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1.
J Clin Neurosci ; 73: 209-214, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32057609

RESUMO

Surgical resection of basal ganglia (BG) and thalamic cavernous malformations (CMs) has not yet become standardized in the field of neurosurgery due to the eloquent location of these lesions and the relative paucity of literature on the subject. This review presents a consolidation of the available literature on outcomes and complication rates after surgical resection of these lesions. A systematic literature review was performed via PubMed database for articles published between 1985 and 2019. Studies comprising ≥2 patients receiving surgery for BG or thalamic CMs with available follow-up data were included. Pooled data included patient demographics, CM preoperative characteristics, and surgical outcomes Twenty studies comprising 227 patients were included for analysis. Complete resection was achieved in 94.7% (fixed-effects pooled estimate [FE]: 94.9%[91.0%-97.8%]; random-effects pooled estimate [RE]: 90.0%[79.8%-96.9%]), and hemorrhage of incompletely resected CMs occurred in 50% (FE: 55.9%[25.9%-83.6%]; RE: 55.9%[25.9%-83.6%]) of patients. Early morbidity was observed in 24.0% (FE: 24.9%[17.8%-32.6%]; RE: 24.9%[17.8%-32.6%]). At final follow-up, 67.3% (FE: 67.7%[58.8%-76.0%]; RE: 67.8%[52.2%-81.6%]) and 20.6% (FE: 20.6%[13.6%-28.6%]; RE: 20.9%[9.8%-34.9%]) had improvement and stability of preoperative symptoms, respectively. Mortality rate was 1.3% (FE: 2.3%[0.6%-5.1%]; RE: 2.3%[0.6%-5.1%]). Therefore, high cure rates with low rates of postoperative morbidity can be achieved in BG or thalamic CM surgery. Most patients had improved neurological function at final follow-up. Complete resection should be attempted to reduce rates of repeat hemorrhage.


Assuntos
Gânglios da Base/patologia , Neoplasias Encefálicas/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Procedimentos Neurocirúrgicos/métodos , Tálamo/patologia , Adulto , Gânglios da Base/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Tálamo/cirurgia , Resultado do Tratamento
2.
World Neurosurg ; 130: e880-e887, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301441

RESUMO

BACKGROUND: The basal ganglia and thalamus are uncommon locations for infiltrating gliomas. Tumors here are usually managed with biopsy and adjuvant therapy, with relatively poor results. Rarely do patients undergo extensive surgical intervention. It seems reasonable to suggest that successful cytoreduction may help these patients. However, this hypothesis has not been studied because of the general view that it is not possible to remove deep-seated brain tumors with acceptable outcomes. METHODS: Through retrospective data collection, we describe a small case series of patients undergoing awake contralateral, transcallosal surgery for deep-seated brain tumors affecting the basal ganglia. We describe our patient cohort, report on patient outcomes, and describe our surgical technique. RESULTS: Four patients underwent awake contralateral, transcallosal surgery for glioblastoma invading the basal ganglia. All 4 patients demonstrated hemibody weakness contralateral to the side of their tumors, with 3 patients confined to wheelchairs at presentation. Their ages ranged from 25 to 64 years. Tumor volumes ranged from 14 to 93 cm3. More than 50% resection of each tumor was achieved during surgery. In 2 cases, approximately 90% resection was achieved. Motor strength improved in 1 patient who presented with hemiplegia. Two patients required ventriculoperitoneal shunting for complications related to hydrocephalus. At the writing of this article, 2 of our patients were still alive, functional, and free of tumor progression. CONCLUSIONS: We present the results of our attempts to resect large gliomas infiltrating the basal ganglia in 4 patients. Our technique combined a contralateral, transcallosal approach with awake neuromonitoring. Our results suggest it is possible to remove these tumors with reasonable outcomes.


Assuntos
Gânglios da Base/cirurgia , Neoplasias Encefálicas/cirurgia , Corpo Caloso/cirurgia , Glioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Vigília , Adulto , Gânglios da Base/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Estudos de Coortes , Corpo Caloso/diagnóstico por imagem , Feminino , Seguimentos , Glioma/diagnóstico por imagem , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Prog Brain Res ; 249: 297-305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31325988

RESUMO

Oculomotor abnormalities are fast becoming a proxy for disease diagnosis and progression. Saccades-ballistic eye movements-are known to be affected by dopaminergic cell loss in the basal ganglia, caused by Parkinson's disease. Pharmaceutical and neurosurgical interventions such as deep brain stimulation and functional neurosurgery have both been noted to have an effect on saccades. Comparing and contrasting these effects may yield insights into Parkinson's disease pathophysiology, and the mechanisms of pharmacological and neurosurgical treatments. Computational models of saccadic control, such as the LATER model, can help to interpret the distribution of saccadic latencies, providing a framework for objectively comparing the effects of pharmaceutical interventions and deep brain stimulation.


