scholarly journals Paramedian transparietal approach to a dominant hemisphere intraventricular meningioma: illustrative case

2021 ◽  
Vol 2 (7) ◽  
Author(s):  
John P. Andrews ◽  
Tarun Arora ◽  
Philip Theodosopoulos ◽  
Mitchel S. Berger
Keyword(s):  
Lateral Ventricle ◽  
Diffusion Tensor ◽  
Three Dimensional ◽  
Neurological Deficits ◽  
Illustrative Case ◽  
Dominant Hemisphere ◽  
Fiber Tracts ◽  
Left Lateral Ventricle ◽  
Magnetic Resonance Imaging Mri ◽  
Oblique Approach

BACKGROUND Meningiomas of the atrium of the lateral ventricle present a unique operative challenge. Parietal transcortical approaches have been described with an oblique approach, but a strictly paramedian approach may offer advantages in a dominant hemisphere atrial meningioma. OBSERVATIONS The patient presented with several weeks of intermittent headaches. Magnetic resonance imaging (MRI) showed an enhancing intraventricular mass in the atrium of the left lateral ventricle. Three-dimensional reconstructions were created from a preoperative MRI, with 1-mm slices for neuronavigation. Diffusion tensor imaging (DTI) was obtained, and tracts were reconstructed in the patient’s three-dimensional brainspace. DTI tractography delineated a paramedian transparietal corridor devoid of functional white matter tracks. The patient was positioned supine, in a semislouch position. A left parietal craniotomy was performed. Neuronavigation identified a gyrus posterior to the sensory cortex, anterior to the optic radiations and medial to superior longitudinal and arcuate fasciculus fiber tracts. The tumor was debulked to allow mobilization to coagulate capsular blood supply. Gross total resection was achieved. The patient was discharged postoperatively on day 3 without neurological deficits. LESSONS A paramedian transparietal approach to a dominant hemisphere meningioma of the lateral ventricle can be a safe and effective way to resect tumors in this anatomically unique operative corridor.

scholarly journals The utility of diffusion tractography for speech preservation in laser ablation of the dominant insula: illustrative case

2021 ◽  
Vol 1 (19) ◽  
Author(s):  
Timothy J. Kaufmann ◽  
Vance T. Lehman ◽  
Lily C. Wong-Kisiel ◽  
Panagiotis Kerezoudis ◽  
Kai J. Miller
Keyword(s):  
Laser Ablation ◽  
White Matter ◽  
Diffusion Tensor ◽  
Neurological Deficits ◽  
Illustrative Case ◽  
Dominant Hemisphere ◽  
White Matter Tracts ◽  
Dti Tractography ◽  
Magnetic Resonance Imaging Mri ◽  
Open Surgical Treatment

BACKGROUND Open surgical treatment of insular epilepsy holds particular risk of injury to middle cerebral artery branches, the operculum (through retraction), and adjacent language-related white matter tracts in the language-dominant hemisphere. Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LITT) is a surgical alternative that allows precise lesioning with potentially less operative risk. The authors presented the case of a 13-year-old girl with intractable, MRI-negative, left (dominant hemisphere) insular epilepsy that was treated with LITT. Diffusion tensor imaging (DTI) tractography was used to aid full posterior insular lesioning in the region of stereo electroencephalography–determined seizure onset while avoiding thermal injury to the language-related superior longitudinal fasciculus (SLF)/arcuate fasciculus (AF) and inferior fronto-occipital fasciculus (IFOF). OBSERVATIONS DTI tractography was used successfully in planning insular LITT and facilitated a robust insular ablation with sharp margins at the interfaces with the SLF/AF and IFOF. These tracts were spared, and no neurological deficits were induced through LITT. LESSONS Although it is technically demanding and has important limitations that must be understood, clinically available DTI tractography adds precision and confidence to insular laser ablation when used to protect important language-related white matter tracts.

