Use of an intracranial near-infrared probe for localization during stereotactic surgery for movement disorders

2000 ◽  
Vol 93 (3) ◽  
pp. 498-505 ◽  
Author(s):  
Cole A. Giller ◽  
Maureen Johns ◽  
Hanli Liu
Keyword(s):  
White Matter ◽  
Gray Matter ◽  
Movement Disorders ◽  
Near Infrared ◽  
Subcortical White Matter ◽  
Stereotactic Surgery ◽  
Resected Specimen ◽  
Subcortical Structures ◽  
Content Type ◽  
Fine Print

✓ Localization of targets during stereotactic surgery is frequently accomplished by identification of the boundaries between the gray matter of various nuclei and the surrounding white matter. The authors describe an intracranial probe developed for this purpose, which uses near-infrared (NIR) light.The probe fits through standard stereotactic holders and emits light at its tip. The scattered light is detected and analyzed by a spectrometer, with the slope of the trailing portion of the reflectance curve used as the measurement value.Near-infrared readings were obtained during 27 neurosurgical procedures. The first three operations were temporal lobectomies, with values obtained from tracks in the resected specimen and resection bed. In the next five procedures, the probe was inserted stereotactically to a depth of 1 to 2 cm with measurements obtained every 1 mm. The probe was then used in 19 stereotactic procedures for movement disorders, obtaining measurements every 0.5 to 1 mm to target depths of 6 to 8 cm to interrogate subcortical structures. The NIR signals were correlated to distances beneath the cortical surface measured on postoperative computerized tomography or magnetic resonance imaging by using angle correction and three-dimensional reconstruction techniques.The NIR values for white and gray matter obtained during the lobectomies were significantly different (white matter 2.5 ± 0.37, gray matter 0.82 ± 0.23 mean ± standard deviation). The NIR values from the superficial stereotactic tracks showed initial low values corresponding to cortical gray matter and high values corresponding to subcortical white matter.There was good correlation between the NIR signals and postoperative imaging in the 19 stereotactic cases. Dips due to adjacent sulci, a plateau of high signal due to subcortical white matter, a dip in the NIR signal during passage through the ventricle, dips due to the caudate nucleus, and peaks due to the white matter capsule between ventricle and thalamus were constant features. The putamen—capsule boundary and the lamina externa and interna of the globus pallidus could be distinguished in three cases. Elevated signals corresponding to the thalamic floor were seen in 10 cases. Nuances such as prior lesions and nonspecific white matter changes were also detected. There was no incidence of morbidity associated with use of the probe. Data acquisition was straightforward and the equipment required for the studies was inexpensive.The NIR probe described in this article seems to be able to detect gray—white matter boundaries around and within subcortical structures commonly encountered in stereotactic functional neurosurgery. This simple, inexpensive method deserves further study to establish its efficacy for stereotactic localization.

Validation of a near-infrared probe for detection of thin intracranial white matter structures

2003 ◽  
Vol 98 (6) ◽  
pp. 1299-1306 ◽  
Author(s):  
Cole A. Giller ◽  
Hanli Liu ◽  
Prem Gurnani ◽  
Sundar Victor ◽  
Umar Yazdani ◽  
...  
Keyword(s):  
Computer Simulation ◽  
White Matter ◽  
Corpus Callosum ◽  
Gray Matter ◽  
Initial Segment ◽  
Near Infrared ◽  
Stereotactic Surgery ◽  
Content Type ◽  
Infrared Measurements ◽  
Fine Print

