoencephalopathy. Three additional MDC1A patients were diagnosed with cobblestone malformation on brain MRI. Unlike the autopsied patient whose brain had a symmetric distribution of cobblestone pathology, the latter patients had asymmetric involvement, most severe in the occipital lobes. These cases demonstrate that cobblestone malformation may be an important manifestation of the brain pathology in MDC1A and can be present even when patients have a structurally normal brain MRI.

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Positron emission tomography, magnetic resonance imaging and proton NMR spectroscopy of white matter in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/135245859700300102 ◽

1997 ◽

Vol 3 (1) ◽

pp. 8-17 ◽

Cited By ~ 57

Author(s):

Christiaan Schiepers ◽

Paul Van Hecke ◽

Rik Vandenberghe ◽

Sylvie Van Oostende ◽

Patrick Dupont ◽

...

Keyword(s):

White Matter ◽

Nmr Spectroscopy ◽

Glucose Metabolism ◽

Glucose Utilization ◽

Brain Mri ◽

Proton Nmr ◽

Lesion Detection ◽

Stable Phase ◽

Normal Brain ◽

Proton Nmr Spectroscopy

Objective: To assess characteristics of MS lesions and normal appearing white matter (NAWM) with various imaging modalities. Glucose metabolism was investigated with FDG - PET, metabolite concentration with proton NMR spectroscopy, and lesion detection with routine brain MRI. Methods: Thirteen patients were studied in a stable phase of their disease, and two during an acute episode. Nine healthy volunteers served as controls. Results: Three patients had a normal brain MRI, 12 had typical lesions. MR images were registered to the PET planes. Lesions and contra-lateral control areas were analyzed, 10/15 lesions showed relative hyper-metabolism and 2 hypo-metabolism. NAA concentration was significantly decreased in both lesions and NAWM. Conclusion: In stable MS, most large lesions have a relatively increased glucose utilization and decreased NAA concentration. NAWM showed a significantly decreased NAA concentration compared to healthy subjects, but no difference in glucose metabolism. Active lesions in acute MS are also hyper-metabolic. This finding opens a new window on the classification of white matter lesions based on glucose utilization.

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Normal cerebral ventricular volume growth in childhood

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.5.peds20178 ◽

2020 ◽

Vol 26 (5) ◽

pp. 517-524

Author(s):

Noah S. Cutler ◽

Sudharsan Srinivasan ◽

Bryan L. Aaron ◽

Sharath Kumar Anand ◽

Michael S. Kang ◽

...

Keyword(s):

Brain Mri ◽

Volume Growth ◽

Ventricular Volume ◽

Growth Patterns ◽

Diagnostic Process ◽

Growth Charts ◽

Normal Brain ◽

Mr Images ◽

Ventricular Volumes ◽

Brain Mr Images

OBJECTIVENormal percentile growth charts for head circumference, length, and weight are well-established tools for clinicians to detect abnormal growth patterns. Currently, no standard exists for evaluating normal size or growth of cerebral ventricular volume. The current standard practice relies on clinical experience for a subjective assessment of cerebral ventricular size to determine whether a patient is outside the normal volume range. An improved definition of normal ventricular volumes would facilitate a more data-driven diagnostic process. The authors sought to develop a growth curve of cerebral ventricular volumes using a large number of normal pediatric brain MR images.METHODSThe authors performed a retrospective analysis of patients aged 0 to 18 years, who were evaluated at their institution between 2009 and 2016 with brain MRI performed for headaches, convulsions, or head injury. Patients were excluded for diagnoses of hydrocephalus, congenital brain malformations, intracranial hemorrhage, meningitis, or intracranial mass lesions established at any time during a 3- to 10-year follow-up. The volume of the cerebral ventricles for each T2-weighted MRI sequence was calculated with a custom semiautomated segmentation program written in MATLAB. Normal percentile curves were calculated using the lambda-mu-sigma smoothing method.RESULTSVentricular volume was calculated for 687 normal brain MR images obtained in 617 different patients. A chart with standardized growth curves was developed from this set of normal ventricular volumes representing the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. The charted data were binned by age at scan date by 3-month intervals for ages 0–1 year, 6-month intervals for ages 1–3 years, and 12-month intervals for ages 3–18 years. Additional percentile values were calculated for boys only and girls only.CONCLUSIONSThe authors developed centile estimation growth charts of normal 3D ventricular volumes measured on brain MRI for pediatric patients. These charts may serve as a quantitative clinical reference to help discern normal variance from pathologic ventriculomegaly.