Assuntos
Antiparkinsonianos/farmacologia , Gânglios da Base , Estimulação Encefálica Profunda , Transtornos da Motilidade Ocular , Doença de Parkinson , Movimentos Sacádicos , Gânglios da Base/efeitos dos fármacos , Gânglios da Base/fisiopatologia , Gânglios da Base/cirurgia , Humanos , Modelos Neurológicos , Neuronavegação , Transtornos da Motilidade Ocular/tratamento farmacológico , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Motilidade Ocular/cirurgia , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/cirurgia , Movimentos Sacádicos/efeitos dos fármacos , Movimentos Sacádicos/fisiologia
4.
World Neurosurg ; 130: e213-e221, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31252080

RESUMO

OBJECTIVE: Maximal safe resection prolongs the survival of patients with glioblastoma (GB). However, whether total resection of the enhanced lesion is pursued or abandoned depends on preoperative judgments based on the findings of magnetic resonance imaging (MRI). Anatomically, medial temporal tumor tends to invade toward the temporal stem, insula, and basal ganglia, representing tumor with high surgical risk. In the present study, we describe the key radiologic features of medial temporal GB to achieve extent of resection. METHODS: We reviewed all GB cases located in the temporal lobe (tGB) treated between April 2013 and March 2018 at Kitasato University Hospital. On the basis of MRI, tGB was simply classified into 3 groups: medial tGB and nonmedial tGB, and medial tGB was further subdivided into invading type and mimicking type. We focused on the resectability of medial tGB. RESULTS: Twenty-seven patients with tGB were identified. Twenty were included in the nonmedial tGB, and 7 were in the medial tGB. All medial tGB seemed to invade into the basal ganglia and/or the lenticulostriate arteries, but detailed examination revealed 2 types of tumor, invading type (3 cases) and mimicking type (4 cases). The invading type had true involvement of the basal ganglia and/or lenticulostriate arteries, whereas the mimicking type had no involvement of these structures. This new classification is highly effective, as the former is unresectable, but the latter is totally resectable. CONCLUSIONS: Medial tGB is a challenging tumor for maximal safe resection, so our classification will help to identify cases of removable medial tGB.


Assuntos
Gânglios da Base/diagnóstico por imagem , Neoplasias Encefálicas/classificação , Neoplasias Encefálicas/diagnóstico por imagem , Glioblastoma/classificação , Glioblastoma/diagnóstico por imagem , Lobo Temporal/diagnóstico por imagem , Idoso , Gânglios da Base/cirurgia , Neoplasias Encefálicas/cirurgia , Diagnóstico Diferencial , Feminino , Glioblastoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Estudos Retrospectivos , Lobo Temporal/cirurgia
5.
World Neurosurg ; 129: e494-e501, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150853

RESUMO

OBJECTIVE: Hemorrhage in the basal ganglia is a common type of intracerebral hemorrhage and has high mortality and poor prognosis. In our study, we aimed to evaluate surgical outcomes and functional recovery after evacuation of hematoma using either craniotomy or endoscopy. METHODS: We analyzed retrospective data from 58 patients with basal ganglia hemorrhage who were treated with hematoma evacuation using either craniotomy or endoscopy. Magnetic resonance imaging and a navigation system were used for calculating hematoma volume and for navigation during surgery. Clinical information and surgical outcomes were recorded. At 6-month follow-up, the recovery of neurologic function and the results of the Aphasia Battery of Chinese test were assessed. RESULTS: The endoscopy group showed lower intraoperative blood loss (75.36 ± 45.56 vs. 462.67 ± 120.08 mL, P < 0.001), shorter operation time (1.59 ± 0.30 vs. 4.17 ± 0.86 hours, P < 0.001), and a higher hematoma clearance rate (0.93% ± 0.05% vs. 0.88% ± 0.13%, P = 0.04) than the craniotomy group, respectively. No significant differences in mortality were identified, but a trend toward lower mortality in the endoscopy group was apparent (7.14% in the endoscopy group vs. 16.67% in the craniotomy group, P = 0.43). Assessment of neurologic recovery indicated significant differences in the modified Rankin Scale grades between the 2 groups (χ2 = 4.381, P = 0.036). Listening comprehension and speaking ability were also better in the endoscopy group than the craniotomy group (χ2 = 4.693, P = 0.03). CONCLUSIONS: Evacuation by endoscopy had better surgical outcomes, recovery of neurologic function, and aphasia recovery than evacuation by craniotomy. It appears that endoscopy is the surgical treatment of choice for middle-aged and elderly patients with a basal ganglia hemorrhage volume of >35 mL.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Gânglios da Base/cirurgia , Craniotomia/métodos , Neuroendoscopia/métodos , Recuperação de Função Fisiológica/fisiologia , Idoso , Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
J Neurosurg ; 132(1): 122-131, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30641831

