RESUMO
Resumen El tracto oblicuo frontal (TOF) conecta el área mo tora suplementaria (AMS) con la pars opercularis. Su rol en el lenguaje y su implicancia en la cirugía de gliomas siguen en discusión. Presentamos un estu dio anatomoquirúrgico de tres casos con resolución quirúrgica. Se operaron tres pacientes con gliomas en el lóbu lo frontal izquierdo utilizando protocolo de paciente despierto con técnicas de mapeo cortical y subcortical realizando evaluación motora y del lenguaje. Las trac tografías fueron realizadas con el software DSI Studio. Los tres pacientes presentaron inhibición intraopera toria del lenguaje mediante la estimulación subcortical de TOF. La resección en contacto con el TOF se correla cionó con déficits del lenguaje en todos los casos y en dos casos déficits en la iniciación del movimiento. Todos los pacientes recuperaron su déficit a los seis meses postoperatorios. En conclusión, se ha logrado reconstruir al tracto. Éste presenta una complejidad anatómica y funcional, que apoya la idea de su mapeo y preservación en la cirugía de gliomas. Futuros estudios interdisciplinarios son necesarios para determinar el carácter transitorio o permanente de los déficits.
Abstract The frontal aslant tract (FAT) connects the supple mentary motor area (SMA) with the pars opercularis. Its role in language and its implications in glioma sur gery remain under discussion. We present an anatomo-surgical study of three cases with surgical resolution. Three patients with gliomas in the left frontal lobe were operated on using an awake patient protocol with cortical and subcortical mapping techniques, conduct ing motor and language evaluations. Tractography was performed using DSI Studio software. All three patients showed intraoperative language inhibition through subcortical stimulation of the FAT. Resection involving the FAT correlated with language deficits in all cases and movement initiation deficits in two cases. All patients recovered from their deficits at six months postoperatively. In conclusion, the tract has been successfully re constructed, showing both anatomical and functional complexity, supporting the idea of its mapping and preservation in glioma surgery. Future interdisciplin ary studies are necessary to determine the transient or permanent nature of the deficits.
RESUMO
Tractography fluorescence and confocal endomicroscopy are complementary technologies to targeted tumor resection, and it is certain that as our technology for fluorescent probes continues to evolve, the confocal microscope will continue to be refined. Recent work suggests that intraoperative high-resolution augmented reality endomicroscopy, a real-time alternative to invasive biopsy and histopathology, has the potential to better quantify tumor burden at the final stages of surgery and ultimately to improve patient outcomes when combined with wide-field imaging approaches. Additional studies are needed to further elucidate the clinical benefits of these new technologies for brain tumor patients.
Assuntos
Neoplasias Encefálicas , Imagem de Tensor de Difusão , Microscopia Confocal , Humanos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Microscopia Confocal/métodos , Imagem de Tensor de Difusão/métodos , Neuroendoscopia/métodosRESUMO
Diffusion Magnetic Resonance Imaging tractography is a non-invasive technique that produces a collection of streamlines representing the main white matter bundle trajectories. Methods, such as fiber clustering algorithms, are important in computational neuroscience and have been the basis of several white matter analysis methods and studies. Nevertheless, these clustering methods face the challenge of the absence of ground truth of white matter fibers, making their evaluation difficult. As an alternative solution, we present an innovative brain fiber bundle simulator that uses spline curves for fiber representation. The methodology uses a tubular model for the bundle simulation based on a bundle centroid and five radii along the bundle. The algorithm was tested by simulating 28 Deep White Matter atlas bundles, leading to low inter-bundle distances and high intersection percentages between the original and simulated bundles. To prove the utility of the simulator, we created three whole-brain datasets containing different numbers of fiber bundles to assess the quality performance of QuickBundles and Fast Fiber Clustering algorithms using five clustering metrics. Our results indicate that QuickBundles tends to split less and Fast Fiber Clustering tends to merge less, which is consistent with their expected behavior. The performance of both algorithms decreases when the number of bundles is increased due to higher bundle crossings. Additionally, the two algorithms exhibit robust behavior with input data permutation. To our knowledge, this is the first whole-brain fiber bundle simulator capable of assessing fiber clustering algorithms with realistic data.