Object. The authors have developed an intracranial near-infrared (NIR) probe that analyzes the scattering of light emitted from its tip to measure the optical properties of cerebral tissue. Despite its success in distinguishing gray matter from white matter in humans during stereotactic surgery, the limits of this instrument's resolution remain unclear. In this study, the authors determined the spatial resolution of this new probe by using a rodent model supplemented with phantom measurements and computer simulation. Methods. A phantom consisting of Intralipid and gelatin was constructed to resemble a layer of white matter overlying a layer of gray matter. Near-infrared measurements were obtained as the probe was inserted through the gray—white matter transition. A computer simulation of NIR measurements through a gray—white matter transition was also performed using Monte Carlo techniques. The NIR probe was then used to study 19 tracks from the cortical surface through the corpus callosum in an in vivo rodent preparation. The animals were killed and histological sections through the tracks were obtained. Data from the phantom models and computer simulations showed that the NIR probe samples a volume of tissue extending 1 to 1.5 mm in front of the probe tip (this distance is termed the “lookthrough” distance). Measurements obtained from an NIR probe passing through a thin layer of white matter consisted of an initial segment of increasing values, a maximum (peak) value, and a trailing segment of decreasing values. The length of the initial segment is the lookthrough distance, the position of the peak indicates the location of the superficial white matter boundary, and the length of the trailing segment is the thickness of the layer. These considerations were confirmed in experiments with rodents. All tracks passed through the corpus callosum, which was demonstrated as a broad peak on each NIR graph. The position of the dorsal boundary of the corpus callosum and its width (based on histological measurements) correlated well with the peak of the NIR curve and its trailing segment, respectively. The initial segments correlated well with estimates of the lookthrough distance. Five of the tracks transected the smaller anterior commissure (diameter 0.2 mm), producing a narrow NIR peak at the correct depth. Conclusions. Data in this study confirm that the NIR probe can reliably detect and measure the thickness of layers of white matter as thin as 0.2 mm. Such resolution should be adequate to detect larger structures of interest encountered during stereotactic surgery in humans.

Early metabolic alterations in edematous perihematomal brain regions following experimental intracerebral hemorrhage

1998 ◽  
Vol 88 (6) ◽  
pp. 1058-1065 ◽  
Author(s):  
Kenneth R. Wagner ◽  
Guohua Xi ◽  
Ya Hua ◽  
Marla Kleinholz ◽  
Gabrielle M. de Courten-Myers ◽  
...  
Keyword(s):  
White Matter ◽  
Intracerebral Hemorrhage ◽  
Gray Matter ◽  
High Energy ◽  
Brain Regions ◽  
Large Animal ◽  
High Energy Phosphate ◽  
Content Type ◽  
Water Contents ◽  
Fine Print

Object. The authors previously demonstrated, in a large-animal intracerebral hemorrhage (ICH) model, that markedly edematous (“translucent”) white matter regions (> 10% increases in water contents) containing high levels of clotderived plasma proteins rapidly develop adjacent to hematomas. The goal of the present study was to determine the concentrations of high-energy phosphate, carbohydrate substrate, and lactate in these and other perihematomal white and gray matter regions during the early hours following experimental ICH. Methods. The authors infused autologous blood (1.7 ml) into frontal lobe white matter in a physiologically controlled model in pigs (weighing approximately 7 kg each) and froze their brains in situ at 1, 3, 5, or 8 hours postinfusion. Adenosine triphosphate (ATP), phosphocreatine (PCr), glycogen, glucose, lactate, and water contents were then measured in white and gray matter located ipsi- and contralateral to the hematomas, and metabolite concentrations in edematous brain regions were corrected for dilution. In markedly edematous white matter, glycogen and glucose concentrations increased two- to fivefold compared with control during 8 hours postinfusion. Similarly, PCr levels increased several-fold by 5 hours, whereas, except for a moderate decrease at 1 hour, ATP remained unchanged. Lactate was markedly increased (approximately 20 µmol/g) at all times. In gyral gray matter overlying the hematoma, water contents and glycogen levels were significantly increased at 5 and 8 hours, whereas lactate levels were increased two- to fourfold at all times. Conclusions. These results, which demonstrate normal to increased high-energy phosphate and carbohydrate substrate concentrations in edematous perihematomal regions during the early hours following ICH, are qualitatively similar to findings in other brain injury models in which a reduction in metabolic rate develops. Because an energy deficit is not present, lactate accumulation in edematous white matter is not caused by stimulated anaerobic glycolysis. Instead, because glutamate concentrations in the blood entering the brain's extracellular space during ICH are several-fold higher than normal levels, the authors speculate, on the basis of work reported by Pellerin and Magistretti, that glutamate uptake by astrocytes leads to enhanced aerobic glycolysis and lactate is generated at a rate that exceeds utilization.

