RESUMO
Taste consists of sensation and perception. Specific neural structures transmit a stimulus from the taste buds to the gustatory cortex to generate taste sensation. Any disruption of this pathway, whether it affects sensation or perception, can result in taste disorders. Stereotactic procedures involving the thalamus may result in gustatory complications. A 41-year-old female patient who underwent stereotactic drainage of a thalamic cyst suffered transient ageusia. Subsequently, she developed metallic taste perception. When her stereotactic plan was re-evaluated, it was noted that the posteromedial ventral thalamus nucleus was in the path of the needle tract and the needle had passed through it. Follow-up was recommended and her symptoms completely resolved within 2 months following surgery. Modern imaging techniques allow for the visualization of neural structures related to the sense of taste. Additionally, care must be taken when planning stereotactic procedures for such lesions.
Assuntos
Ageusia , Drenagem , Disgeusia , Humanos , Feminino , Adulto , Ageusia/etiologia , Disgeusia/etiologia , Drenagem/métodos , Cistos/cirurgia , Imageamento por Ressonância Magnética , Técnicas Estereotáxicas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Doenças Talâmicas/cirurgia , Doenças Talâmicas/diagnóstico por imagem , Tálamo/diagnóstico por imagem , Tálamo/cirurgiaRESUMO
BACKGROUND AND OBJECTIVES: Accessing lesions in the posterior-medial thalamus can be challenging because of their deep location and intricate neurovascular anatomy. This study aims to describe the techniques and feasibility of the endoscopic supracerebellar infratentorial transpineal approach for treating posterior-medial thalamus lesions. METHODS: We reviewed and analyzed the clinical outcomes and endoscopic surgical experience of 11 patients with posterior-medial thalamic lesions. The first 4 cases used the endoscopic midline supracerebellar infratentorial transpineal approach, whereas the subsequent 7 cases used the endoscopic contralateral paramedian supracerebellar infratentorial transpineal approach. All cases involved the upward transposition of the pineal gland to access the posterior-medial thalamus. The extent of resection and the endoscopic techniques were the main focus of analysis. Neurological examinations and MRI/computed tomography follow-up were conducted for 3-12 months after surgery. RESULTS: The pathology of the group included 6 gliomas, 1 cavernous malformation, 1 inflammation, 1 melanoma, and 2 hematomas. All 11 patients achieved gross total resection (6 patients, 54.5%) or subtotal resection (5 patients, 45.5%) with no new neurological deficits. Most patients (9 patients, 81.8%) experienced improvement in Karnofsky Performance Status after surgery. Postoperative hydrocephalus occurred in 2 patients (18.2%) and was relieved by endoscopic third ventriculostomy. CONCLUSION: The endoscopic supracerebellar infratentorial transpineal approach is an effective approach for removing posterior-medial thalamic lesions that require access through the third ventricle surfaces of the thalamus. The endoscopic contralateral paramedian supracerebellar infratentorial transpineal approach provides a more superior and lateral view of the posterior-medial thalamic lesions.
Assuntos
Neuroendoscopia , Tálamo , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Tálamo/cirurgia , Tálamo/diagnóstico por imagem , Neuroendoscopia/métodos , Idoso , Resultado do Tratamento , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Adulto Jovem , Cerebelo/cirurgia , Cerebelo/diagnóstico por imagem , Doenças Talâmicas/cirurgia , Doenças Talâmicas/diagnóstico por imagem , Glioma/cirurgia , Glioma/diagnóstico por imagem , Glândula Pineal/cirurgia , Glândula Pineal/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Adolescente , Estudos Retrospectivos , Imageamento por Ressonância Magnética/métodos , Melanoma/cirurgia , Melanoma/diagnóstico por imagemRESUMO
Congenital Zika virus syndrome (CZVS) is associated with severe neurological deficits. Clinical characteristics of epilepsy and the electroencephalographic (EEG) pattern in CZVS were documented in infancy. In this study, we aimed to describe the EEG findings observed during the follow-up of children with CZVS. Seventy-six EEGs of 55 children (60% female; mean age = 50 months) with confirmed CZVS were analyzed, considering the background, interictal, and ictal epileptiform discharges. Continuous (or almost continuous) epileptiform discharges during non-rapid eye movement sleep were identified in 22 (40%) patients. In 20 (90.1%) patients, the pattern was symmetrical, with an anterior predominance of the epileptiform activity. All patients with this pattern had epilepsy, which was severe in 15 (68.2%) and demanded polytherapy in 19 (86.4%). Subcortical calcifications (77.3%) and multifocal EEGs (72.8%) in earlier ages occurred more often in patients with this pattern. Other unspecific interictal EEG patterns were focal epileptiform discharges in 23 (41.8%) and multifocal activity in six (10.9%). In CZVS, continuous (or almost continuous) epileptiform discharges during sleep emerge as a pattern after the second year of life. This was associated with severe and drug-resistant epilepsy, but not necessarily with an apparent regression. Subcortical calcifications and multifocal epileptiform discharges in infancy are associated with this pattern.