RESUMO
The frontal aslant tract (FAT) connects the supplementary motor area (SMA) with the pars opercularis. Its role in language and its implications in glioma surgery remain under discussion. We present an anatomosurgical study of three cases with surgical resolution. Three patients with gliomas in the left frontal lobe were operated on using an awake patient protocol with cortical and subcortical mapping techniques, conducting motor and language evaluations. Tractography was performed using DSI Studio software. All three patients showed intraoperative language inhibition through subcortical stimulation of the FAT. Resection involving the FAT correlated with language deficits in all cases and movement initiation deficits in two cases. All patients recovered from their deficits at six months postoperatively. In conclusion, the tract has been successfully reconstructed, showing both anatomical and functional complexity, supporting the idea of its mapping and preservation in glioma surgery. Future interdisciplinary studies are necessary to determine the transient or permanent nature of the deficits.
El tracto oblicuo frontal (TOF) conecta el área motora suplementaria (AMS) con la pars opercularis. Su rol en el lenguaje y su implicancia en la cirugía de gliomas siguen en discusión. Presentamos un estudio anatomoquirúrgico de tres casos con resolución quirúrgica. Se operaron tres pacientes con gliomas en el lóbulo frontal izquierdo utilizando protocolo de paciente despierto con técnicas de mapeo cortical y subcortical realizando evaluación motora y del lenguaje. Las tractografías fueron realizadas con el software DSI Studio. Los tres pacientes presentaron inhibición intraoperatoria del lenguaje mediante la estimulación subcortical de TOF. La resección en contacto con el TOF se correlacionó con déficits del lenguaje en todos los casos y en dos casos déficits en la iniciación del movimiento. Todos los pacientes recuperaron su déficit a los seis meses postoperatorios. En conclusión, se ha logrado reconstruir al tracto. Éste presenta una complejidad anatómica y funcional, que apoya la idea de su mapeo y preservación en la cirugía de gliomas. Futuros estudios interdisciplinarios son necesarios para determinar el carácter transitorio o permanente de los déficits.
Assuntos
Neoplasias Encefálicas , Lobo Frontal , Glioma , Humanos , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Glioma/cirurgia , Glioma/diagnóstico por imagem , Glioma/patologia , Masculino , Lobo Frontal/cirurgia , Lobo Frontal/diagnóstico por imagem , Pessoa de Meia-Idade , Feminino , Adulto , Procedimentos Neurocirúrgicos/métodos , Mapeamento Encefálico/métodos , Córtex Motor/diagnóstico por imagem , Córtex Motor/cirurgia , Córtex Motor/anatomia & histologia , Imagem de Tensor de DifusãoRESUMO
In recent years, there has been a growing interest in studying the Superficial White Matter (SWM). The SWM consists of short association fibers connecting near giry of the cortex, with a complex organization due to their close relationship with the cortical folding patterns. Therefore, their segmentation from dMRI tractography datasets requires dedicated methodologies to identify the main fiber bundle shape and deal with spurious fibers. This paper presents an enhanced short fiber bundle segmentation based on a SWM bundle atlas and the filtering of noisy fibers. The method was tuned and evaluated over HCP test-retest probabilistic tractography datasets (44 subjects). We propose four fiber bundle filters to remove spurious fibers. Furthermore, we include the identification of the main fiber fascicle to obtain well-defined fiber bundles. First, we identified four main bundle shapes in the SWM atlas, and performed a filter tuning in a subset of 28 subjects. The filter based on the Convex Hull provided the highest similarity between corresponding test-retest fiber bundles. Subsequently, we applied the best filter in the 16 remaining subjects for all atlas bundles, showing that filtered fiber bundles significantly improve test-retest reproducibility indices when removing between ten and twenty percent of the fibers. Additionally, we applied the bundle segmentation with and without filtering to the ABIDE-II database. The fiber bundle filtering allowed us to obtain a higher number of bundles with significant differences in fractional anisotropy, mean diffusivity, and radial diffusivity of Autism Spectrum Disorder patients relative to controls.