Decompressive aspiration in myelinoclastic diffuse sclerosis or Schilder disease

2002 ◽  
Vol 97 (6) ◽  
pp. 1447-1449 ◽  
Author(s):  
Farideh Nejat ◽  
Behzad Eftekhar
Keyword(s):  
White Matter ◽  
Intracranial Hypertension ◽  
Demyelinating Disease ◽  
Corticosteroid Treatment ◽  
Mass Effect ◽  
Subcortical White Matter ◽  
Brain Images ◽  
Content Type ◽  
Fine Print ◽  
Diffuse Sclerosis

✓ This 9-year-old girl with rapidly progressive cerebral demyelinating disease presented with hemiplegia and intracranial hypertension. Brain images revealed four lesions with mass effect in the subcortical white matter of both hemispheres. Demyelination was found on pathological studies of these lesions. The patient experienced some recovery with corticosteroid treatment but improved completely with decompressive aspiration of the largest lesion.

Presence and significance of CD-95 (Fas/APO1) expression after spinal cord injury

2001 ◽  
Vol 94 (2) ◽  
pp. 257-264 ◽  
Author(s):  
Mercedes Zurita ◽  
Jesús Vaquero ◽  
Isabel Zurita
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
White Matter ◽  
Gray Matter ◽  
Spinal Cord Tissue ◽  
Injured Spinal Cord ◽  
Content Type ◽  
Cord Injury ◽  
Positive Immunostaining ◽  
Fine Print

Object. A glycoprotein, CD95 (Fas/APO1) is widely considered to be implicated in the development of apoptosis in a number of tissues. Based on the hypothesis that apoptosis is related to cell death after spinal cord injury (SCI), the authors studied the presence and distribution of CD95 (Fas/APO1)-positive cells in injured spinal cord tissue for the purpose of determining the significance of this protein during the early phases of SCI. Methods. The presence and distribution of cells showing positive immunostaining for CD95 (Fas/APO1) were studied 1, 4, 8, 24, 48, and 72 hours and 1, 2, and 4 weeks after induction of experimental SCI in rats. Studies were conducted using a monoclonal antibody to the CD95 (Fas/APO1) protein. Positivity for CD95 (Fas/APO1) was observed in apoptotic cells, mainly in the gray matter, 1 hour after trauma, and the number of immunostained cells increased for the first 8 hours, at which time the protein was expressed in both gray and white matter. From 24 to 72 hours postinjury, the number of immunostained cells decreased in the gray matter, but increased in the white matter. From then on, there were fewer CD95 (Fas/APO1)-positive cells, but some cells in the white matter still exhibited positive immunostaining 1 and 2 weeks after injury. At 4 weeks, there remained no CD95 (Fas/APO1)-positive cells in injured spinal cord. Conclusions. These findings indicate that CD95 (Fas/APO1) is expressed after SCI, suggesting a role for this protein in the development of apoptosis after trauma and the possibility of a new therapeutic approach to SCI based on blocking the CD95 (Fas/APO1) system.

Metastatic melanoma simulating subdural hematoma

1978 ◽  
Vol 49 (2) ◽  
pp. 301-302 ◽  
Author(s):  
F. John Palmer ◽  
Anthony P. Poulgrain
Keyword(s):  
White Matter ◽  
Metastatic Melanoma ◽  
Metastatic Disease ◽  
Subdural Hematoma ◽  
Subcortical White Matter ◽  
Content Type ◽  
Radiological Features ◽  
Fine Print

✓ Metastatic melanoma tends to be found in subcortical white matter and this localization may produce clinical or radiological features that are unusual in metastatic disease. A case is described that closely simulated a subdural hematoma both clinically and radiologically.

