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1.
Recent Results Cancer Res ; 216: 813-841, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32594408

RESUMO

In neurosurgery, the extent of resection plays a critical role, especially in the management of malignant gliomas. These tumors are characterized through a diffuse infiltration into the surrounding brain parenchyma. Delineation between tumor and normal brain parenchyma can therefore often be challenging. During the recent years, several techniques, aiming at better intraoperative tumor visualization, have been developed and implemented in the field of brain tumor surgery. In this chapter, we discuss current strategies for intraoperative imaging in brain tumor surgery, comprising conventional techniques such as neuronavigation, techniques using fluorescence-guided surgery, and further highly precise developments such as targeted fluorescence spectroscopy or Raman spectroscopy.


Assuntos
Encéfalo/cirurgia , Neuronavegação , Cirurgia Assistida por Computador , Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Humanos
2.
BMC Neurol ; 20(1): 178, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393192

RESUMO

BACKGROUND: Glioblastoma multiforme (GBM) is one of the most aggressive malignant brain tumors. Intracranial GBM metastases to the spine are rarely detected clinically. Secondary gliosarcomas after treatment of primary GBM are rarely described. CASE PRESENTATION: Herein, we report the case of a 53-year-old woman who presented to our emergency room with progressive headache and weakness on the left side. Plain computed tomography and contrast magnetic resonance imaging of the brain revealed an approximately 6.8 cm × 4.5 cm right temporoparietooccipital intraaxial cystic tumor with surrounding diffuse perifocal edema that caused midline shift toward the left. Emergency craniotomy was performed to remove the tumor, and pathological examination revealed GBM. The patient received proton beam therapy, Gliadel implantation, and oral temozolomide chemotherapy as well as targeted therapy with bevacizumab. Approximately 15 months after diagnosis, she underwent surgical resection of the right temporal recurrent tumor and was newly diagnosed as having a metastatic spinal tumor. Pathologically, the right temporal and metastatic spinal tumors were gliosarcoma and GBM, respectively. CONCLUSIONS: Concurrent spinal metastasis and gliosarcomatous transformation, which are two types of GBM complications, are rare. To our knowledge, this is the first report of a case of recurrent GBM with gliosarcoma after proton bean therapy.


Assuntos
Neoplasias Encefálicas/patologia , Encéfalo/patologia , Glioblastoma/secundário , Gliossarcoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias da Coluna Vertebral/secundário , Antineoplásicos Alquilantes/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Craniotomia , Evolução Fatal , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/terapia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/terapia , Terapia com Prótons , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Temozolomida/uso terapêutico , Tomografia Computadorizada por Raios X
3.
J Clin Neurosci ; 77: 55-61, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409218

RESUMO

It is commonly known that brain metastases usually have clear boundaries in magnetic resonance imaging. However, little is known regarding the trajectory of white matter fibers around the tumors, especially using the fiber dissection technique. Here, we focused on the anatomical interaction between white matter fibers and the tumor, using the fiber dissection in a postmortem brain with metastatic tumor and compared the findings with those of diffusion tensor imaging (DTI) tractography. One postmortem human brain hemisphere with metastatic adenocarcinoma in the Broca's area was dissected using fiber dissection following the Klingler's method. In order to compare the in vitro and in vivo results, additional brains from 15 patients with metastatic adenocarcinomas, the volumes of which were comparable to that of the adenocarcinoma in the brain used for fiber dissection, were analyzed using DTI tractographic reconstruction. Morphological findings of white matter bundles running around the tumor were compared between the two techniques. In the fiber dissection technique, the superior longitudinal fascicle, arcuate fascicle, and frontal aslant tract could be dissected, and the white matter bundles were curved and retracted to avoid the tumor. In all the cases analyzed, white matter fibers or streamlines surrounding the tumor avoided the lesion. Using the fiber dissection technique, this is the first direct evidence to elucidate the anatomy of white matter fibers affected by a metastatic brain. This suggests that brain metastatic adenocarcinoma is an intra-axial neoplasm with extra-axial white matter structures.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Microdissecção/métodos , Fibras Nervosas Mielinizadas , Substância Branca/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Dissecação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas Mielinizadas/patologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/patologia , Vias Neurais/cirurgia , Substância Branca/patologia , Substância Branca/cirurgia
4.
World Neurosurg ; 138: 408-410, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32247791

RESUMO

Civilian gunshot wounds to the brain are associated with high overall mortality; however, outcomes can vary significantly depending on bullet trajectory. This report details the outcome of a patient who sustained a bifrontal gunshot wound with multiple associated calvarial and frontal sinus fractures. Although surgery for penetrating brain injury is most frequently employed for relief of mass effect and decompression of vital structures, this case report describes a more comprehensive technique involving duroplasty, obliteration of the frontal sinus, and cranial vault reconstruction with the aim of decreasing the rate of cerebrospinal fluid leak, infection, reoperation, and readmission.