RESUMO
Accurately studying structural connectivity requires precise tract segmentation strategies. The U-Net network has been widely recognized for its exceptional capacity in image segmentation tasks and provides remarkable results in large tract segmentation when high-quality diffusion-weighted imaging (DWI) data are used. However, short tracts, which are associated with various neurological diseases, pose specific challenges, particularly when high-quality DWI data acquisition within clinical settings is concerned. Here, we aimed to evaluate the U-Net network ability to segment short tracts by using DWI data acquired in different experimental conditions. To this end, we conducted three types of training experiments involving 350 healthy subjects and 11 white matter tracts, including the anterior, posterior, and hippocampal commissure, fornix, and uncinated fasciculus. In the first experiment, the model was exclusively trained with high-quality data of the Human Connectome Project (HCP) dataset. The second experiment focused on images of healthy subjects acquired from a local hospital dataset, representing a typical clinical routine acquisition. In the third experiment, a hybrid training approach was employed, combining data of the HCP and local hospital datasets. Then, the best model was also tested in unseen DWIs of 10 epilepsy patients of the local hospital and 10 healthy subjects acquired on a scanner from another company. The outcomes of the third experiment demonstrated a notable enhancement in performance when contrasted with the preceding trials. Specifically, the short tracts within the local hospital dataset achieved Dice scores ranging between 0.60 and 0.65. Similar intervals were obtained with HCP data in the first experiment, and a substantial improvement compared to the scores between 0.37 and 0.50 obtained with the local hospital dataset at the same experiment. This improvement persisted when the method was applied to diverse scenarios, including different scanner acquisitions and epilepsy patients. These results indicate that combining datasets from different sources, coupled with resolution standardization strengthens the neural network ability to generalize predictions across a spectrum of datasets. Nevertheless, short tract segmentation performance is intricately linked to the training composition, to validation, and to testing data. Moreover, curved tracts have intricate structural nature, which adds complexities to their segmenting. Although the network training approach tested herein has provided promising results, caution must be taken when extrapolating its application to datasets acquired under distinct experimental conditions, even in the case of higher-quality data or analysis of long or short tracts.
Assuntos
Conectoma , Epilepsia , Processamento de Imagem Assistida por Computador , Substância Branca , Humanos , Masculino , Feminino , Processamento de Imagem Assistida por Computador/métodos , Adulto , Epilepsia/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Imageamento por Ressonância Magnética/métodos , AlgoritmosRESUMO
We present a Python library (Phybers) for analyzing brain tractography data. Tractography datasets contain streamlines (also called fibers) composed of 3D points representing the main white matter pathways. Several algorithms have been proposed to analyze this data, including clustering, segmentation, and visualization methods. The manipulation of tractography data is not straightforward due to the geometrical complexity of the streamlines, the file format, and the size of the datasets, which may contain millions of fibers. Hence, we collected and structured state-of-the-art methods for the analysis of tractography and packed them into a Python library, to integrate and share tools for tractography analysis. Due to the high computational requirements, the most demanding modules were implemented in C/C++. Available functions include brain Bundle Segmentation (FiberSeg), Hierarchical Fiber Clustering (HClust), Fast Fiber Clustering (FFClust), normalization to a reference coordinate system, fiber sampling, calculation of intersection between sets of brain fibers, tools for cluster filtering, calculation of measures from clusters, and fiber visualization. The library tools were structured into four principal modules: Segmentation, Clustering, Utils, and Visualization (Fibervis). Phybers is freely available on a GitHub repository under the GNU public license for non-commercial use and open-source development, which provides sample data and extensive documentation. In addition, the library can be easily installed on both Windows and Ubuntu operating systems through the pip library.
RESUMO
[This corrects the article DOI: 10.3389/fpsyt.2021.764776.].