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Neuroblastoma with intracerebral metastases and the need for neurosurgery: a single-center experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19143 ◽

2020 ◽

Vol 25 (1) ◽

pp. 51-56

Author(s):

Steffen Fleck ◽

Sascha Marx ◽

Clara Bobak ◽

Victoria Richter ◽

Stephan Nowak ◽

...

Keyword(s):

Pediatric Patients ◽

Neurosurgical Procedures ◽

Normal Brain ◽

Indications For Surgery ◽

Single Center ◽

Neurosurgical Procedure ◽

Oncological Treatment ◽

Single Center Experience ◽

Stage 4 ◽

Neurosurgical Treatment

OBJECTIVEIntracerebral metastases in neuroblastoma patients are rare, and information about the indication for and the outcome of neurosurgical procedures in this setting is scarce in the literature. The authors’ aim in the present study was to report a single-center experience with the neurosurgical treatment of intracerebral metastases in neuroblastoma.METHODSThis study is a retrospective single-center analysis of all neurosurgical strategies used in the treatment of intracerebral metastases in neuroblastoma patients.RESULTSBetween 2009 and 2017, 237 pediatric patients (94 girls, 143 boys) with a mean age of 39 months at diagnosis were treated for neuroblastoma. Five (2.1%) of the 237 patients had a neurosurgical procedure for intracerebral metastases. The metastases occurred a mean of 46 months after initial diagnosis. All of these patients had neuroblastoma stage 4. Indications for surgery were recurrent metastases after initial successful oncological treatment or progression of the metastasis under oncological treatment as well as deterioration of neurological function. Intraoperatively, the tumor usually had a distinguishable dissection plane but was infiltrative to adjacent nerves in some spots. Mean overall survival after the neurosurgical procedure was 22 months. Furthermore, in another 3 patients, a neurosurgical procedure was done for an intracranial but extracerebral metastasis.CONCLUSIONSNeurosurgical procedures for intracerebral metastases in neuroblastoma patients are rare and were performed in 2.1% of patients in the present study. Intracerebral metastases occurred during disease progression, and the prognosis after surgery was very limited. The main indications for surgery were rapid neurological deterioration or recurrence of the metastasis after initial successful oncological treatment. Intraoperatively, the metastases usually had a distinguishable dissection plane from the normal brain tissue.

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Magnetic resonance imaging findings and its association to electroencephalogram in children with partial epilepsy (Preprint)

10.2196/preprints.18719 ◽

2020 ◽

Author(s):

Huynh Quang Huy

Keyword(s):

Magnetic Resonance Imaging ◽

Preschool Children ◽

Magnetic Resonance ◽

Brain Mri ◽

Partial Epilepsy ◽

Small Sample ◽

Normal Brain ◽

Resonance Imaging ◽

Normal Children ◽

Eeg Abnormalities

BACKGROUND It is important to identify the neuroimaging features that are associated with partial epilepsy in preschool children. Advances in technology recently to localize focal epileptogenic lesions, especially that of high-resolution structural imaging with magnetic resonance imaging (MRI). The recommendation that electroencephalography (EEG) should be gold criteria and that M.R.I should be optional has been questioned. OBJECTIVE The present study aims to to explore the brain lesions on MRI and its association to electroencephalogram in children with partial epilepsy. METHODS The present study was conducted among 112 preschool children with history of partial seizures. All patients underwent EEG and brain MRI. The epileptogenic lesions were identified on the basis of the signal intensities and morphological abnormalities seen on MRI. The correlation between MRI and EEG abnormalities was explored using a chi-square test. RESULTS Abnormal MRI were found in 34.8% (n = 39) of the sample. The EEG and MRI agreed with respect to classify into abnormal or normal in 48.2% (n = 54). Of the 27 patients with a normal EEG, six (22.2%) were seen to have an abnormal MRI. CONCLUSIONS A number of MRI abnormalities was found in our study of otherwise normal children, although the correlation between these results was not clear. Follow-up of these children will help us identify the important abnormalities. Despite of small sample, our results showed that a normal E.E.G findings does not predict a normal brain MRI in children with partial epilepsy.