Assuntos
Encéfalo/cirurgia , Craniotomia/métodos , Traumatismos Cranianos Penetrantes/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ferimentos por Arma de Fogo/cirurgia , Encéfalo/patologia , Drenagem , Feminino , Traumatismos Cranianos Penetrantes/etiologia , Traumatismos Cranianos Penetrantes/patologia , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Pessoa de Meia-Idade , Crânio/patologia , Crânio/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/patologia
5.
Nat Commun ; 11(1): 1946, 2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32327635

RESUMO

Brain networks are spatiotemporal phenomena that dynamically vary over time. Functional imaging approaches strive to noninvasively estimate these underlying processes. Here, we propose a novel source imaging approach that uses high-density EEG recordings to map brain networks. This approach objectively addresses the long-standing limitations of conventional source imaging techniques, namely, difficulty in objectively estimating the spatial extent, as well as the temporal evolution of underlying brain sources. We validate our approach by directly comparing source imaging results with the intracranial EEG (iEEG) findings and surgical resection outcomes in a cohort of 36 patients with focal epilepsy. To this end, we analyzed a total of 1,027 spikes and 86 seizures. We demonstrate the capability of our approach in imaging both the location and spatial extent of brain networks from noninvasive electrophysiological measurements, specifically for ictal and interictal brain networks. Our approach is a powerful tool for noninvasively investigating large-scale dynamic brain networks.


Assuntos
Encéfalo/fisiopatologia , Eletroencefalografia/métodos , Epilepsias Parciais/fisiopatologia , Neuroimagem Funcional/métodos , Algoritmos , Encéfalo/patologia , Encéfalo/cirurgia , Simulação por Computador , Fenômenos Eletromagnéticos , Epilepsias Parciais/patologia , Epilepsias Parciais/cirurgia , Humanos , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por Computador
6.
Ann R Coll Surg Engl ; 102(5): e107-e110, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233872

RESUMO

The brain is a particularly rare site of metastasis from papillary microcarcinoma, with only few cases described in the literature. We present a case of 59-year-old man who presented with seizures and dysphasia due to left frontal lobe cystic mass, which was excised and turned out on histopathology to be of thyroid origin. Total thyroidectomy was performed and histology showed multifocal papillary microcarcinoma with the largest focus of 3mm with no other adverse features. The patient had ablative radioactive iodine postoperatively, with subsequent exit scan showing no uptake in the brain. Follow-up brain magnetic resonance imaging showed continuous regression of the surgical cavity. Although rare, such cases should be aggressively treated and followed up over the long term, because of reported associated high mortality.


Assuntos
Neoplasias Encefálicas/diagnóstico , Carcinoma Papilar/diagnóstico , Procedimentos Neurocirúrgicos , Convulsões/etiologia , Neoplasias da Glândula Tireoide/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Carcinoma Papilar/secundário , Carcinoma Papilar/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/secundário , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
7.
Ann Palliat Med ; 9(2): 339-345, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233639

RESUMO

BACKGROUND: To evaluate and analyze the therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage. METHODS: Sixty patients with hypertensive cerebral hemorrhage admitted to our hospital from September 2014 to September 2019 were selected for study and randomly divided into study group (n=30) and routine group (n=30) according to admission number. Two groups of patients were given basic treatment after admission, while routine group patients were given small bone window hematoma removal, study group patients were given stereotactic soft channel puncture and drainage, and the clinical effects of the two groups were analyzed. RESULTS: The total effective rate of the study group was 96.67%, which was significantly higher than that of the routine group (80.00%), and the difference was statistically significant (P<0.05). The level of independent living in the study group was significantly higher than that in the conventional group, and the level of neurological deficit was lower than that in the conventional group, with statistically significant difference (P<0.05). Before treatment, there was no significant difference in the hematoma volume between the two groups (P>0.05). after treatment for 1, 2 and 4 weeks, the hematoma volume of the two groups decreased, and the hematoma volume of the study group was significantly less than that of the conventional group, with significant difference (P<0.05). There was no difference in CD3+ positive cell rate and CD8+ positive cell rate between the two groups before treatment (P>0.05). After treatment, the CD8+ positive cell rate in the study group was lower than that in the conventional group, and the CD3+ positive cell rate was higher than that in the conventional group, with statistically significant difference (P<0.05). The incidence of postoperative complications such as pulmonary infection, urinary tract infection, liver and kidney dysfunction in the study group was lower than that in the conventional group, and the difference was statistically significant (P<0.05). CONCLUSIONS: Stereotactic soft-channel puncture and drainage has the advantages of less trauma, less bleeding, fewer complications and rapid postoperative recovery. It can be used for the treatment of hypertensive cerebral hemorrhage, promote the recovery of neurological function of patients, improve independent living standard and effectively improve prognosis.