RESUMO
Background: Diffusion tensor imaging (DTI) tractography facilitates maximal safe resection and optimizes planning to avoid injury during subcortical dissection along descending motor pathways (DMPs). We provide an affordable, safe, and timely algorithm for preoperative DTI motor reconstruction for gliomas adjacent to DMPs. Methods: Preoperative DTI reconstructions were extracted from a prospectively acquired registry of glioma resections adjacent to DMPs. The surgeries were performed over a 7-year period. Demographic, clinical, and radiographic data were extracted from patients' electronic medical records. Results: Nineteen patients (12 male) underwent preoperative tractography between January 1, 2013, and May 31, 2020. The average age was 44.5 years (range, 19-81 years). A complete radiological resection was achieved in nine patients, a subtotal resection in five, a partial resection in three, and a biopsy in two. Histopathological diagnoses included 10 patients with high-grade glioma and nine with low-grade glioma. A total of 16 perirolandic locations (10 frontal and six frontoparietal) were recorded, as well as two in the insula and one in the basal ganglia. In 9 patients (47.3%), the lesion was in the dominant hemisphere. The median preoperative and postoperative Karnofsky Performance Scores were 78 and 80, respectively. Motor function was unchanged or improved over time in 15 cases (78.9%). Conclusion: This protocol of DTI reconstruction for glioma removal near the DMP shows good results in low-term neurological functional outcomes.
RESUMO
SUMMARY: Anatomy education has gathered together a great many of many new modalities and was modified from classical lecture-based and laboratory practice system to the blended modules. In the scope of the present study, we develop a new, practical, cost- effective and efficient three dimensional (3D) educational model, which aimed to be helpful for the detection and better understanding of basic neuroanatomy education. Tractographic imaging, fiber dissection, microscopic anatomy and plastination techniques were applied to the white matter regions of the two brains. After the photographs that were taken were converted to 3D images, the specimens were plastinated. By way of establishing an educational model as a whole, we applied it to 202 second-year medical students. The students were separated into two groups when they attended to the theoretical lecture. Group 1 took the classical laboratory education; on the other hand, Group 2 received the newly designed educational model. Pre and post-tests were introduced to each group before and after laboratory sessions, respectively. The success scores were put to comparison. The average achievement scores of each group showed increase significantly (p<0.05) after the laboratory sessions, besides the increase in the post-test results of Group 2 was more statistically significant (p<0.05). Consequently, this new educational model enriched by newly designed unified methods could be regarded as useful for grasping and improving the basic neuroanatomy knowledge.
La educación en anatomía ha reunido una gran cantidad de nuevas modalidades, modificándose el sistema clásico de la práctica del laboratorio y de las clases basadas en conferencias, hacia los módulos combinados. En el ámbito del presente estudio, desarrollamos un modelo educativo tridimensional (3D) nuevo, práctico, rentable y eficiente, que pretendía ser útil para la detección y una mejor comprensión de la educación básica en neuroanatomía. Se tomaron imágenes tractográficas, disección de fibras, anatomía microscópica y técnicas de plastinación en los cerebros. Después de convertir las fotografías que se tomaron en imágenes 3D, se plastinaron los especímenes. A modo de establecer un modelo educativo en su conjunto, lo aplicamos a 202 estudiantes de segundo año de medicina. Los estudiantes fueron separados en dos grupos cuando asistieron a la clase teórica. El Grupo 1 tomó la educación clásica de laboratorio; por su parte, el Grupo 2 recibió el nuevo modelo educativo diseñado para el estudio. Se introdujeron pruebas previas y posteriores a cada grupo, antes y después de las sesiones de laboratorio. Se compararon las puntuaciones. Los puntajes promedio de rendimiento de cada grupo mostraron un aumento significativo (p<0,05) después de las sesiones de laboratorio. Además, se obtuvo un aumento en los resultados positivos, posteriores a la prueba del Grupo 2, siendo estadísticamente significativo (p<0,05). En consecuencia, este modelo educativo, enriquecido por métodos unificados de nuevo diseño, podría considerarse útil para captar y mejorar los conocimientos básicos de neuroanatomía.