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Electroencephalography in systemic lupus erythematosus patients with neuropsychiatric manifestations

The Egyptian Journal of Internal Medicine ◽

10.1186/s43162-020-00012-1 ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Howaida E. Mansour ◽

Reem A. Habeeb ◽

Noran O. El-Azizi ◽

Heba H. Afeefy ◽

Marwa A. Nassef ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Epileptiform Activity ◽

Brain Mri ◽

Periventricular White Matter ◽

Normal Brain ◽

Systemic Lupus ◽

Specific Test ◽

Eeg Abnormalities ◽

Neuropsychiatric Manifestations

Abstract Background Neuropsychiatric manifestations are frequently reported in systemic lupus erythematosus (SLE) patients. This study was done to describe electroencephalographic (EEG) findings in SLE patients with neuropsychiatric manifestation (NPSLE). Results Among 60 SLE patients, there were 50 females (83.3%) and 10 males (16.7%). EEG abnormalities were reported in 12 patients out of 30 (40%) with NPSLE, while all patients with non-NPSLE (n = 30) had no EEG abnormalities; diffuse slowing (20%) was the most common abnormalities, followed by generalized epileptiform activity (13.3%), and lastly temporal epileptiform activity (6.7%). Seizure was the most reported neuropsychiatric disorder in 13 patients (43.3%); 8 of them had abnormal EEG (61.5%). Periventricular white matter lesion (23.3%) followed by infarction (13.3%) were the most common MRI brain findings among 53.3% of NPSLE group. Half of the cases with EEG abnormality had normal brain MRI. SLEDAI score and ACL IgM positivity were higher in the NPSLE group than the non-NPSLE group. EEG is not a sensitive or specific test for detecting NPSLE with sensitivity (37.5%) and specificity (57.1%). Conclusion Not all patients with NPSLE must have abnormal brain MRI or EEG. EEG is a useful assistant tool in the assessment of different manifestations of NPSLE, but it cannot be used as a screening test alone and must be supplemented by neuroimaging studies.

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The Clinical Value of Periventricular White Matter Hyperintensity on MRI in Sudden Sensorineural Hearing Loss

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211018925 ◽

2021 ◽

pp. 000348942110189

Author(s):

Jung Woo Lee ◽

Deoksu Kim ◽

Seokhwan Lee ◽

Sung-Won Choi ◽

Soo-Keun Kong ◽

...

Keyword(s):

Hearing Loss ◽

Multivariate Analysis ◽

White Matter ◽

Brain Mri ◽

Sudden Sensorineural Hearing Loss ◽

White Matter Hyperintensity ◽

Control Group ◽

Periventricular White Matter ◽

Clinical Value ◽

Hearing Gain

Objectives: To assess the clinical value of periventricular white matter hyperintensity (PWMH) found on brain magnetic resonance imaging (MRI) in patients with sudden sensorineural hearing loss (SSNHL). Methods: In this prospective study, 115 patients who were diagnosed with SSNHL aged between 55 and 75 years were analyzed. All subjects underwent brain MRI and were divided into a PWMH and control groups, depending on the presence of PWMH on MRI. PWMH was subdivided into 3 groups according to severity. Pure-tone average results and hearing gain were compared between the 2 groups before treatment and 2 months after treatment. Hearing improvement was assessed using Sigel’s criteria. Results: A total of 106 patients (43 in the PWMH group and 63 in the control group) finally completed the 2-month follow-up. Average hearing gain in the PWMH group was significantly higher than in the control group (34.8 ± 20.3 and 25.9 ± 20.3, respectively, P = .029). PWMH score 1 showed significantly better hearing levels and hearing gain compared to PWMH score 3 and the control group. Multivariate analysis revealed that younger age, better initial hearing level, and the presence of PVWM score 1 were associated with good recovery. Conclusions: The presence of PWMH score 1 on brain MRI in patients with SSNHL was associated with better treatment response and was a good prognostic factor in a multivariate analysis while the hearing recovery in more severe PWMH (scores 2, 3) was not different from the control group.

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Factors associated with neurodevelopment in preterm infants with systematic inflammation

BMC Pediatrics ◽

10.1186/s12887-021-02583-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eun Sun Lee ◽

Ee-Kyung Kim ◽

Seung han Shin ◽

Young-Hun Choi ◽

Young Hwa Jung ◽

...