Assuntos
Hemorragia Intracraniana Hipertensiva/cirurgia , Paracentese/métodos , Técnicas Estereotáxicas , Adulto , Encéfalo/cirurgia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Resultado do Tratamento
8.
World Neurosurg ; 138: e330-e335, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112943

RESUMO

BACKGROUND: Deep brain stimulation (DBS) is an effective therapy for a variety of refractory movement disorders. Accurate lead placement in the target nucleus is critical to ensure therapeutic effects and to minimize side effects, and intraoperative computed tomography (iCT) scan has been used to target and confirm lead position. The objective of this study is to compare the accuracy of determining the x, y, and z coordinates of final lead placement using iCT scan relative to postoperative magnetic resonance imaging (MRI). METHODS: We conducted a retrospective study on 83 patients who underwent insertion of 145 DBS leads from 2015 to 2017 at a single institution. iCT scan was merged with the preoperative MRI to determine lead coordinates on both magnetic resonance and computed tomography images independently, and the absolute differences between the x, y, and z coordinates between the 2 scans along with the Euclidean vectors were calculated. RESULTS: The mean absolute differences ± standard error of the mean between iCT scan and postoperative MRI coordinates were as follows: x = 0.01 ± 0.09 mm (P = 0.89), y = 1.67 ± 0.14 mm (P < 0.001), and z = 2.75 ± 0.15 mm (P < 0.001). The average Euclidean vector difference was 3.21 ± 0.15 mm (P < 0.001). CONCLUSIONS: Significant differences exist between iCT scan and postoperative MRI DBS y and z lead coordinates, but not with x coordinates. Based on this series, iCT scan is more accurate when confirming x coordinates, and less accurate for confirming y and z coordinates during DBS operations.


Assuntos
Encéfalo/diagnóstico por imagem , Estimulação Encefálica Profunda , Transtornos dos Movimentos/cirurgia , Neuroimagem/métodos , Tomografia Computadorizada por Raios X/métodos , Encéfalo/cirurgia , Eletrodos Implantados , Humanos , Período Intraoperatório , Imagem por Ressonância Magnética , Estudos Retrospectivos , Técnicas Estereotáxicas
9.
World Neurosurg ; 137: e479-e486, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058113

RESUMO

OBJECTIVE: This study aims to present a practical method to accurately diagnose ventriculoperitoneal shunt (VPS) malfunction and to detect the exact level at which the system has failed to tailor VPS revision at that level only. METHODS: A tertiary referral single-center algorithm for diagnosis of VPS malfunction is proposed. Based on clinical symptoms and confirmed ventricular dilatation on computed tomography, the VPS reservoir is punctured; if no cerebrospinal fluid is obtained, ventricular catheter replacement is recommended. Conversely, if cerebrospinal fluid is obtained, a sample is sent for cultural examination and the macroscopic integrity of the whole system is checked via plain radiography in the angiographic suite. Then, through the injection of iodate contrast medium into the reservoir and selective exclusion of the proximal and distal catheters, the patency and correct VPS functioning are investigated. RESULTS: A total of 102 (56 males) patients (mean age, 41.5 years; range, 1-86 years) underwent a VPS function test from 2012 to 2018: 59 cases of VPS malfunction (57.8%) were diagnosed. Ventricular catheter obstruction/damage/displacement occurred in 12/59 patients (20.3%), valve damage in 11/59 patients (18.6%), distal catheter obstruction/damage/displacement in 17/59 patients (28.8%) and 2-level (valve/proximal catheter or valve/distal catheter) obstruction/damage/displacement in 16/59 patients (27.1%). Subclinical infection was diagnosed in 3 patients (5.1%). VPS revision was performed selectively at the level of failure. CONCLUSIONS: The proposed algorithm is a practical, simple and minimally invasive technique to accurately diagnose VPS malfunction, identifying the exact level of system failure and allowing surgical VPS revision to be tailored, avoiding unnecessary complete system replacement.


