Intraoperative ventricular puncture during supraorbital craniotomy via an eyebrow incision

2006 ◽  
Vol 105 (3) ◽  
pp. 485-486 ◽  
Author(s):  
Tomas Menovsky ◽  
Joost de Vries ◽  
Johannes A. L. Wurzer ◽  
J. Andre Grotenhuis
Keyword(s):  
Mr Imaging ◽  
Frontal Lobe ◽  
Entry Point ◽  
Imaging Studies ◽  
Line Parallel ◽  
Frontal Horn ◽  
Imaginary Line ◽  
Eyebrow Incision ◽  
Ventricular Puncture ◽  
Supraorbital Craniotomy

✓ The authors determined the landmarks and coordinates for intraoperative ventricular puncture directly from the supraorbital craniotomy opening via an eyebrow incision. Fifty magnetic resonance (MR) imaging studies were obtained from patients with no pathological cerebral characteristics or ventricular distortion. The cerebral entry point of the ventriculostomy was located directly under the key bur hole (just behind the zygomatic process of the frontal bone) at the base of the frontal lobe because it represents a stable, reliable point that can be used as the bur hole during supraorbital craniotomy via an eyebrow incision. From this point, the coordinates for lateral ventricular puncture were determined using MR imaging studies and neuronavigational software. The cerebral entry point of the ventriculostomy was situated directly under the key bur hole at the base of the frontal lobe. The catheter was directed at a 45° angle to the midline and a 20° angle up from an imaginary line parallel to the orbitomeatal line. The catheter will usually be inserted into the ventricle at a point 5 cm deep to the cortex and may be inserted as deep as 6.5 cm. Using this technique, the frontal horn of the lateral ventricle can be easily tapped. The landmark required for this technique is readily available in all patients.

scholarly journals Glioblastoma multiforme subterfuge as acute cerebral hemorrhage: A case report and literature review

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Seidu A. Richard ◽  
Yunxia Ye ◽  
Hao Li ◽  
Lu Ma ◽  
Chao You
Keyword(s):  
Glioblastoma Multiforme ◽  
Cerebral Hemorrhage ◽  
Immunohistochemical Staining ◽  
Imaging Studies ◽  
Intracranial Hematoma ◽  
Who Grade ◽  
Neurological Signs ◽  
Frontal Horn ◽  
Vascular Origin ◽  
Hemorrhagic Lesion

Hemorrhagic related Glioblastoma multiforme (GBM) are rare and characterizes with severe clinical scuffle. The etiology of this presentation although not well known is believed to be multifactorial. We present a case as well as review on the pathogenesis of evolution of the hematoma into ring enhancing features of GBM on imaging studies. We present a case of 28 years old man who suddenly went into coma for 9 hours preceded with seizures that latest for 10 minutes. He had no focal neurological signs. CT-Scans images indicated acute cerebral hemorrhage near the frontal horn of the left ventricle with brain edema about the hemorrhagic lesion and MRI done a week later revealed a cerebral ring enhancing lesion. The lesion was partially resected during surgery and immunohistochemical staining confirmed GBM (WHO, grade 4). The diagnosis of intratumoral hemorrhage in GBM was very challenging at the initial stages but with time the hematoma evolved into ring enhancing images typical of GBM. It’s not every intracranial hematoma that is of pure vascular origin.

Is the Concept of Frontal–Subcortical Dementia Relevant to Schizophrenia?

1992 ◽  
Vol 160 (4) ◽  
pp. 442-460 ◽  
Author(s):  
Christos Pantelis ◽  
Thomas R. E. Barnes ◽  
Hazel E. Nelson
Keyword(s):  
Basal Ganglia ◽  
Frontal Cortex ◽  
Brain Imaging ◽  
Frontal Lobe ◽  
Clinical Features ◽  
Negative Symptoms ◽  
Neuropsychological Deficits ◽  
Type Ii ◽  
Imaging Studies ◽  
Subcortical Dementia

A syndrome of subcortical dementia has been described in conditions predominantly affecting the basal ganglia or thalamus, structures that have also been implicated in the pathogenesis of schizophrenia. There are similarities between subcortical dementia and the type II syndrome of schizophrenia, in terms of clinical features, pattern of neuropsychological deficits, pathology, biochemistry and data from brain-imaging studies. These similarities raise the possibility that certain schizophrenic symptoms, particularly negative symptoms and disturbance of movement, may reflect subcortical pathology. Neuropsychological deficits of presumed frontal lobe origin have been reported in some schizophrenic subjects. The occurrence of such deficits in a condition in which frontal lobe pathology has not been clearly demonstrated may be explicable in terms of a subcortical deafferentation of the pre-frontal cortex.