Studies of experimental cervical spinal cord transection

1979 ◽  
Vol 50 (5) ◽  
pp. 633-638 ◽  
Author(s):  
Phillip A. Tibbs ◽  
Byron Young ◽  
R. G. McAllister ◽  
Edward P. Todd
Keyword(s):  
Blood Flow ◽  
White Matter ◽  
Gray Matter ◽  
Injured Patient ◽  
Control Group ◽  
Content Type ◽  
Cervical Laminectomy ◽  
Cortical Gray Matter ◽  
Experimental Group ◽  
Fine Print

✓ Regional cerebral blood flow (CBF) was measured by the microsphere technique in anesthetized, mechanically ventilated dogs before and after cervical laminectomy in four (control group), or cervical laminectomy followed by cervical cord transection (CCT) at the C-6 level in six (experimental group). No significant differences in arterial pH, pO2 or pCO2 were observed between control and experimental dogs. Baseline values for mean arterial pressure (MAP) were also similar in the two groups, but MAP fell in all experimental dogs after CCT (p < 0.025). At 120 minutes after CCT, three of the six dogs had an MAP > 60 torr (66 ± 4 torr), and in three the MAP was < 50 torr (45 ± 3 torr). Regional CBF in cortical gray matter, white matter, and medulla did not change significantly after CCT in dogs with MAP > 60 torr. The CBF fell significantly at 120 minutes after CCT in all regions sampled in the dogs with MAP < 50 torr (p < 0.025). At 30 and 120 minutes after CCT, cerebellar blood flow fell significantly in all experimental animals (p < 0.05). These findings indicate that, despite hypotension and sympathetic denervation of cerebral vessels, CBF in cortical gray matter, white matter, and medulla is maintained at normal levels after CCT by autoregulation as long as MAP exceeds 60 torr. Decreased cerebellar blood flow in the experimental group suggests redistribution of CBF after CCT with relative preservation of flow to gray matter, white matter, and medulla. Reduced CBF in the acutely cord-injured patient with significant hypotension (MAP < 60 torr) may simulate or complicate coexistent head injury.

Blood flow in normal and injured monkey spinal cord

1975 ◽  
Vol 43 (2) ◽  
pp. 162-171 ◽  
Author(s):  
W. George Bingham ◽  
Harold Goldman ◽  
Stewart J. Friedman ◽  
Sharon Murphy ◽  
David Yashon ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
White Matter ◽  
Gray Matter ◽  
Rhesus Monkeys ◽  
Time Intervals ◽  
Flow Rates ◽  
Content Type ◽  
Macaca Rhesus ◽  
Fine Print

✓ The authors used indicator fractionation techniques to determine blood flow in normal and bluntly traumatized spinal cords of Macaca rhesus monkeys. Normal flow rates were determined for several levels of spinal cord as well as differential values for white and gray matter from representative areas. Flow rates in traumatized tissue, obtained at several different time intervals up to 4 hours after injury, demonstrated marked differences in regional perfusion of the white matter and gray matter after trauma. Gray matter perfusion was nearly obliterated while white matter blood flow persisted and in fact was higher than uninjured controls. The findings do not support the concept of ischemia as a factor in white matter failure. If toxic pathobiochemical alterations are induced by trauma, it may be possible to reverse these changes by exploiting the preserved white matter blood flow for chemotherapeutic intervention.

Localization of fibrinolytic activity and inhibition of plasmin in the spinal cord of rat, guinea pig, and rabbit

1978 ◽  
Vol 48 (6) ◽  
pp. 1008-1014 ◽  
Author(s):  
Athanasios Smokovitis ◽  
Tage Astrup
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Guinea Pig ◽  
Gray Matter ◽  
Spinal Canal ◽  
Fibrinolytic Activity ◽  
Pia Mater ◽  
Content Type ◽  
Additional Area ◽  
Fine Print

✓ Fibrinolytic activity (caused by a plasminogen activator) in the spinal cord was highest in the rat, lowest in the rabbit, and intermediate in the guinea pig. In all species the activity was highest in relation to the pia mater. The central spinal canal was active in the rat and the rabbit, but mostly inactive in the guinea pig. Foci of activity were more numerous in the gray matter than in the white matter corresponding to the greater vascularity of the former. In all species ability to inhibit plasmin was related mainly to the gray matter, with an additional area related to the dura mater. The high fibrinolytic activity of the spinal leptomeninges may play a role in the pathogenesis of hemorrhagic processes related to the spinal cord.