Assuntos
Humanos , Modelos Educacionais , Educação Médica/métodos , Neuroanatomia/educação , Dissecação , Cérebro/anatomia & histologia , Imagem de Tensor de Difusão , Substância Branca/anatomia & histologia , Plastinação , Microscopia , Fibras NervosasRESUMO
Background: The aim of the study was to describe the origin, course, and termination of frontal aslant tract (FAT) in the Mexican population of neurosurgical referral centers. Methods: From January 2018 to May 2019, we analyzed 50 magnetic resonance imaging (MRI) studies in diffusion tensor imaging sequences of patients of the National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez." Five brains were fixed by the Klingler method and dissected in the neurosurgery laboratory of the Hospital Civil de Guadalajara to identify the origin, trajectory, and ending of the FAT. Results: FAT was identified in 100% of the MRI and brain dissections. The origin of the FAT was observed in 63% from the supplementary premotor area, 24% from the supplementary motor area, and 13% in both areas. Its ending was observed in the pars opercularis in 81%, pars triangularis in 9%, and in both pars opercularis and ventral premotor area in 10% in the magnetic resonance images, with a left side predominance. In the hemispheres dissections, the origin of FAT was identified in 60% from the supplementary premotor area, 20% from the supplementary motor area, and 20% in both areas. Its ending was observed in the pars opercularis in 80% and the pars triangularis in 20%. It was not identified as an individual fascicle connected with the contralateral FAT. Conclusion: In the Mexican population, FAT has a left predominance; it is originated more frequently in the supplementary premotor area, passes dorsal to the superior longitudinal fascicle II and the superior periinsular sulcus, and ends more commonly in the pars opercularis.
RESUMO
OBJECTIVE: Prelemniscal radiation (Raprl) lesions and deep brain stimulation effectively control motor symptoms of Parkinson disease, but individual variations in the stereotactic location of its fiber components constitute a significant concern. The objective of this study was to determine individual variations in the stereotactic location of fiber tracts composing Raprl. METHODS: Raprl fiber composition was determined in a group of 10 Parkinson patients and 10 matched controls using 3T magnetic resonance imaging, brain imaging processed for diffusion-weighted images, tract density imaging, and constrained spherical deconvolution. The stereotactic position of the point of maximal proximity (PMP), which is the point where the most significant number of fibers is concentrated in the smallest volume in the tractography, was evaluated in the right and left hemispheres of the same person, between individuals and between patients and controls for each tract in coordinates "x," "y," and "z." The stereotactic coordinates at which PMP of all tracts meet were statistically determined, representing the recommended aim for this target. RESULTS: Stereotactic coordinates of the 3 fiber tracts composing Raprl, cerebellar-thalamic-cortical, globus pallidus-peduncle-pontine nucleus, and mesencephalic-orbital frontal cortex, did not vary between right and left hemispheres in the same person and between patients and controls. In contrast, PMP variability between individuals was significant, mainly for the mesencephalic-orbitofrontal tract. Therefore, probabilistic tractography can better determine individual variations to plan electrode trajectories. CONCLUSIONS: Individual PMP variations for fiber tracts in Raprl, identified by probabilistic tractography, provide a platform for planning the stereotactic approach to conform volumes for deep brain stimulation and lesions.
Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson , Substância Branca , Encéfalo , Estimulação Encefálica Profunda/métodos , Humanos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/terapia , TálamoRESUMO
BACKGROUND: To examine structural connectivity of white matter tracts in patients with Pantothenate Kinase-Associated Neurodegeneration (PKAN) dystonia and identify those ones which correlate negatively to severity of symptoms. METHODS: In a group of 41 patients suffering from PKAN dystonia and an age- and gender-matched control group, white matter tractography was carried out, based on diffusion tensor imaging magnetic resonance data. Postprocessing included assessment of Quantitative Anisotropy (QA) using q-space diffeomorphic reconstruction in order to reduce influence of iron accumulation in globus pallidus of patients. RESULTS: Whole brain tractography presented significantly reduced QA values in patients (0.282 ± 0.056, as compared to controls (0.325 ± 0.046, p < 0.001). 9 fiber clusters of tracts correlated negatively to the dystonia score of patients: the middle cerebellar peduncle and the tracts of both cerebellar hemispheres as well as corpus callosum, forceps minor, the superior cortico-striate tracts and the superior thalamic radiations of both cerebral hemispheres (False Discovery Rate FDR = 0.041). CONCLUSION: The finding of a reduced global structural connectivity within the white matter and of negative correlation of motor system-related tracts, mainly those between the basal ganglia, cortical areas and the cerebellum, fits well to the concept of a general functional disturbance of the motor system in PKAN.