Effectiveness and handling characteristics of a three-layer polymer dura substitute: a prospective multicenter clinical study

2006 ◽  
Vol 105 (6) ◽  
pp. 853-858 ◽  
Author(s):  
A. Martina Messing-Jünger ◽  
Javier Ibáñez ◽  
Fabio Calbucci ◽  
Maurice Choux ◽  
Gabriel Lena ◽  
...  
Keyword(s):  
Clinical Study ◽  
Mr Imaging ◽  
Disease Transmission ◽  
Valsalva Maneuver ◽  
Adhesion Formation ◽  
Type I ◽  
Imaging Studies ◽  
Handling Characteristics ◽  
Csf Leakage ◽  
Multicenter Clinical Study

Object The goal of this study was to assess the effectiveness and handling characteristics of a dura substitute composed of two outer layers of expanded polytetrafluoroethylene (PTFE) and a middle layer consisting of an elastomeric fluoropolymer. Methods In a prospective multicenter study, the dura substitute was implanted using a standard technique in 119 patients undergoing cranial or spinal surgery requiring duraplasty. Intraoperative assessments of the dura patch consisted of testing for cerebrospinal fluid (CSF) leakage employing the Valsalva maneuver and a surgeon’s standard evaluation of the handling characteristics of the device. Postoperative assessments conducted during a mean follow-up time of 15.7 months (range 0.3–45.6 months) consisted of physical examinations, routine computed tomography (CT) or magnetic resonance (MR) imaging studies, and histological studies of any removed dura patches. The mean age of the 119 patients was 40 years (range < 1–81 years). The dura substitute was implanted cranially in 102 patients and spinally in 17. Intraoperative assessment including the Valsalva maneuver led to application of additional sutures in 17 patients. Handling features were rated very good to excellent. Postoperative clinical evaluation resulted in 79 excellent and 18 good results. Imaging studies (MR imaging studies in 69 patients and CT studies in 34 patients) showed no adhesions in 87 patients and minimal adhesions in seven patients (the dura was not visualized in nine patients). Postoperative complications occurred in 12 patients. There were six cases of CSF leakage, three cases of extradural hematoma, one case of arachnoid fibrosis after decompression of a Chiari malformation Type I, and two cases of infection. Eight (7%) of these complications were potentially related to the dura patch. Conclusions In a large, multicenter clinical study of the use of an expanded-PTFE–containing dura substitute, the device was found to be easy to handle and implant. No serious dura patch–related intraoperative adverse events were observed. Postoperatively, there were no major sealing problems or long-term complications. In two cases the patch had to be removed due to fibrosis and infection. The three-layer polymer dura substitute appears to be safe and effective in minimizing CSF leakage and adhesion formation, and its use avoids any risk of prion disease transmission.

scholarly journals Pharmacokinetics of Gd(DO3A-Lys) and MR imaging studies in an orthotopic U87MG glioma tumor model

2015 ◽  
Vol 10 (3) ◽  
pp. 237-244 ◽  
Author(s):  
Prashant Chandrasekharan ◽  
Chang-Tong Yang ◽  
Fatima Ali Nasrallah ◽  
Hui Chien Tay ◽  
Kai-Hsiang Chuang ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Model ◽  
Imaging Studies ◽  
Glioma Tumor

Dural damage due to a loosened hydroxyapatite intraspinous spacer after spinous process–splitting laminoplasty

2007 ◽  
Vol 7 (2) ◽  
pp. 230-235 ◽  
Author(s):  
Atsushi Ono ◽  
Toru Yokoyama ◽  
Takuya Numasawa ◽  
Kanichiro Wada ◽  
Satoshi Toh
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Postoperative Complications ◽  
Mr Imaging ◽  
Nerve Root ◽  
Spinous Process ◽  
Imaging Studies ◽  
Dural Sac ◽  
Neck And Shoulder Pain ◽  
Axial Pain

✓Excellent results from laminoplasty for cervical spinal myelopathy have been reported in many studies. Nevertheless, C-5 nerve root palsy or axial pain such as neck and shoulder pain after laminoplasty are known postoperative complications. To the authors' knowledge, dural damage from dislocation of the hydroxyapatite intraspinous spacer due to absorption of the tip of the spinous process has not been reported. Two cases of dural damage from dislocation of the hydroxyapatite intraspinous spacer after laminoplasty are described. Radiographs, computed tomography myelography, and magnetic resonance (MR) imaging revealed the dislocation of the hydroxyapatite intraspinous spacer, the absorption of the tip of the spinous process, and dural sac compression due to the hydroxyapatite intraspinous spacer. In one patient, the MR imaging studies revealed liquorrhea around the hydroxyapatite intraspinous spacers. Both patients underwent removal of the hydroxyapatite intraspinous spacer and attained good neurological recovery. In patients with dislocation of the hydroxyapatite intraspinous spacer associated with absorption of the tip of the spinous process after spinous process–splitting laminoplasty, each case should be evaluated for aggravating symptoms of myelopathy, dural damage, and liquorrhea around the spacer.