Assuntos
Encéfalo/fisiopatologia , Epilepsia/fisiopatologia , Malformações do Desenvolvimento Cortical/fisiopatologia , Sono , Infecção por Zika virus/congênito , Infecção por Zika virus/fisiopatologia , Anticonvulsivantes/uso terapêutico , Doenças dos Gânglios da Base/diagnóstico por imagem , Doenças dos Gânglios da Base/fisiopatologia , Encéfalo/diagnóstico por imagem , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Pré-Escolar , Progressão da Doença , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/fisiopatologia , Eletroencefalografia , Epilepsias Parciais/diagnóstico por imagem , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/fisiopatologia , Epilepsia/diagnóstico por imagem , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Malformações do Desenvolvimento Cortical/diagnóstico por imagem , Tamanho do Órgão , Polimicrogiria/diagnóstico por imagem , Polimicrogiria/fisiopatologia , Índice de Gravidade de Doença , Síndrome , Doenças Talâmicas/diagnóstico por imagem , Doenças Talâmicas/fisiopatologia , Infecção por Zika virus/diagnóstico por imagemRESUMO
BACKGROUND: Although surgeries for intracerebral hemorrhage remain controversial, endoscopic surgery is considered a promising surgical treatment. The most fatal type of thalamic hemorrhage is the medial type, which is always combined with expansion of the hematoma into the third ventricle. The current endoscopic approach to this lesion involves injury to the mediodorsal nucleus of the thalamus (MDT). CASE DESCRIPTION: We report 5 cases of medial thalamic hemorrhage with third intraventricular involvement treated by an endoscopic-assisted translateral ventricular transchoroidal fissure approach. The preoperative average volume of the parenchymal hematomas was 9.63 mL, while the preoperative average volume of the intraventricular hematomas was 23.35 mL. The average surgical duration was 80.6 minutes. No intraoperative MDT incision was needed in any patient. The evacuation rates of parenchymal and intraventricular hematomas were 74.21%-98.84% and 85.89%-99.51%, respectively. Three months after the surgery, the average Glasgow Coma Scale scores improved to 13.8 from 7.2 preoperatively. No ventriculoperitoneal shunt was needed in any patient. CONCLUSIONS: The endoscopic-assisted translateral ventricular transchoroidal fissure approach is a safe and effective approach for evacuation of a medial thalamic hemorrhage with third intraventricular involvement. This approach allows parenchymal hematoma evacuation through the rupture of the third ventricle without incising the MDT in the lateral ventricle.
Assuntos
Endoscopia/métodos , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doenças Talâmicas/cirurgia , Terceiro Ventrículo/cirurgia , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Feminino , Escala de Coma de Glasgow , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Núcleo Mediodorsal do Tálamo/diagnóstico por imagem , Núcleo Mediodorsal do Tálamo/cirurgia , Pessoa de Meia-Idade , Duração da Cirurgia , Cirurgia Assistida por Computador , Doenças Talâmicas/diagnóstico por imagem , Terceiro Ventrículo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Odor detection, recognition, and identification were assessed in 19 acute ischemic stroke patients who had no magnetic resonance imaging-detectable thalamic lesions but in whom technetium-99m ethyl cysteinate dimer single photon emission tomography revealed thalamic hypoperfusion. Although these patients were unaware of reduced olfactory function, they exhibited significantly lower scores in tests for odor identification and recognition threshold as compared with 9 ischemic stroke controls that had normal thalamic hypoperfusion. However, absolute odor detection thresholds were similar in the 2 groups. These results demonstrate the usefulness of cerebral perfusion scintigraphy in assessing sensory loss after ischemic stroke and provide further evidence for the role of the thalamus in olfaction.