Assuntos
Encéfalo/cirurgia , Falha de Equipamento , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Turk Neurosurg ; 30(3): 400-406, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32091118

RESUMO

AIM: To examine the spinal cord status by using diffusion tensor imagıng (DTI) and tractography preoperatively and postoperatively in patients with Chiari malformation type 1 (CM1) and compare the results with the data obtained from healthy people. MATERIAL AND METHODS: Overall, 48 patients (33 patients with CM1, and 15 in the control group for DTI and tractography measurements) were included in the study. Mean age was 37.7 ± 11.8 years (minimum and maximum: 12 and 57 years). The DTI and tractography data were obtained from the craniocervical region in patients with CM1 and control group. Patients with CM1 were operated using the suboccipital decompression technique without opening the dura. Surgical results were evaluated using Chicago Chiari Outcome Scale (CCOS) and Asgari scale. RESULTS: Based on the CCOS and Asgari scale results, the surgical technique was determined to be clinically beneficial. The DTI and tractography values from the pontobulbar, cervicomedullary, and spinal cord C3â€"4 levels in patients with CM1 were compared to those of the control group. These values were observed to be near normal after surgery in patients with CM1. CONCLUSION: Based on the improvement in DTI-tractography data observed in our study, DTI and tractography can serve as a guiding measurement method for assessing the prognosis of patients with CM1.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Medula Espinal/diagnóstico por imagem , Adolescente , Adulto , Encéfalo/cirurgia , Criança , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medula Espinal/cirurgia , Resultado do Tratamento , Adulto Jovem
12.
World Neurosurg ; 137: 149-157, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035198

RESUMO

BACKGROUND: Few studies have examined the usefulness of intraoperative magnetic resonance spectroscopy (iMRS) for identifying abnormal signals at the resection margin during glioma surgery. The aim of this study was to assess the value of iMRS for detecting proliferative remnants of glioma at the resection margin. METHODS: Fifteen patients with newly diagnosed glioma underwent single-voxel 3-T iMRS concurrently with intraoperative magnetic resonance imaging-assisted surgery. Volumes of interest (VOIs) were placed at T2-hyperintense or contrast-enhancing lesions at the resection margin. In addition to technical verification, the correlation between the MIB-1 labeling index (a pathologic feature) and metabolites measured using iMRS (N-acetyl-L-aspartate [NAA], choline [Cho], and Cho/NAA ratio) was analyzed. RESULTS: iMRS was performed for 20 VOIs in 15 patients. Fourteen (70%) of these VOIs were confirmed to be MIB-1-positive. There was a significant positive correlation between the Cho/NAA ratio and MIB-1 index (r = 0.46, P = 0.04). Cho level (P = 0.003) and Cho/NAA ratio (P = 0.002) were significantly higher in VOIs that were MIB-1-positive than in those that were MIB-1-negative. Detection of a Cho level >1.074 mM and a Cho/NAA ratio >0.48 using iMRS resulted in high diagnostic accuracy for MIB-1-positive remnants (Cho level: sensitivity 86%, specificity 100%; Cho/NAA ratio: sensitivity 79%, specificity 100%). CONCLUSIONS: This study provides evidence that 3-T iMRS can detect proliferative remnants of glioma at the resection margin using the Cho level and Cho/NAA ratio, suggesting that intraoperative magnetic resonance imaging-assisted surgery with iMRS would be practicable in glioma.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Glioma/patologia , Glioma/cirurgia , Espectroscopia de Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/patologia , Encéfalo/cirurgia , Colina/metabolismo , Creatina/metabolismo , Feminino , Humanos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
13.
Clin Neurophysiol ; 131(3): 734-743, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32007920