RESUMO

OBJECTIVE: Arteriovenous malformations (AVMs) of the basal ganglia (BG) and thalamus are associated with elevated risks of both hemorrhage if left untreated and neurological morbidity after resection. Therefore, stereotactic radiosurgery (SRS) has become a mainstay in the management of these lesions, although its safety and efficacy remain incompletely understood. The aim of this retrospective multicenter cohort study was to evaluate the outcomes of SRS for BG and thalamic AVMs and determine predictors of successful endpoints and adverse radiation effects. METHODS: The authors retrospectively reviewed data on patients with BG or thalamic AVMs who had undergone SRS at eight institutions participating in the International Gamma Knife Research Foundation (IGKRF) from 1987 to 2014. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes (RICs). Multivariable models were developed to identify independent predictors of outcome. RESULTS: The study cohort comprised 363 patients with BG or thalamic AVMs. The mean AVM volume and SRS margin dose were 3.8 cm3 and 20.7 Gy, respectively. The mean follow-up duration was 86.5 months. Favorable outcome was achieved in 58.5% of patients, including obliteration in 64.8%, with rates of post-SRS hemorrhage and permanent RIC in 11.3% and 5.6% of patients, respectively. Independent predictors of favorable outcome were no prior AVM embolization (p = 0.011), a higher margin dose (p = 0.008), and fewer isocenters (p = 0.044). CONCLUSIONS: SRS is the preferred intervention for the majority of BG and thalamic AVMs. Patients with morphologically compact AVMs that have not been previously embolized are more likely to have a favorable outcome, which may be related to the use of a higher margin dose.


Assuntos
Gânglios da Base/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Radiocirurgia/métodos , Tálamo/cirurgia , Adolescente , Adulto , Gânglios da Base/irrigação sanguínea , Gânglios da Base/diagnóstico por imagem , Embolização Terapêutica , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Hemorragia Pós-Operatória/etiologia , Doses de Radiação , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Tálamo/irrigação sanguínea , Tálamo/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
7.
J Neurosurg ; 132(2): 473-480, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30641842

RESUMO

OBJECTIVE: With the increasing use of flow diversion as treatment for intracranial aneurysms, there is a concomitant increased vigilance in monitoring complications. The low porosity of flow diverters is concerning when the origins of vessels are covered, whether large circle of Willis branches or critical perforators. In this study, the authors report their experience with flow diverter coverage of the lenticulostriate vessels and evaluate their safety and outcomes. METHODS: The authors retrospectively reviewed 5 institutional databases of all flow diversion cases from August 2012 to June 2018. Information regarding patient presentation, aneurysm location, treatment, and outcomes were recorded. Patients who were treated with flow diverters placed in the proximal middle cerebral artery (MCA), proximal anterior cerebral artery, or distal internal carotid artery leading to coverage of the medial and lateral lenticulostriate vessels were included. Clinical outcomes according to the modified Rankin Scale were reviewed. Univariate and multivariate analyses were performed to establish risk factors for lenticulostriate infarct. RESULTS: Fifty-two patients were included in the analysis. Postprocedure cross-sectional images were available in 30 patients. Two patients experienced transient occlusion of the MCA during the procedure; one was asymptomatic, and the other had a clinical and radiographic ipsilateral internal capsule stroke. Five patients had transient symptoms without radiographic infarct in the lenticulostriate territory. Two patients experienced in-stent thrombosis, leading to clinical MCA infarcts (one in the ipsilateral caudate) after discontinuing antiplatelet therapy. Discontinuation of dual antiplatelet therapy prior to 6 months was the only variable that was significantly correlated with stroke outcome (p < 0.01, OR 0.3, 95% CI 0-0.43), and this significance persisted when controlled for other risk factors, including age, smoking status, and aneurysm location. CONCLUSIONS: The use and versatility of flow diversion is increasing, and safety data are continuing to accumulate. Here, the authors provide early data on the safety of covering lenticulostriate vessels with flow diverters. The authors concluded that the coverage of these perforators does not routinely lead to clinically significant ischemia when dual antiplatelet therapy is continued for 6 months. Further evaluation is needed in larger cohorts and with imaging follow-up as experience develops in using these devices in more distal circulation.