Diffusion Tensor Imaging and Fiber Tractography

2009 ◽  
pp. 229-246
Author(s):  
Evanthia E. Tripoliti ◽  
Dimitrios I. Fotiadis ◽  
Konstantia Veliou
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Diffusion Tensor ◽  
Brain Regions ◽  
Cerebral White Matter ◽  
Tissue Microstructure ◽  
Diffusion Weighted Images ◽  
Fiber Tracts ◽  
Diffusion Weighted ◽  
Magnetic Resonance Imaging Mri

Diffusion Tensor Imaging (DTI) is a magnetic resonance imaging (MRI) modality which can significantly improve our understanding of the brain structures and neural connectivity. DTI measures are thought to be representative of brain tissue microstructure and are particularly useful for examining organized brain regions, such as white matter tract areas. DTI measures the water diffusion tensor using diffusion weighted pulse sequences which are sensitive to microscopic random water motion. The resulting diffusion weighted images (DWI) display and allow quantification of how water diffuses along axes or diffusion encoding directions. This can help to measure and quantify the tissue’s orientation and structure, making it an ideal tool for examining cerebral white matter and neural fiber tracts. In this chapter the authors discuss the theoretical aspects of DTI, the information that can be extracted from DTI data, and the use of the extracted information for the reconstruction of fiber tracts and the diagnosis of a disease. In addition, a review of known fiber tracking algorithms is presented.

Progressive brain changes in schizophrenia: a 1-year follow-up study of diffusion tensor imaging

2009 ◽  
Vol 21 (6) ◽  
pp. 301-307 ◽  
Author(s):  
Miho Ota ◽  
Satoko Obu ◽  
Noriko Sato ◽  
Katsuyoshi Mizukami ◽  
Takashi Asada
Keyword(s):  
Diffusion Tensor Imaging ◽  
Diffusion Tensor ◽  
Three Dimensional ◽  
Anterior Cingulate ◽  
Volume Data ◽  
Cross Sectional ◽  
Schizophrenic Patients ◽  
Brain Changes ◽  
Magnetic Resonance Imaging Mri

Objective:Recent cross-sectional studies suggest that brain changes in schizophrenia are progressive during the course of the disorder. However, it remains unknown whether this is a global process or whether some brain areas are affected to a greater degree. The aim of this study was to examine the longitudinal brain changes in patients with chronic older schizophrenia by magnetic resonance imaging (MRI).Methods:Three-dimensional (3D) T1-weighted and diffusion tensor (DT) MRI were performed twice on each of 16 chronic older schizophrenia patients (mean age = 58.1 ± 6.7 years ) with an interval of 1 year between imaging sessions. To clarify the longitudinal morphological and white matter changes, volume data and normalised diffusion tensor imaging (DTI) metrics were compared between the first and follow-up studies using a paired t-test.Results:Focal cortical volume loss was observed in the left prefrontal lobe and anterior cingulate on volumetric study. In addition, DTI metrics changed significantly at the bilateral posterior superior temporal lobes, left insula, genu of the corpus callosum and anterior cingulate.Conclusion:There are ongoing changes in the brains of schizophrenic patients during the course of the illness. Discrepancies between volume data and DTI metrics may indicate that the pattern of progressive brain changes varies according to brain region.

COMPREHENSIVE 3D FIBER TRACKING AS A NEW VISUALIZATION SYSTEM IN BRAIN STUDIES

2007 ◽  
Vol 07 (04) ◽  
pp. 749-765 ◽  
Author(s):  
DANMARY SANCHEZ ◽  
MALEK ADJOUADI ◽  
NOLAN R. ALTMAN ◽  
DANIEL SANCHEZ ◽  
BYRON BERNAL
Keyword(s):  
Diffusion Tensor ◽  
3D Visualization ◽  
Fiber Tracking ◽  
Brain Images ◽  
Visualization System ◽  
Fiber Tracts ◽  
Desirable Outcome ◽  
White Matter Fiber Tracts ◽  
Magnetic Resonance Imaging Mri ◽  
Using Data

Comprehensive spatial visualization of fiber tracts from all perspectives is a highly desirable outcome in brain studies. To achieve this aim, this study establishes the foundation for a new 3D visual interface that integrates Magnetic Resonance Imaging (MRI) to Diffusion Tensor Imaging (DTI). The need for such an interface is critical for understanding brain dynamics, and for providing accurate diagnosis of key brain dysfunctions, in terms of neuronal connectivity in the human brain. Two research fronts were explored: (1) the development of new image processing techniques resulting in comprehensive visualization mechanisms that accurately establish relational positioning of neuronal fiber tracts and key landmarks in semi-transparent 3D brain images, and (2) the design of key algorithms that do not tax the computational requirements of 3D rendering and feature extraction using 2D MRI and DTI frames, remaining within practical time constraints. The system was evaluated using data from thirty patients and volunteers with the Brain Institute at Miami Children's Hospital. The highly integrated and fully embedded fiber-tracking software system provides an optimal research environment for innovative visualization mechanisms of white matter fiber tracts. This 3D visualization system reached the implementation level that makes it ready for deployment at other clinical sites.