Assuntos
Distonia , Leucoaraiose , Neurodegeneração Associada a Pantotenato-Quinase , Substância Branca , Encéfalo/patologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Imagem de Tensor de Difusão/métodos , Distonia/patologia , Humanos , Leucoaraiose/patologia , Neurodegeneração Associada a Pantotenato-Quinase/diagnóstico por imagem , Neurodegeneração Associada a Pantotenato-Quinase/genética , Substância Branca/diagnóstico por imagem , Substância Branca/patologiaRESUMO
Spontaneous recovery after a stroke accounts for a significant part of the neurological recovery in patients. However limited, the spontaneous recovery is mechanistically driven by axonal restorative processes for which several molecular cues have been previously described. We report the acceleration of spontaneous recovery in a preclinical model of ischemia/reperfusion in rats via a single intracerebroventricular administration of extracellular vesicles released from primary cortical astrocytes. We used magnetic resonance imaging and confocal and multiphoton microscopy to correlate the structural remodeling of the corpus callosum and striatocortical circuits with neurological performance during 21 days. We also evaluated the functionality of the corpus callosum by repetitive recordings of compound action potentials to show that the recovery facilitated by astrocytic extracellular vesicles was both anatomical and functional. Our data provide compelling evidence that astrocytes can hasten the basal recovery that naturally occurs post-stroke through the release of cellular mediators contained in extracellular vesicles.
Assuntos
Vesículas Extracelulares , Acidente Vascular Cerebral , Animais , Astrócitos , Axônios , Modelos Animais de Doenças , Humanos , Imageamento por Ressonância Magnética , Ratos , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/patologiaRESUMO
BACKGROUND: The cerebellum has emerged as an attractive and promising target for neuromodulation in movement disorders due to its vast connection with important cortical and subcortical areas. Here, we describe a novel technique of deep brain stimulation (DBS) of the dentate nucleus (DN) aided by tractography. METHODS: Since 2015, patients with movement disorders including dystonia, ataxia, and tremor have been treated with DN DBS. The cerebellar target was initially localized using coordinates measured from the fastigial point. The target was adjusted with direct visualization of the DN in the susceptibility-weighted imaging and T2 sequences of the MRI and finally refined based on the reconstruction of the dentatorubrothalamic tract (DRTT). RESULTS: Three patients were treated with this technique. The final target was located in the anterior portion of DN in close proximity to the DRTT, with the tip of the lead on the white matter and the remaining contacts on the DN. Clinical outcomes were variable and overall positive, with no major side effect. CONCLUSION: Targeting the DN based on tractography of the DRTT seems to be feasible and safe. Larger studies will be necessary to support our preliminary findings.
RESUMO
Studies of the superior longitudinal fasciculus (SLF) have multiplied in recent decades owing to methodological advances, but the absence of a convention for nomenclature remains a source of confusion. Here, we have reviewed existing nomenclatures in the context of the research studies that generated them and we have identified their agreements and disagreements. A literature search was conducted using PubMed/MEDLINE, Web-of-Science, Embase, and a review of seminal publications, without restrictions regarding publication date. Our search revealed that diffusion imaging, autoradiography, and fiber dissection have been the main methods contributing to tract designation. The first two have been particularly influential in systematizing the horizontal elements distant from the lateral sulcus. Twelve approaches to naming were identified, eight of them differing considerably from each other. The terms SLF and arcuate fasciculus (AF) were often used as synonyms until the second half of the 20th century. During the last 15 years, this has ceased to be the case in a growing number of publications. The term AF has been used to refer to the assembly of three different segments, or exclusively to long frontotemporal fibers. Similarly, the term SLF has been employed to denote the whole superior longitudinal associative system, or only the horizontal frontoparietal parts. As only partial correspondence can be identified among the available nomenclatures, and in the absence of an official designation of all anatomical structures that can be encountered in clinical practice, a high level of vigilance regarding the effectiveness of every oral or written act of communication is mandatory.