RESUMO

OBJECTIVE: To localize the seizure onset zone (SOZ) and irritative zone (IZ) using electric source imaging (ESI) on intracranial EEG (iEEG) and assess their clinical value in predicting epilepsy surgery outcome in children with focal cortical dysplasia (FCD). METHODS: We analyzed iEEG data from 25 children with FCD-associated medically refractory epilepsy (MRE) who underwent surgery. We performed ESI on ictal onset to localize SOZ (ESI-SOZ) and on interictal discharges to localize IZ (ESI-IZ). We tested whether resection of ESI-SOZ and ESI-IZ predicted good surgical outcome (Engel 1). We further compared the prediction performance of ESI-SOZ and ESI-IZ to those of SOZ and IZ defined using conventional methods, i.e. by identifying iEEG-contacts showing ictal onsets (conventional-SOZ) or being the most interictally active (conventional-IZ). RESULTS: The proximity of ESI-SOZ (p = 0.043, odds-ratio = 3.9) and ESI-IZ (p = 0.011, odds-ratio = 7.04) to resection has higher effect on patients' outcome than proximity of conventional-SOZ (p = 0.17, odds-ratio = 1.7) and conventional-IZ (p = 0.038, odds-ratio = 2.6). Resection of ESI-SOZ and ESI-IZ presented higher discriminative power in predicting outcome (68% and 60%) than conventional-SOZ and conventional-IZ (48% and 53%). CONCLUSIONS: Localizing SOZ and IZ via ESI on iEEG offers higher predictive value compared to conventional-iEEG interpretation. SIGNIFICANCE: iEEG-ESI may help surgical planning and facilitate prognostic assessment of children with FCD-associated MRE.


Assuntos
Encéfalo/fisiopatologia , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsia/fisiopatologia , Malformações do Desenvolvimento Cortical do Grupo I/fisiopatologia , Adolescente , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Mapeamento Encefálico , Criança , Pré-Escolar , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia , Epilepsia/diagnóstico por imagem , Epilepsia/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Malformações do Desenvolvimento Cortical do Grupo I/diagnóstico por imagem , Malformações do Desenvolvimento Cortical do Grupo I/cirurgia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
14.
Brain Lang ; 202: 104741, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31931399

RESUMO

Postoperative functional neuroimaging provides a unique opportunity to investigate the neural mechanisms that facilitate language network reorganization. Previous studies in patients with low grade gliomas (LGGs) in language areas suggest that postoperative recovery is likely due to functional neuroplasticity in peritumoral and contra-tumoral healthy regions, but have attributed varying degrees of importance to specific regions. In this study, we used Magnetoencephalography (MEG) to investigate functional connectivity changes in peritumoral and contra-tumoral regions after brain tumor resection. MEG recordings of cortical activity during resting-state were obtained from 12 patients with LGGs in left-hemisphere language brain areas. MEG data were recorded before (Pre session), and 3 (Post_1 session) and 6 (Post_2 session) months after awake craniotomy. For each MEG session, we measured the functional connectivity of the peritumoral and contra-tumoral regions to the rest of the brain across the 1-100 Hz frequency band. We found that functional connectivity in the Post_1 and Post_2 sessions was higher than in the Pre session only in peritumoral regions and within the alpha frequency band. Functional connectivity in peritumoral regions did not differ between the Post_1 and Post_2 sessions. Alpha connectivity enhancement in peritumoral regions was observed in all patients regardless of the LGG location. Together, these results suggest that postoperative language functional reorganization occurs in peritumoral regions regardless of the location of the tumor and mostly develops within 3 months after surgery.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Glioma/diagnóstico por imagem , Idioma , Plasticidade Neuronal/fisiologia , Adolescente , Adulto , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Feminino , Glioma/fisiopatologia , Glioma/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Magnetoencefalografia/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Adulto Jovem
16.
Radiology ; 294(3): 676-685, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31909701