scholarly journals Endoscopic Surgery for Supratentorial Deep Cavernous Malformation Adjacent to Cortical Spinal Tract: Preliminary Experience and Technical Note

2021 ◽  
Vol 12 ◽  
Author(s):  
Fuxin Lin ◽  
Chunwang Li ◽  
Xiaorong Yan ◽  
Dengliang Wang ◽  
Yuanxiang Lin ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Diffusion Tensor ◽  
Mean Value ◽  
Technical Note ◽  
Motor Deficits ◽  
Cavernous Malformations ◽  
Fiber Tracts ◽  
Fiber Number ◽  
Magnetic Resonance Imaging Mri ◽  
Poor Outcomes

In this study, we aimed to introduce a technical note and to explore the efficacy of endoscopic surgery combined with diffusion tensor imaging (DTI) navigation for supratentorial deep cerebral cavernous malformations (CCM). A prospectively maintained database of CCM patients was reviewed to identify all CCM patients treated by endoscopic surgery. The sagittal T1-weighted anatomical magnetic resonance imaging (MRI) and DTI were acquired before surgery. Endoscopic surgery was planned and performed based on preoperative DTI images and intraoperative DTI navigation. All patients were followed up more than 6 months. Motor function deficit and modified Rankin scale (mRS) scores were documented on follow-up. A final mRS score of 0–2 was considered a good outcome, and a final mRS score >2 was considered a poor outcome. Second DTI and 3DT1 were performed at 3 months after surgery. We tracked the ipsilateral corticospinal tract (CST) on pre- and postoperative DTI images. The overall mean FA values and the number of fibers of tracked CST were compared on pre- and postoperative DTI images. Risk factors associated with motor deficits and poor outcomes were analyzed. Seven patients with deep CCM and treated by endoscopic surgery were enrolled in this study. The mean value of preoperative mRS was 1.5 ± 0.98, but that score recovered to 0.86 ± 1.22 3 months later. The mRS scores were improved significantly according to statistical analysis (p = 0.012). According to the Spearman non-parametric test, only the fiber number of ipsilateral CST on postoperative DTI was significantly associated with muscle strength 6 months after surgery (p = 0.032). Compared with preoperative CST characteristics on DTI, the change of FA value (p = 0.289) and fiber number (p = 0.289) of ipsilateral CST on postoperative DTI was not significant It meant that the CST was protected during endoscopic surgery. Endoscopic surgery based on DTI navigation might be an effective method to protect fiber tracts in supratentorial deep CCM patients and improve long-term outcomes. However, more studies and cases are needed to confirm our findings.

Another Piece of the Puzzle of Anomalous Connectivity in Joubert's Syndrome

2021 ◽  
Author(s):  
Avner Meoded ◽  
Marcia Kukreja ◽  
Gunes Orman ◽  
Eugen Boltshauser ◽  
Thierry A.G.M. Huisman
Keyword(s):  
White Matter ◽  
Diffusion Tensor ◽  
Three Dimensional ◽  
Axonal Guidance ◽  
Molar Tooth ◽  
Superior Cerebellar Peduncle ◽  
Corticospinal Tracts ◽  
Cerebellar Peduncles ◽  
Cerebellar Peduncle ◽  
Magnetic Resonance Imaging Mri