Assuntos
Córtex Cerebral/anatomia & histologia , Vias Neurais/anatomia & histologia , Substância Branca/anatomia & histologia , Humanos , Terminologia como AssuntoRESUMO
Objective: Deep brain stimulation (DBS) was proposed in 1999 to treat refractory obsessive-compulsive disorder (OCD). Despite the accumulated experience over more than two decades, 30-40% of patients fail to respond to this procedure. One potential reason to explain why some patients do not improve in the postoperative period is that DBS might not have engaged structural therapeutic networks that are crucial to a favorable outcome in non-responders. This article reviews magnetic resonance imaging diffusion studies (DTI-MRI), analyzing neural networks likely modulated by DBS in OCD patients and their corresponding clinical outcome. Methods: We used a systematic review process to search for studies published from 2005 to 2020 in six electronic databases. Search terms included obsessive-compulsive disorder, deep brain stimulation, diffusion-weighted imaging, diffusion tensor imaging, diffusion tractography, tractography, connectome, diffusion analyses, and white matter. No restriction was made concerning the surgical target, DTI-MRI technique and the method of data processing. Results: Eight studies published in the last 15 years were fully assessed. Most of them used 3 Tesla DTI-MRI, and different methods of data acquisition and processing. There was no consensus on potential structures and networks underlying DBS effects. Most studies stimulated the ventral anterior limb of the internal capsule (ALIC)/nucleus accumbens. However, the contribution of different white matter pathways that run through the ALIC for the effects of DBS remains elusive. Moreover, the improvement of cognitive and affective symptoms in OCD patients probably relies on electric modulation of distinct networks. Conclusion: Though, tractography is a valuable tool to understand neural circuits, the effects of modulating different fiber tracts in OCD are still unclear. Future advances on image acquisition and data processing and a larger number of studies are still required for the understanding of the role of tractography-based targeting and to clarify the importance of different tracts for the mechanisms of DBS.
RESUMO
Introducción: Los cavernomas representan el 5 al 13% de las malformaciones cerebrales y suelen tener una localización supratentorial. Clínicamente pueden permanecer asintomáticos o presentar síntomas neurológicos progresivos. Para estos últimos, así como los que presentan hemorragia recurrente, la resección quirúrgica es el tratamiento de elección. Sin embargo, para aquellos que presentan una localización profunda es menester estudiar la relación que existe entre la lesión y las estructuras cerebrales adyacentes. La tractografía (DTI) y las técnicas de navegación intraoperatoria son herramientas fundamentales para planificar y guiar el abordaje a la lesión y realizar un mapeo de las vías de proyección, asociación y comisurales, permitiendo un acceso seguro mediante corticotomías pequeñas y mínima retracción del parénquima cerebral. Objetivo: Describir la técnica quirúrgica guiada por neuronavegación para la resección de un cavernoma frontal derecho profundo yuxtaventricular a través de una pequeña corticotomía. Caso: Paciente de sexo masculino de 20 años de edad, deportista profesional, con parestesias miembro superior izquierdo y cefalea severa. Resonancia magnética evidencia lesión heterogénea en T1 y T2 y presencia de un halo de hemosiderina, compatible con cavernoma a nivel del techo del cuerpo en el ventrículo lateral derecho. Mide 28 mm x 31 mm x 28 mm en sus diámetros transversal, dorso-ventral y rostro-caudal. Tractografía evidencia lesión en íntima relación con el tracto corticoespinal en su recorrido por la corona radiada. Resultados: Exéresis completa de la lesión. El paciente evolucionó sin déficit neurológico y fue dado de alta a las 72 horas del postoperatorio. Conclusión: El uso de la tractografía y de la navegación intraoperatorio, permite abordar lesiones profundas, en contacto con áreas elocuentes, mediante corticotomías pequeñas con mínima retracción cerebral
Introduction: Cavernous malformation represents among 5 to 13% of brain vascular malformations, most of them have a supratentorial location. Clinically they can remain asymptomatic or present with neurological symptoms. In cavernomas with recurrent hemorrhage, located in safe areas, surgical resection is the treatment of choice. However, for those which have a deep yuxta-ventricular localization it is necessary to know the relationship between the lesion and eloquent cerebral structures. Fiber tractography and intraoperative navigation systems are essentials tools to plan and guide the surgical approach and make a mapping of the projection, association and commissural fibers in order to have a safe access to the lesion. Objective: To describe the surgical technique using neuronavigation for the resection of a right frontal yuxta-ventricular cavernous malformation through a minimal approach. Case: A 20-year-old man, professional athlete with left arm paresthesia and severe headache. Magnetic resonance shows a heterogeneous lesion in T1 and T2 with a hemosiderin in the roof of the right lateral ventricle, compatible with a cavernous malformation. Its size was 28 mm x 31mm x 28 mm in the transversal, dorsoventral and rostrocaudal diameter. The fiber tractography shows an intimate relationship with the corticospinal tract on its path through the corona radiata. Results: Complete resection of the lesion. The patient evolved without a neurological deficit and was discharged 72 hours later. Conclusion: The fiber tractography and the intraoperative navigation system allow the deep lesions approach, especially for those who have an intimal relationship with eloquent Ìs areas, using minimally corticotomy with less parenchymal retraction.