RESUMO

Background MRI-guided focused US thalamotomy of ventral intermediate nucleus of the thalamus is a treatment for tremor disorders. Purpose To evaluate white matter integrity before and after thalamotomy and its correlation with clinical outcome. Materials and Methods Participants with essential tremor (ET) or Parkinson disease (PD) undergoing thalamotomy were prospectively recruited between March 2016 and October 2018. Tremor and quality of life were assessed before, 1 month after, and 6 months after thalamotomy. Participants underwent T1-weighted, T2-weighted fluid-attenuated image recovery, and diffusion-tensor MRI before and 1 day, 7-10 days, 1-3 months, and 6 months or longer after treatment. Diffusivity and fiber tractography measures were calculated. Repeated measures analysis of variance with post hoc paired t test and Skillings-Mack test with post hoc Wilcoxon signed-rank test were used for normally and nonnormally distributed data, respectively, and Bonferroni method corrected for multiple comparisons. Results Twenty-two study participants with ET (mean age, 72 years ± 6 [standard deviation]; 14 men), 17 participants with PD (mean age, 65 years ± 8; 13 men), and a replication set of 17 participants with ET (mean age, 73 years ± 6; 10 men) were evaluated. Long-term damage was found in the ablated core (mean fractional anisotropy [FA] at baseline, 0.41 ± 0.10, and at ≥6 months, 0.23 ± 0.09; P < .001) and thalamus to red nucleus tract (mean number of tracts at baseline, 1663, and at ≥6 months, 1070; P = .003). Negative correlation was observed between motor thalamus FA 1 day after ablation and tremor improvement (ET: R = -0.52 [P = .03]; PD: R = -0.61 [P = .003]). Better tremor relief in ET was associated with lower fractional anisotropy before treatment (R = -0.5; P = .02). Conclusion MRI-guided focused US thalamotomy resulted in short- and long-term white-matter changes. Diffusion-tensor imaging provided evidence for long-term damage in the ablation core and in the thalamus and red nucleus tract, and a correlation between preablation fractional anisotropy in the motor thalamus and clinical outcome. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Tremor Essencial , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Imagem por Ressonância Magnética Intervencionista/métodos , Tálamo , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Tremor Essencial/diagnóstico por imagem , Tremor Essencial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tálamo/diagnóstico por imagem , Tálamo/cirurgia , Resultado do Tratamento
17.
PLoS One ; 15(1): e0227879, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929603

RESUMO

Accumulating evidence suggests that Alzheimer's disease is associated with brain insulin resistance, as are some other types of dementia. Intranasal insulin administration has been suggested as a potential approach to overcoming brain insulin resistance and improving cognitive functions. Islet transplantation into the cranial subarachnoid cavity was used as an alternative route for insulin delivery into the brain. Recently, the authors showed the short-term beneficial cognitive effect of a small number of intracranially grafted islets in rats with cognitive dysfunction induced by intracerebroventricular administration of streptozotocin (icv-STZ). This was associated with continuous and safe insulin delivery to the rat brain. The current study investigated the long-term effect of intracranial grafting of islets on cognitive functioning in icv-STZ rats. Severe dementia, associated with obesity and cerebral amyloid-ß angiopathy, was induced in Lewis inbred rats by icv-STZ. Two months after icv-STZ, one hundred syngeneic islets were transplanted into the cranial subarachnoid space. Two and six months later, cognitive alterations were assessed by Morris water-maze tests. Islet graft survival was evaluated by immunohistochemical and biochemical assays. Improvement was found in spatial learning and memory of grafted rats as opposed to the sham-operated icv-STZ rats. The grafted islets showed intact morphology, intensive expression of insulin, glucagon and glucose transporter 2. Normoglycemic obesity and cerebral amyloid-ß angiopathy were found in both grafted and sham-operated icv-STZ rats. In conclusion, islet grafting into cranial subarachnoid space provides an efficient and safe approach for insulin delivery to the brain, leading to a long-term attenuation of icv-STZ-induced cognitive dysfunction.


Assuntos
Doença de Alzheimer/terapia , Transtornos Cognitivos/terapia , Insulina/biossíntese , Transplante das Ilhotas Pancreáticas/métodos , Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Animais , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/cirurgia , Cognição/fisiologia , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/patologia , Modelos Animais de Doenças , Hipocampo/metabolismo , Hipocampo/patologia , Hipocampo/cirurgia , Humanos , Ilhotas Pancreáticas/metabolismo , Aprendizagem em Labirinto , Memória/fisiologia , Ratos
18.
J Comput Assist Tomogr ; 44(3): 399-404, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929377

RESUMO

To report feasibility, safety, and technical advantages of flat-detector computed tomography perfusion (FD-CTP) during balloon test occlusion (BTO) angiography studies, 10 patients patients scheduled for BTO were evaluated. Cerebral blood volume maps were extracted from FD-CTP images acquired during the test. The FD-CTP perfusion combined with BTO is feasible and safe in intracranial tumor, and aneurysm cases in which vessel sacrifice should be considered.