AbstractWe report on the conventional and diffusion tensor imaging (DTI) findings of a 2-year-old child with clinical presentation of Joubert's Syndrome (JS) and brainstem structural abnormalities as depicted by neuroimaging.Conventional magnetic resonance imaging (MRI) showed a “molar tooth” configuration of the brainstem. A band-like formation coursing in an apparent axial plane anterior to the interpeduncular fossa was noted and appeared to partially cover the interpeduncular fossa.DTI maps and three-dimensional (3D) tractography demonstrated a prominent red-encoded white matter bundle anterior to the midbrain. Probable aberrant course of the bilateral corticospinal tracts (CST) was also depicted. Absence of the decussation of the superior cerebellar peduncles and elongated thickened, horizontal superior cerebellar peduncle (SCP) reflecting the molar tooth sign were also shown.Our report and the review of the published cases suggest that DTI and tractography may be very helpful to differentiate between interpeduncular heterotopias and similarly located white matter bundles corroborating the underlying etiology of axonal guidance disorders in the complex group of ciliopathies including JS. Our case represents an important additional puzzle piece to explore the variability of these ciliopathies.

scholarly journals Pediatric Air Gunshot Penetrating Head Injury with Good Outcome: A Case Report

2020 ◽  
Vol 16 (2) ◽  
pp. 119
Author(s):  
Yusriandi Ramadhan ◽  
Zainal Abidin ◽  
Ardik Lahdimawan Lahdimawan
Keyword(s):  
Case Report ◽  
Head Injury ◽  
Lateral Ventricle ◽  
Stable Condition ◽  
Neurological Deficits ◽  
Left Lateral Ventricle ◽  
Air Gun ◽  
Perifocal Edema ◽  
Gun Shot ◽  
The Brain

Abstract: Ball bearing (BB) and pellet guns are non-power guns but their related injuries have been reported worldwide. They represent a significant cause of injury especially among children and teenagers. Their potentially harmful and lethal effects have been well documented in the medical literature since the early 1980s. Fatality rate is closely related to the damaged part of the brain and the level of the damage. In this Case Report we documented a 6-years-old girl was getting shot at the head by herself, who initially want to play around, using her neighbour’s Air gun rifle. The pellet trajectory passed through the left frontal lobe, left temporal lobe, left posterior putamen, posteriorly left crus posterior of internal capsule, left occipital horn of lateral ventricle, left occipital lobe, and ended at left cerebral falx between both medial surfaces of occipital lobes. Directional slope of the pellet was medially upward, with its tracking left Intracerebral Hemorrhage (ICH) with perifocal edema and Intraventricular Hemorrhage (IVH) dominant in the left lateral ventricle. After 8 days management, the patient was discharged from our hospital with stable condition, GCS 15 without any significant neurological deficits. Intracranial intracerebral pellet due to air gun shot injury, may have fatal and lethal manifestation if the pellet damage the eloquent area and/or deep area of the brain (hypothalamus, thalamus and brain stem). If accessible the foreign body or pellet should be removed immediately for better outcome. Keywords: Head Injury, Air Gun Shot, Intracerebral Haemorrhage

scholarly journals Acute disseminated encephalomyelitis following endonasal resection of a craniopharyngioma: illustrative case

2021 ◽  
Vol 2 (16) ◽  
Author(s):  
Konrad Gag ◽  
Jonas Müller ◽  
Marie Süße ◽  
Robert Fleischmann ◽  
Henry W. S. Schroeder
Keyword(s):  
White Matter ◽  
White Matter Lesions ◽  
Acute Disseminated Encephalomyelitis ◽  
Intravenous Immunoglobulins ◽  
Neurological Deficits ◽  
Illustrative Case ◽  
Sensorimotor Deficits ◽  
Fluid Analysis ◽  
Magnetic Resonance Imaging Mri

BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a rare, acquired demyelination syndrome that causes cognitive impairment and focal neurological deficits and may be fatal. The potentially reversible disease mainly affects children, often after vaccination or viral infection, but may be seen rarely in adults. OBSERVATIONS A 50-year-old woman presented with loss of visual acuity of the left eye. Magnetic resonance imaging (MRI) revealed an intra- and suprasellar mass, which was removed successfully. On postoperative day 1, MRI showed gross total resection of the lesion and no surgery-related complications. On postoperative day 2, the patient presented with a progressive left-sided hemiparesis, hemineglect, and decline of cognitive performance. MRI showed white matter edema in both hemispheres. Cerebrospinal fluid analysis revealed mixed pleocytosis (355/µL) without further evidence of infection. In synopsis of the findings, ADEM was diagnosed and treated with intravenous immunoglobulins. Shortly thereafter, the patient recovered, and no sensorimotor deficits were detected in the follow-up examination. LESSONS Pituitary gland pathologies are commonly treated by transsphenoidal surgery, with only minor risks for complications. A case of ADEM after craniopharyngioma resection has not been published before and should be considered in case of progressive neurological deterioration with multiple white matter lesions.