Assuntos
Masculino , Malformações Vasculares do Sistema Nervoso Central , Anormalidades Congênitas , Espectroscopia de Ressonância Magnética , Neuronavegação , CefaleiaRESUMO
OBJECTIVE: This study's objective was to compare the transinsular (TI-AH), transuncus (TU-AH), and temporopolar (TP-AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline. METHODS: We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI-AH, TU-AH, or TP-AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre- and postoperative memory performance and intelligence quotient (IQ). RESULTS: There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow-up with TP-AH (69.5%) and TI-AH (76.7%) as compared to the TU-AH (43.5%) approach (p = .03). The number of fibers of the inferior fronto-occipital fasciculus postoperatively was reduced in the TI-AH group compared with the TU-AH and TP-AH groups (p = .001). The rate of visual field defects was significantly higher with TI-AH (14/19, 74%) in comparison to the TU-AH (5/15, 33%) and TP-AH (13/40, 32.5%) approaches (p = .008). Finally, there was a significant postoperative decline in verbal memory in left-sided surgeries (p = .019) and delayed recall for both sides (p < .001) regardless of the surgical approach. However, TP-AH was the only group that showed a significant improvement in visual memory (p < .001) and IQ (p < .001) for both right- and left-sided surgeries. SIGNIFICANCE: The TP-AH group had better short-term seizure control than TU-AH, a lower rate of visual field defects than TI-AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP-AH is a better surgical approach for temporal lobe epilepsy with HS than TI-AH and TU-AH.
Assuntos
Tonsila do Cerebelo/cirurgia , Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Hipocampo/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Cognitivas Pós-Operatórias/epidemiologia , Adulto , Lobectomia Temporal Anterior , Córtex Cerebral , Imagem de Tensor de Difusão , Feminino , Hipocampo/patologia , Humanos , Testes de Inteligência , Masculino , Memória , Pessoa de Meia-Idade , Giro Para-Hipocampal , Complicações Cognitivas Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Esclerose , Lobo Temporal , Resultado do Tratamento , Campos VisuaisRESUMO
Objective: The goal is to evaluate longitudinally with diffusion tensor imaging (DTI) the integrity of cerebral white matter in patients with moderate and severe DAI and to correlate the DTI findings with cognitive deficits.Methods: Patients with DAI (n = 20) were scanned at three timepoints (2, 6 and 12 months) after trauma. A healthy control group (n = 20) was evaluated once with the same high-field MRI scanner. The corpus callosum (CC) and the bilateral superior longitudinal fascicles (SLFs) were assessed by deterministic tractography with ExploreDTI. A neuropschychological evaluation was also performed.Results: The CC and both SLFs demonstrated various microstructural abnormalities in between-groups comparisons. All DTI parameters demonstrated changes across time in the body of the CC, while FA (fractional anisotropy) increases were seen on both SLFs. In the splenium of the CC, progressive changes in the mean diffusivity (MD) and axial diffusivity (AD) were also observed. There was an improvement in attention and memory along time. Remarkably, DTI parameters demonstrated several correlations with the cognitive domains.Conclusions: Our findings suggest that microstructural changes in the white matter are dynamic and may be detectable by DTI throughout the first year after trauma. Likewise, patients also demonstrated improvement in some cognitive skills.