Assuntos
Oclusão com Balão/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Adulto , Encéfalo/irrigação sanguínea , Encéfalo/cirurgia , Neoplasias Encefálicas/irrigação sanguínea , Neoplasias Encefálicas/cirurgia , Circulação Cerebrovascular/fisiologia , Estudos de Viabilidade , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Software , Tomografia Computadorizada por Raios X/métodos
19.
Proc Natl Acad Sci U S A ; 117(6): 2835-2845, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-31974306

RESUMO

Recording cell-specific neuronal activity while monitoring behaviors of freely moving subjects can provide some of the most significant insights into brain function. Current means for monitoring calcium dynamics in genetically targeted populations of neurons rely on delivery of light and recording of fluorescent signals through optical fibers that can reduce subject mobility, induce motion artifacts, and limit experimental paradigms to isolated subjects in open, two-dimensional (2D) spaces. Wireless alternatives eliminate constraints associated with optical fibers, but their use of head stages with batteries adds bulk and weight that can affect behaviors, with limited operational lifetimes. The systems introduced here avoid drawbacks of both types of technologies, by combining highly miniaturized electronics and energy harvesters with injectable photometric modules in a class of fully wireless, battery-free photometer that is fully implantable subdermally to allow for the interrogation of neural dynamics in freely behaving subjects, without limitations set by fiber optic tethers or operational lifetimes constrained by traditional power supplies. The unique capabilities of these systems, their compatibility with magnetic resonant imaging and computed tomography and the ability to manufacture them with techniques in widespread use for consumer electronics, suggest a potential for broad adoption in neuroscience research.


Assuntos
Encéfalo/fisiologia , Fotometria/métodos , Animais , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Desenho de Equipamento , Imagem por Ressonância Magnética , Camundongos , Camundongos Endogâmicos C57BL , Fotometria/instrumentação , Próteses e Implantes , Tecnologia sem Fio/instrumentação
20.
Cerebrovasc Dis ; 49(1): 79-87, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940632

RESUMO

BACKGROUND: Emerging evidence indicates a beneficial effect of mesenchymal stem cell (MSC) transplantation in subarachnoid hemorrhage (SAH). Chronic hydrocephalus is a common complication after SAH, which is associated with subarachnoid fibrosis promoted by transforming growth factor-ß1 (TGF-ß1). This study investigated the effect of human umbilical cord derived MSCs (hUC-MSCs) with TGF-ß1 knockdown on chronic hydrocephalus after SAH. METHODS: About 0.5 mL autologous blood was injected into the cerebellomedullaris cistern of 6-week SD rats to establish SAH model. hUC-MSCs or hUC-MSCs carrying TGF-ß1 knockdown (1 × 105 cells) were intraventricularly transplanted at 1 day before surgery and at P10. Neurological behavior score and water maze test were performed to assess neurological functions. Hydrocephalus was evaluated by Nissl staining. Concentrations of proinflammatory cytokines were measured by enzyme-linked immunosorbent assay. The levels of TGF-ß1, p-Smad2/3, and Smad2/3 were measured using western blotting. RESULTS: Intraventricular hUC-MSCs transplantation significantly attenuated SAH-induced chronic hydrocephalus, upregulation of inflammatory cytokines, and behavioral impairment. Knockdown of TGF-ß1 in hUC-MSCs enhanced these effects. hUC-MSCs also reduced the upregulation of TGF-ß1 levels and Smad2/3 phosphorylation after SAH, and this effect was also enhanced by TGF-ß1 knockdown. CONCLUSION: Transplantation of hUC-MSCs exerts beneficial effect after SAH, possibly be through inhibiting TGF-ß1/Smad2/3 signaling pathway. Knockdown of TGF-ß1 in hUC-MSCs enhanced these effects.


Assuntos
Encéfalo/cirurgia , Hidrocefalia/prevenção & controle , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/metabolismo , Hemorragia Subaracnóidea/cirurgia , Fator de Crescimento Transformador beta1/metabolismo , Cordão Umbilical/citologia , Animais , Comportamento Animal , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Células Cultivadas , Doença Crônica , Citocinas/metabolismo , Modelos Animais de Doenças , Técnicas de Silenciamento de Genes , Humanos , Hidrocefalia/metabolismo , Hidrocefalia/patologia , Hidrocefalia/fisiopatologia , Masculino , Atividade Motora , Fosforilação , Ratos Sprague-Dawley , Proteína Smad2/metabolismo , Proteína Smad3/metabolismo , Hemorragia Subaracnóidea/metabolismo , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/fisiopatologia , Fator de Crescimento Transformador beta1/genética
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