Assuntos
AVC Isquêmico/fisiopatologia , Transtornos do Olfato/fisiopatologia , Doenças Talâmicas/fisiopatologia , Idoso , Feminino , Humanos , AVC Isquêmico/diagnóstico por imagem , Masculino , Odorantes/análise , Transtornos do Olfato/diagnóstico por imagem , Doenças Talâmicas/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
OBJECTIVE: To test whether robot-assisted surgery can improve prognosis of small-volume thalamic hemorrhage and to provide a surgical basis for treatment of small-volume thalamic hemorrhage. METHODS: This retrospective study included patients with thalamic hemorrhage and hematoma volume of 5-15 mL treated from December 2015 to December 2018. Patients were divided into an operation group and a nonoperation group. General data, types of hematoma, incidence of complications, Scandinavian Stroke Scale score, and modified Rankin Scale score were recorded and analyzed. RESULTS: Retrospectively, 84 cases met inclusion criteria: 35 cases in operation group and 49 cases in nonoperation group. At 90 days after onset, mortality was 11.4% in the operation group and 4.1% in the nonoperation group (P > 0.05). The Scandinavian Stroke Scale score in the operation group (43.3 ± 8.5) was higher than in the nonoperation group (36.1 ± 10.0) (P < 0.05). The modified Rankin Scale score in the operation group (2.9 ± 0.3) was lower than in the nonoperation group (3.7 ± 0.2) (P < 0.05). The incidence of pneumonia (8.6%) and renal dysfunction (14.3%) was lower in the operation group than in the nonoperation group (28.6% and 34.7%, respectively) (P < 0.05). There was no significant difference between the 2 groups in the incidence of central fever (5.7% vs. 12.2%), stress ulcer (11.4% vs. 16.3%), and ion balance disturbance (20.0% vs. 26.5%) (P > 0.05). CONCLUSIONS: Robot-assisted drainage of thalamic hemorrhage can improve prognosis and reduce the incidence of pneumonia and renal dysfunction.
Assuntos
Hematoma/cirurgia , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Doenças Talâmicas/cirurgia , Idoso , Drenagem/métodos , Feminino , Hematoma/diagnóstico por imagem , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Mortalidade , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal/epidemiologia , Doenças Talâmicas/diagnóstico por imagem , Resultado do TratamentoAssuntos
Neoplasias Encefálicas/diagnóstico por imagem , Desfibriladores Implantáveis , Glioblastoma/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Taquicardia Ventricular/terapia , Doenças Talâmicas/diagnóstico por imagem , Amiodarona/uso terapêutico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagemAssuntos
Infarto Encefálico/diagnóstico por imagem , Craniofaringioma/cirurgia , Músculos Oculomotores/fisiopatologia , Oftalmoplegia/fisiopatologia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Doenças Talâmicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Infarto Encefálico/complicações , Criança , Feminino , Humanos , Procedimentos Neurocirúrgicos , Músculos Oculomotores/inervação , Oftalmoplegia/etiologia , Doenças Talâmicas/complicações , Núcleos Talâmicos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To investigate whether functional magnetic resonance imaging (fMRI) can be used to detect fatigue after traumatic brain injury (TBI). SETTING: Neurorehabilitation clinic. PARTICIPANTS: Patients with TBI (n = 57) and self-experienced fatigue more than 1 year postinjury, and age- and gender-matched healthy controls (n = 27). MAIN MEASURES: Self-assessment scales of fatigue, a neuropsychological test battery, and fMRI scanning during performance of a fatiguing 27-minute attention task. RESULTS: During testing within the fMRI scanner, patients showed a higher increase in self-reported fatigue than controls from before to after completing the task (P < .001). The patients also showed lower activity in several regions, including bilateral caudate, thalamus, and anterior insula (all P < .05). Furthermore, the patients failed to display decreased activation over time in regions of interest: the bilateral caudate and anterior thalamus (all P < .01). Left caudate activity correctly identified 91% of patients and 81% of controls, resulting in a positive predictive value of 91%. CONCLUSION: The results suggest that chronic fatigue after TBI is associated with altered striato-thalamic-cortical functioning. It would be of interest to study whether fMRI can be used to support the diagnosis of chronic fatigue in future studies.
Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Síndrome de Fadiga Crônica/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Doenças Talâmicas/diagnóstico por imagem , Adulto , Análise de Variância , Lesões Encefálicas Traumáticas/reabilitação , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Síndrome de Fadiga Crônica/epidemiologia , Síndrome de Fadiga Crônica/etiologia , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Medição de Risco , Autoavaliação (Psicologia) , Índice de Gravidade de Doença , Doenças Talâmicas/etiologiaRESUMO
BACKGROUND: Thalamopeduncular tumors arise at the junction of the inferior thalamus and cerebral peduncle, and present with a common clinical syndrome of progressive spastic hemiparesis. METHOD: Formal preoperative magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) were performed. Postoperative MRI was obtained to evaluate the extent of tumor resection. A prospective analysis of clinical outcomes was then conducted by the senior author. CONCLUSIONS: Preoperative tractography is a useful adjunct to surgical planning in tumors that displace motor pathways. Gross total resection of pilocytic astrocytomas usually results in cure, and therefore should be entertained when developing treatment strategies for thalamopeduncular tumors of childhood.
Assuntos
Astrocitoma/cirurgia , Neoplasias Encefálicas/cirurgia , Pedúnculo Cerebral/cirurgia , Procedimentos Neurocirúrgicos/métodos , Cirurgia Assistida por Computador/métodos , Doenças Talâmicas/cirurgia , Adulto , Astrocitoma/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Pedúnculo Cerebral/diagnóstico por imagem , Criança , Imagem de Tensor de Difusão/métodos , Humanos , Imageamento por Ressonância Magnética , Estudos Prospectivos , Doenças Talâmicas/diagnóstico por imagemRESUMO
Bithalamic lesions are uncommon, however, both focal and systemic disorders may present bilateral abnormalities in the thalamus in different acute and chronic clinical situations. Neuroimaging, in particular magnetic resonance imaging, plays an essential role in diagnostic approach. Imaging features such as signal alterations, diffusion restriction or contrast enhancement are helpful in characterization of these abnormalities. The location of the lesions may provide key information because some pathologies typically involve a certain part of the thalamus. In addition to thalamic findings, neuroimaging findings in other parts of the brain associated with the clinical and laboratory information should be taken into account to make a correct diagnosis.
Assuntos
Neuroimagem/métodos , Doenças Talâmicas/diagnóstico por imagem , Diagnóstico Diferencial , HumanosRESUMO
BACKGROUND: The thalamus is a deep-seated and crucial structure for the sensorimotor system. It has been long considered a surgically inaccessible area because of the morbidity associated with surgical resections. Astrocytomas of the thalamus are usually treated with bioptic procedures followed by adjuvant treatments. Intraoperative neurophysiologic monitoring (IONM) allows safe and satisfactory resections of lobar gliomas, but few data are available for thalamic lesions. The aim of this study was to review the outcome of a small series of patients with thalamic astrocytomas that were treated with surgical resection with the aid of IONM. METHODS: Surgical resection with IONM was performed in 5 patients with thalamic astrocytomas (1 grade I, 1 grade II, 2 grade III, 1 grade IV). Two astrocytomas were in the dominant hemisphere. Preoperative and postoperative neuropsychological assessments were performed in 3 patients. IONM was tailored to the individual patient and consisted of transcranial motor evoked potential monitoring, cortical motor evoked potential monitoring, somatosensory evoked potential monitoring, direct electrical stimulation, electroencephalography, and electrocorticography. RESULTS: None of the patients experienced permanent motor deficits; 2 patients had a transient hemiparesis requiring rehabilitation; 1 patient had a transient aphasia, and 1 patient had permanent aphasia. None of the patients had intraoperative seizures, but 1 patient experienced postoperative transient status epilepticus. The extent of resection on postoperative volumetric magnetic resonance imaging was >70% in all cases. CONCLUSIONS: Surgical resection of thalamic astrocytomas appeared to be effective and relatively safe when guided by IONM. Larger series of patients are required to confirm these preliminary data.
Assuntos
Astrocitoma/cirurgia , Neoplasias Encefálicas/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Procedimentos Neurocirúrgicos/métodos , Paresia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estado Epiléptico/epidemiologia , Doenças Talâmicas/cirurgia , Tálamo/cirurgia , Adolescente , Adulto , Afasia/epidemiologia , Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Criança , Estimulação Elétrica , Eletrocorticografia , Eletroencefalografia , Potencial Evocado Motor , Potenciais Somatossensoriais Evocados , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Paresia/reabilitação , Complicações Pós-Operatórias/reabilitação , Doenças Talâmicas/diagnóstico por imagem , Tálamo/diagnóstico por imagem , Adulto JovemRESUMO
A typical case of Fahr's syndrome is described in a 76-year-old Brazilian female who underwent a total thyroidectomy three decades ago. Six years before the current admission, she started with generalized tonic-clonic seizures. Associated disorders involved extra-pyramidal, cognitive, nocturnal terror and mood changes. With suspicion of hypocalcemia due to secondary hypoparathyroidism, laboratory determinations confirmed the diagnoses. Furthermore, imaging studies of the central nervous system detected multiple calcifications, with characteristic distribution of Fahr's syndrome. Clinical management was successful.