Keyword(s):

White Matter ◽

Preterm Infants ◽

Systemic Inflammation ◽

Head Circumference ◽

Brain Mri ◽

White Matter Injury ◽

Social Emotional ◽

Postmenstrual Age ◽

Neurodevelopmental Impairment ◽

Near Term

Abstract Background Several studies have suggested that adverse neurodevelopment could be induced by systemic inflammation in preterm infants. We aimed to investigate whether preterm infants with systemic inflammation would have impaired neurodevelopment and which biomarkers and neurophysiologic studies during inflammation are associated with poor neurodevelopment. Methods This prospective cohort study enrolled infants born before 30 weeks of gestation or with birth weight < 1250 g. Infants were grouped according to the presence of systemic inflammation: Control (no inflammation, n = 49), I (systemic inflammation, n = 45). Blood and cerebrospinal fluid samples for markers of brain injury and inflammation were collected and amplitude-integrated electroencephalography (aEEG) was performed within 4 h of septic workup. We evaluated aEEG at 35 weeks postmenstrual age (PMA), head circumference at 36 weeks PMA, and brain MRI at discharge. The Bayley Scales of Infant and Toddler Development III (Bayley-III) was performed at a corrected age (CA) of 18 months. Results The I group had more white matter injuries (2 vs. 26.7%, Control vs. I, respectively) at the time of discharge, lower brain functional maturation (9.5 vs. 8), and smaller head size (z-score − 1.45 vs. -2.12) at near-term age and poorer neurodevelopment at a CA of 18 months than the control (p < 0.05). Among the I group, the proportion of immature neutrophils (I/T ratios) and IL-1 beta levels in the CSF were associated with aEEG measures at the day of symptom onset (D0). Seizure spike on aEEG at D0 was significantly correlated with motor and social-emotional domains of Bayley-III (p < 0.05). The I/T ratio and CRP and TNF-α levels of blood at D0, white matter injury on MRI at discharge, head circumference and seizure spikes on aEEG at near-term age were associated with Bayley-III scores at a CA of 18 months. Conclusions Systemic inflammation induced by clinical infection and NEC are associated with neurodevelopmental impairment in preterm infants. The seizure spike on aEEG, elevated I/T ratio, CRP, and plasma TNF-alpha during inflammatory episodes are associated with poor neurodevelopment.

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In utero MRI identifies consequences of early-gestation alcohol drinking on fetal brain development in rhesus macaques

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1919048117 ◽

2020 ◽

Vol 117 (18) ◽

pp. 10035-10044

Author(s):

Xiaojie Wang ◽

Verginia C. Cuzon Carlson ◽

Colin Studholme ◽

Natali Newman ◽

Matthew M. Ford ◽

...

Keyword(s):

White Matter ◽

Brain Development ◽

Ex Vivo ◽

Early Recognition ◽

Brain Mri ◽

Fetal Brain ◽

Fetal Mri ◽

Diffusion Anisotropy ◽

Self Administration ◽

White Matter Tracts

One factor that contributes to the high prevalence of fetal alcohol spectrum disorder (FASD) is binge-like consumption of alcohol before pregnancy awareness. It is known that treatments are more effective with early recognition of FASD. Recent advances in retrospective motion correction for the reconstruction of three-dimensional (3D) fetal brain MRI have led to significant improvements in the quality and resolution of anatomical and diffusion MRI of the fetal brain. Here, a rhesus macaque model of FASD, involving oral self-administration of 1.5 g/kg ethanol per day beginning prior to pregnancy and extending through the first 60 d of a 168-d gestational term, was utilized to determine whether fetal MRI could detect alcohol-induced abnormalities in brain development. This approach revealed differences between ethanol-exposed and control fetuses at gestation day 135 (G135), but not G110 or G85. At G135, ethanol-exposed fetuses had reduced brainstem and cerebellum volume and water diffusion anisotropy in several white matter tracts, compared to controls. Ex vivo electrophysiological recordings performed on fetal brain tissue obtained immediately following MRI demonstrated that the structural abnormalities observed at G135 are of functional significance. Specifically, spontaneous excitatory postsynaptic current amplitudes measured from individual neurons in the primary somatosensory cortex and putamen strongly correlated with diffusion anisotropy in the white matter tracts that connect these structures. These findings demonstrate that exposure to ethanol early in gestation perturbs development of brain regions associated with motor control in a manner that is detectable with fetal MRI.

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