Diffusion-Weighted and Diffusion Tensor Magnetic Resonance Brain Imaging: Principles and Applications

2003 ◽  
Vol 16 (2) ◽  
pp. 207-220 ◽  
Author(s):  
F. Pizzini ◽  
A. Beltramello ◽  
E. Piovan ◽  
F. Alessandrini
Keyword(s):  
White Matter ◽  
Magnetic Resonance ◽  
Brain Tissue ◽  
Diffusion Weighted Imaging ◽  
Diffusion Tensor ◽  
Three Dimensional ◽  
Functional Studies ◽  
Fiber Tracts ◽  
Normal Appearing White Matter ◽  
Diffusion Weighted

Diffusion Weighted Imaging (DWI) is one of the most recent products of Magnetic Resonance (MR) technology evolution. DWI has been proposed as a noninvasive tool for evaluating structural and physiologic states in biologic tissues as hyperacute ischemic changes within brain tissue. Recently, its more complex and detailed evolution, Diffusion Tensor Imaging (DTI), has been introduced and its clinical applications are the evaluation of anatomical structures and pathologic processes in white matter. White matter quantitative maps that indicate the integrity of brain tissue, color map, and tractography that identifies macroscopic three-dimensional architecture of fiber tracts (e.g., projections and association pathways) can be obtained with DTI. Diffusion weighted imaging visualization techniques (ADC and Trace) are applied for the study of stroke, in the differential diagnosis of expansive lesions (e.g. epidermoid vs. arachnoid cyst) and in detecting traumatic and other lesions associated with restricted diffusion (e.g. MS plaques). On the other hand, DTI provides the identification of abnormalities in the otherwise normal appearing white matter with the understanding of the organization of the fibers, both in tumors and in other cortical or white matter diseases (including stroke, dementias, demyelinating-dismyelinating diseases, epilepsy, schizophrenia). Furthermore, in combination with functional MR, DTI might contribute to the comprehension of brain development, aging and connectivity, thus having a significant impact on brain functional studies.

Real-Time Atlas-Based Stereotactic Neuronavigation

Neurosurgery ◽  
2013 ◽  
Vol 74 (1) ◽  
pp. 128-134 ◽  
Author(s):  
Mark Vabulas ◽  
Vinodh A. Kumar ◽  
Jackson D. Hamilton ◽  
Juan J. Martinez ◽  
Ganesh Rao ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Real Time ◽  
Functional Mri ◽  
Navigation System ◽  
Diffusion Tensor ◽  
Inferior Frontal Gyrus ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Magnetic Resonance Imaging Mri ◽  
Time Image

Abstract BACKGROUND: Surgery for tumors in eloquent brain faces immense challenges when attempting to maximize resection and avoid neurological deficits. OBJECTIVE: In order to give the surgeon real-time atlas-based anatomic information linked to the patient's anatomy, we developed a software-based interface between deformable anatomic templates (DATs) and an intraoperative navigation system. METHODS: Magnetic resonance imaging (MRI), diffusion tensor imaging, and/or functional MRI were performed on 3 patients preoperatively for the purposes of tumor resection by the use of neuronavigation. The DAT was registered to the patients' navigation coordinate system and utilized coordinates from the navigation system during surgery. This provided the surgeon with a list of proximal anatomic and functional structures and a real-time image of the atlas at that location fused to the patient's MRI. The clinical feasibility of this approach was evaluated during the resection of 3 eloquent tumors (right postcentral gyrus, left inferior frontal gyrus, and left occipital cuneus gyrus). RESULTS: Tumor resection was performed successfully in all 3 patients. With the use of the coordinates from the navigation system, anatomic and functional structures and their distances were visualized interactively during tumor resection by using the DAT. CONCLUSION: This is a proof of concept that an interactive atlas-based navigation can provide detailed anatomic and functional information that supplements MRI, diffusion tensor imaging, and functional MRI. The atlas-based navigation generated distances to important anatomic structures from the navigation probe tip. It can be used to guide direct electrical stimulation and highlight areas to avoid during tumor resection.

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