Hemorrhagic complication of stereotactic surgery in patients with movement disorders

2003 ◽  
Vol 98 (6) ◽  
pp. 1241-1246 ◽  
Author(s):  
Tohru Terao ◽  
Hiroshi Takahashi ◽  
Fusako Yokochi ◽  
Makoto Taniguchi ◽  
Ryouichi Okiyama ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Movement Disorders ◽  
Contrast Material ◽  
Stereotactic Surgery ◽  
Hemorrhagic Complication ◽  
Electrode Implantation ◽  
Content Type ◽  
Traditional Approaches ◽  
Actual Incidence ◽  
Fine Print

Object. Small, asymptomatic hemorrhages are easier to detect during stereotactic surgery when magnetic resonance (MR) imaging is used for targeting rather than when traditional approaches, such as ventriculography, are performed with contrast material. In the present study the authors examined the actual incidence of intraoperative hemorrhages in patients with movement disorders who had undergone MR imaging—targeted surgery, microelectrode recording (MER)-guided implantation of deep brain stimulation (DBS) electrodes, or radiofrequency-induced coagulation surgery performed. Methods. Ninety-six consecutive patients underwent a total of 116 stereotactic operations for movement disorders (57 operations for radiofrequency-induced coagulation and 59 for DBS electrode implantation) between January 1998 and November 2002. The authors investigated the correlation between hemorrhages and other factors including the location of the hemorrhage and the type of surgery performed. Postoperative computerized tomography scans demonstrated the occurrence of intraoperative hemorrhages at 12 locations during 11 procedures (9.5% of all procedures). Nine hemorrhages occurred during 57 coagulation operations (15.8%). Within this group, the frequency of hemorrhages was highest during thalamotomy (five [21.7%] of 23 procedures) and lower during pallidotomy (four [11.8%] of 34 procedures). In contrast, only two intraventricular hemorrhages developed during 59 operations in which DBS electrodes were implanted (3.4%). In no case was hemorrhage detected in the main DBS target, that is, the subthalamic nucleus. Conclusions. When small, asymptomatic hemorrhages were included in the estimation, the actual rate of hemorrhage was higher than that previously reported. Judging from the incidence of hemorrhage during coagulation and DBS surgeries, the authors suggest that the heat induced by coagulation may play a larger role than microelectrode penetration in the development of hemorrhage.

Comparison of spinal cord gray matter and white matter softness: measurement by pipette aspiration method

2001 ◽  
Vol 95 (2) ◽  
pp. 221-224 ◽  
Author(s):  
Hiroshi Ozawa ◽  
Takeo Matsumoto ◽  
Toshiro Ohashi ◽  
Masaaki Sato ◽  
Shoichi Kokubun
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Gray Matter ◽  
Modulus Of Elasticity ◽  
Element Analysis ◽  
Axial Section ◽  
Content Type ◽  
Significant Difference ◽  
Video Microscope ◽  
Fine Print

Object. Although the gray matter of the spinal cord has been thought to be softer than the white matter, there is no evidence to support this belief. Because the spinal cord is extremely soft, it has been difficult to measure the mechanical properties of the gray and white matter. The modulis of elasticity of the gray and white matter were measured in situ by using a pipette aspiration method. Method. The spinal cord specimens were excised from Japanese white rabbits. Specimens were cut to display the surfaces of axial, frontal, and sagittal sections. The surfaces of the gray and white matter were aspirated using a 0.8-mm-inner-diameter glass pipette while monitoring with a video microscope, and the deformed length in the pipette was measured on a monitor. In each case the modulus of elasticity was calculated by comparing the relationship between the aspiration pressure and aspirated volume of the specimen with that determined by finite element analysis. The moduli of elasticity of the gray and white matter were 3.4 ± 1.4 kPa (mean ± standard deviation) and 3.4 ± 0.9 kPa in the axial section, 3 ± 0.3 kPa and 3.5 ± 0.5 kPa in the frontal section, and 3.5 ± 0.9 kPa and 2.8 ± 0.4 kPa in the sagittal section, respectively. Conclusions. No significant difference in modulus of elasticity was shown between the gray and white matter of the spinal in sections made in various directions.

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