Hypoechogenicity of the midbrain raphe detected by transcranial sonography: an imaging biomarker for depression in migraine patients.

BACKGROUND: The high comorbidity of migraine and depression is suggestive of shared risk factors or common mechanisms between the two diseases. In individuals with a depressive disorder, there is a high prevalence of altered midbrain raphe (MBR) echogenicity, detectable via transcranial sonography (TCS), that is suggested to be linked with a dysfunction of the serotoninergic system. In patients with migraine, this alteration has seldom been explored in earlier studies, and conclusions are often lacking. Our study aimed to elucidate whether this alteration is specific to migraine and to determine whether it is related with depression. METHODS: This study enrolled patients with migraine (n = 100, 72% female) and patients with tension-type headache disorders (TTH) (n = 62, 78.5% female) from a headache clinic. In addition, 79 healthy subjects (79.7% female) were recruited as controls. All participants underwent a standard interview to evaluate headache information and an interview with psychiatrists for depression evaluation. TCS examinations were performed on all participants. RESULTS: Patients with migraine had a higher rate of MBR hypoechogenicity (28%) compared with that of healthy controls (15.2%) and that of patients with TTH (12.9%). In patients with migraine, reduced MBR echogenicity was associated with depressive symptoms assessed using the Hamilton Depression Rating Scale (HAM-D). No association between migraine self-medication and MBR echogenicity was found. CONCLUSION: Reduced-echoic MBR detected by TCS is prevalent in migraine patients and is associated with depressive symptoms. TCS-detected hypoechogenic MBR abnormality could be an imaging biomarker of depressive symptoms in patients with migraine.

Internal Carotid Artery and its Relationship with Structures in Sellar Region: Anatomic Study and Clinical Applications.

BACKGROUND: Complications of the internal carotid artery (ICA) in surgery are rare but severe. This study aimed to locate the ICA with 5 stationary bony structures in the sellar region: the anterior clinoid process, the tuberculum sellae, the bottom of the hypophyseal fossa, the posterior edge of the hypophyseal fossa, and the postclinoid process and to do measurements to determine their anatomic relationship with the ICA. METHODS: After multiple planar reconstructions on computer tomographic angiography images of 120 ICA in 60 individuals, we defined the 5 bony structures as 5 origins in the horizontal, sagittal, and vertical planes with the 3D coordinate system and got the cross-sections of bilateral ICA on the coronal plane passing through each origin. We measured the distances between the cross-sections and the origins and angles between the horizontal plane and the line passing through the origin and the cross-sections on each coronal plane. We also measured the distances between the bilateral ICA on the 5 coronal planes. Besides, we measured the coordinate of the anterior edge of bilateral ICA, taking the anterior clinoid process as the origin. RESULTS: With the 3-dimensional coordinate system, we located the ICA to the bony structures in skull base. The distance between the bilateral ICA on coronal planes were 18.8 ± 2.9 mm, 23.6 ± 3.7 mm, 19.9 ± 3.4 mm, 24.7 ± 4.3 mm, and 23.5 ± 3.5 mm, from anterior to posterior, respectively. CONCLUSION: The 3D coordinate system used in this study is of value in preoperational assessment, and data we obtained indicate the safety ranges avoiding damage to the ICA in surgery.

Three-Dimensional Imaging Anatomic Study and Clinical Application of the Third Ventricle Transcallosal-Transforniceal Approach.

The third ventricle is a narrow, funnel-shaped, unilocular, midline cavity located between the 2 thalami, under the body of the lateral ventricle, in the center of the head. Damaging of brain tissue in the third ventricle when conducting operation under the microscope will lead to serious consequence. The study aimed to precisely detect the relative location of specific structures on the approach to the third ventricle. The authors rebuilt a 3-dimensional reconstruction of the brain and selected specific sections and then measured several crucial distance, angle to precisely assure the approaching pathway and localize the hypothalamic sulcus, interthalamic adhesion, anterior commissure, optic chiasm, and pineal body. In the study, canthomeatal line was used as base line to measure angle. Parameters were obtained from 58 samples (22 males and 36 females) between 21 and 76 years old. Means and standard deviation were calculated as well as the 95% confidence interval for the mean value of the measured data. The data were analyzed by SPSS, statistical software with the comparison between sexes and sides. The results could be reference for clinical and anatomic utilities.