Assuntos
Doenças dos Gânglios da Base/etiologia , Calcinose/etiologia , Transtornos Cognitivos/etiologia , Epilepsia Tônico-Clônica/etiologia , Hipocalcemia/etiologia , Hipoparatireoidismo/etiologia , Tireoidectomia/efeitos adversos , Idoso , Doenças dos Gânglios da Base/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/etiologia , Núcleos Cerebelares/diagnóstico por imagem , Feminino , Humanos , Terrores Noturnos/etiologia , Síndrome , Doenças Talâmicas/diagnóstico por imagem , Doenças Talâmicas/etiologia , Tomografia Computadorizada por Raios XRESUMO
Bilateral thalamic glioma is one of the rarest tumor occurrences, representing a small fraction of thalamic gliomas, which only accounts for 1-1.5% of all brain tumors. It is usually a diffuse, low-grade astrocytoma (WHO grade II), seen mainly in adults, with approximately 25% of them involving children under the age of 15. Radiotherapy is the main mode of treatment since surgical intervention is limited to a role of biopsy and management of secondary effects, due to the deep brain location of the lesion and the complexity of the involved structures. We report a 1-year follow-up of a 55-year-old female patient with bilateral WHO grade II thalamic astrocytoma. Following histological and neuroradiological consensus regarding the diagnosis, the patient was referred for radiotherapy. The effectiveness of available therapy and long-term neuroradiological follow-up is not reliably established due to rapid fatal evolution following diagnosis. Contrary to the norm, our patient showed stable disease with radiotherapy for a 1-year period.
Assuntos
Neoplasias Encefálicas/patologia , Glioma/patologia , Doenças Talâmicas/patologia , Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Neoplasias Encefálicas/diagnóstico por imagem , Feminino , Glioma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Cintilografia , Doenças Talâmicas/diagnóstico por imagem , Núcleos Talâmicos/diagnóstico por imagem , Núcleos Talâmicos/patologia , Tálamo/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Neoplasias do Tronco Encefálico/diagnóstico , Neurocitoma/diagnóstico , Doenças Talâmicas/diagnóstico , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Lactente , Imageamento por Ressonância Magnética , Neurocitoma/diagnóstico por imagem , Doenças Talâmicas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
This study aimed to identify (1) the thalamic gliomas suitable for surgical resection and (2) the appropriate surgical approach based on their location and the displacement of the posterior limb of the internal capsule (PLIC). A retrospective study over a 5-year period (from 2006 to 2010) was performed in 41 patients with thalamic gliomas. The mean age of these patients was 20.4 years (range, 2-65 years). Twenty (49 %) tumors were thalamic, 19 (46 %) were thalamopeduncular, and 2 (5 %) were bilateral. The PLIC, based on T2-weighted magnetic resonance axial sections, was displaced anterolaterally in 23 (56 %) cases and laterally in 6 (14 %) cases. It was involved by lesion in eight (20 %) cases and could not be identified in four (10 %) cases. Resection, favored in patients with well-defined, contrast-enhancing lesions, was performed in 34 (83 %) cases, while a biopsy was resorted to in 7 (17 %) cases. A gross total resection or near total resection (>90 %) could be achieved in 26 (63 %) cases. The middle temporal gyrus approach, used when the PLIC was displaced anterolaterally, was the commonly used approach (63.5 %). Common pathologies were pilocytic astrocytoma (58 %) in children and grade III/IV astrocytomas (86 %) in adults. Preoperative motor deficits improved in 64 % of the patients with pilocytic lesions as compared to 0 % in patients with grade III/IV lesions (P value, 0.001). Postoperatively, two patients (5 %) had marginal worsening of motor power, two patients developed visual field defects, and one patient developed a third nerve paresis. Radical resection of thalamic gliomas is a useful treatment modality in a select subset of patients and is the treatment of choice for pilocytic astrocytomas. Tailoring the surgical approach, depending on the relative position of the PLIC, has an important bearing on outcome.
Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doenças Talâmicas/cirurgia , Adolescente , Adulto , Idoso , Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Astrocitoma/cirurgia , Biópsia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Criança , Pré-Escolar , Interpretação Estatística de Dados , Feminino , Lateralidade Funcional/fisiologia , Glioblastoma/diagnóstico por imagem , Glioblastoma/patologia , Glioblastoma/cirurgia , Glioma/diagnóstico por imagem , Glioma/patologia , Humanos , Cápsula Interna/patologia , Cápsula Interna/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Procedimentos Neurocirúrgicos/efeitos adversos , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Doenças Talâmicas/diagnóstico por imagem , Doenças Talâmicas/patologia , Resultado do Tratamento , Ultrassonografia , Adulto JovemRESUMO
Image guidance has proven to be an important tool in surgery for deep-seated or eloquently located cavernomas. However, neuronavigation depending on preoperative images can fail. Thus, the displayed anatomy might be distorted already during the approach. This report demonstrates the use of three-dimensional intraoperative ultrasound (3D-US) as a rescue tool, when conventional navigation is erroneous. Two patients with symptomatic cavernomas, the one located subcortically in the right peritrigonum, the other in the left thalamus, were operated in our clinic via an image-guided approach. An integrated ultrasound-navigation system was used for neuronavigation. In both cases, navigation based on preoperative MRI failed after the craniotomy because patient-to-image registration was lost. In both cases, a simple registration of the patient's orientation was performed. Then a 3D-US volume was acquired and navigation was performed using the 3D-US data set. This is accurate as image acquisition and navigation are done in the same system. The cavernoma was visualized without difficulties in both cases. It could be reached directly via the ultrasound-guided approach. Patients' symptoms improved postoperatively and a complete resection could be documented. Two cavernomas were successfully resected using 3D-US guidance. In our experience, stand-alone 3D-US navigation is an effective option if conventional MRI-based navigation fails.
Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Imageamento Tridimensional/métodos , Neuronavegação/métodos , Cirurgia Assistida por Computador , Adolescente , Adulto , Anticonvulsivantes/uso terapêutico , Encéfalo/patologia , Encéfalo/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Epilepsia/tratamento farmacológico , Epilepsia/etiologia , Epilepsia/cirurgia , Falha de Equipamento , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Doenças do Sistema Nervoso/etiologia , Exame Neurológico , Doenças Talâmicas/diagnóstico por imagem , Doenças Talâmicas/cirurgia , Resultado do Tratamento , UltrassonografiaAssuntos
Neoplasias Encefálicas/complicações , Glioma/complicações , Doença de Parkinson/complicações , Doenças Talâmicas/complicações , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Glioma/diagnóstico por imagem , Glioma/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia , Doenças Talâmicas/diagnóstico por imagem , Doenças Talâmicas/patologia , Tomografia Computadorizada de Emissão de Fóton ÚnicoAssuntos
Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/etiologia , Idoso , Anti-Inflamatórios/uso terapêutico , Aspirina/uso terapêutico , Biópsia , Infartos do Tronco Encefálico/etiologia , Infartos do Tronco Encefálico/patologia , Infartos do Tronco Encefálico/fisiopatologia , Progressão da Doença , Evolução Fatal , Arterite de Células Gigantes/patologia , Arterite de Células Gigantes/fisiopatologia , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Radiografia , Artérias Temporais/patologia , Artérias Temporais/fisiopatologia , Doenças Talâmicas/diagnóstico por imagem , Doenças Talâmicas/etiologia , Doenças Talâmicas/patologia , Ultrassonografia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia , Insuficiência Vertebrobasilar/patologiaRESUMO
The clinical features of familial Creutzfeldt-Jakob disease with a codon 200 point mutation [fCJD (E200K)] are similar to those of sporadic CJD (sCJD). MRI diffusion-weighted imaging (MRI-DWI) has been reported to be useful for the early diagnosis of CJD. We describe a Japanese fCJD (E200K) case in which thalamic symptoms were the initial manifestations. On admission, electroencephalography (ECG) showed no periodic synchronous discharge (PSD), and MRI showed no abnormalities. However, single photon emission computed tomography (SPECT) using (99m)Tc-ethyl cysteinate dimer ((99m)Tc-ECD) revealed hypoperfusion in the right thalamus. We conclude that the thalamic form of CJD tends to show no high-intensity area (HIA) by MRI-DWI, and that SPECT may be more useful for visualizing the affected area responsible for the thalamic symptoms at an early stage.