scholarly journals Improved memory functioning and frontal lobe maturation between childhood and adolescence: A structural MRI study

2001 ◽  
Vol 7 (3) ◽  
pp. 312-322 ◽  
Author(s):  
ELIZABETH R. SOWELL ◽  
DEAN DELIS ◽  
JOAN STILES ◽  
TERRY L. JERNIGAN
Keyword(s):  
Frontal Lobe ◽  
Functional Imaging ◽  
Gray Matter ◽  
Gray Matter Volume ◽  
Verbal Learning ◽  
Magnetic Resonance Images ◽  
Visuospatial Memory ◽  
Imaging Studies ◽  
Matter Volume ◽  
Memory Functioning

Previous studies conducted by our group have provided evidence for age-related reductions in cortical thickness in dorsal frontal and parietal regions between childhood and adulthood, and gray matter volume increases of mesial temporal and anterior diencephalic structures. The purpose of this study was to describe neurobehavioral correlates of these brain maturational changes using morphometric analyses of brain magnetic resonance images (MRI) and two tests of cognitive abilities. Participants were 35 normal children roughly stratified by age (7 to 16 years) and sex (20 boys and 15 girls) and frontal and mesial temporal regions were anatomically defined in each subjects' MRI data. The California Verbal Learning Test–Children's Version and the Rey-Osterrieth Complex Figure test were used as measures of verbal and visuospatial memory and organizational abilities. Analyses designed to show regionally specific relationships between the brain and behavioral measures revealed interesting results. Specifically, frontal lobe gray matter thinning was more strongly predictive of delayed verbal memory functioning than was the mesial temporal lobe gray matter volume, and this relationship did not appear to be mediated by factors indexed in chronological age. Similar, but less regionally specific relationships were observed for measures of visuospatial memory abilities and frontal lobe maturation. Functional imaging studies in the literature consistently report activation in frontal regions in adults during retrieval tasks. The relationship between frontal lobe maturation and delayed recall observed here may be reflective of the children's development towards the more adult-like frontal lobe function revealed in the functional imaging studies. (JINS, 2001, 7, 312–322.)

Subcortical surgical anatomy of the lateral frontal region: human white matter dissection and correlations with functional insights provided by intraoperative direct brain stimulation

2012 ◽  
Vol 117 (6) ◽  
pp. 1053-1069 ◽  
Author(s):  
Alessandro De Benedictis ◽  
Silvio Sarubbo ◽  
Hugues Duffau
Keyword(s):  
White Matter ◽  
Frontal Lobe ◽  
Inferior Frontal Gyrus ◽  
Postoperative Outcome ◽  
Surgical Anatomy ◽  
Frontal Region ◽  
Surgical Approaches ◽  
Subcortical Structures ◽  
Functional Responses ◽  
Frontal Horn

Object Recent neuroimaging and surgical results support the crucial role of white matter in mediating motor and higher-level processing within the frontal lobe, while suggesting the limited compensatory capacity after damage to subcortical structures. Consequently, an accurate knowledge of the anatomofunctional organization of the pathways running within this region is mandatory for planning safe and effective surgical approaches to different diseases. The aim of this dissection study was to improve the neurosurgeon's awareness of the subcortical anatomofunctional architecture for a lateral approach to the frontal region, to optimize both resection and postoperative outcome. Methods Ten human hemispheres (5 left, 5 right) were dissected according to the Klingler technique. Proceeding lateromedially, the main association and projection tracts as well as the deeper basal structures were identified. The authors describe the anatomy and the relationships among the exposed structures in both a systematic and topographical surgical perspective. Structural results were also correlated to the functional responses obtained during resections of infiltrative frontal tumors guided by direct cortico-subcortical electrostimulation with patients in the awake condition. Results The eloquent boundaries crucial for a safe frontal lobectomy or an extensive lesionectomy are as follows: 1) the motor cortex; 2) the pyramidal tract and premotor fibers in the posterior and posteromedial part of the surgical field; 3) the inferior frontooccipital fascicle and the superior longitudinal fascicle posterolaterally; and 4) underneath the inferior frontal gyrus, the head of the caudate nucleus, and the tip of the frontal horn of the lateral ventricle in the depth. Conclusions Optimization of results following brain surgery, especially within the frontal lobe, requires a perfect knowledge of functional anatomy, not only at the cortical level but also with regard to subcortical white matter connectivity.

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