Assuntos
Gânglios da Base/diagnóstico por imagem , Gânglios da Base/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Stents Metálicos Autoexpansíveis/tendências , Idoso , Gânglios da Base/irrigação sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Clin Neurol Neurosurg ; 174: 180-184, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30261475

RESUMO

OBJECTIVE: The risk of hemorrhages after stereotactic biopsy is known to be low. Nevertheless hemorrhages in eloquent areas result in neurological deficit for the patients. Since the basal ganglia resemble a particularily high vascularized and eloquent location, which is often the source of hypertensive hemorrhages, we aimed to analyse possible risk factors for hemorrhage after stereotactic biopsy in this region. PATIENTS AND METHODS: We performed a retrospective analysis including patients who underwent stereotactic biopsies of lesions in the basal ganglia between January 2012 and January 2017. 63 patients were included in this study. We accessed age, gender, histopathological diagnosis, hypertension, blood pressure intraoperative, anticoagulative medication and postoperative hemorrhage. RESULTS: Fishers exact test revealed no significant p-values concerning anticoagulative therapy, gender, smoking and hypertension concerning postoperative hemorrhage. Wilcoxon-Mann-Whitney-Test showed no significant correlation for systolic blood pressure intraoperative, number of tissue samples and age with hemorrhage. A trend for lymphoma in correlation with postoperative hemorrhage was in patients with Lymphoma (Wilcoxon-Mann-Whitney Test). CONCLUSION: Stereotactic biopsies even in eloquent areas as the basal ganglia are a safe procedure even if patients suffer under hypertension or are smoker. None of the here examined risk factors showed a significant correlation with postoperative hemorrhage. Accessing tumor tissue for histopathological diagnosis is mandatory for adequate therapy.


Assuntos
Gânglios da Base/diagnóstico por imagem , Gânglios da Base/cirurgia , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/cirurgia , Técnicas Estereotáxicas/efeitos adversos , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
9.
Neurosci Lett ; 683: 1-6, 2018 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-29913198

RESUMO

We compared the firing rates and proportion of patterns of oscillatory neurons in the subthalamic nucleus (STN), globus pallidus internus (GPi), and ventrolateral thalamus (VL) in Parkinson disease (PD). Twenty-nine patients with PD who underwent stereotactic neurosurgery were included in the study. Microelectrode recordings in the STN (n = 16), GPi (n = 9), and VL (n = 9) were performed. Power spectral analysis was used to explore neuronal oscillation. Of 76 STN neurons, 39.5% were tremor frequency oscillatory neurons (4-6 Hz, TFB) and 28.9% were ß frequency oscillatory neurons (ßFB); their mean spontaneous firing rate (MSFR) was 44.2 ±â€¯7.6 Hz (n = 52). Of 62 GPi neurons, 37.1% were TFB oscillatory neurons and 27.4% were ßFB oscillatory neurons; the MSFR was 80.9 ±â€¯9.6 Hz. Of 69 V L neurons, 65.2% were TFB oscillatory neurons and 11.6% were ßFB oscillatory neurons; the MSFR was 26.7 ±â€¯5.0 Hz. The increased MSFR of GPi and reduced MSFR of VL oscillatory neurons in parkinsonian patients further support prediction of a pathophysiology model of PD. The high proportion of ßFB oscillatory neurons in the STN and GPi suggests that dopaminergic deficits result in abnormal ß oscillatory synchronization in the basal ganglia in the parkinsonian state. The high proportion of TFB oscillatory neurons in the VL demonstrates that both the basal ganglia and cerebellothalamic circuits are involved in the generation of parkinsonian tremor; the latter circuit might have a more important role in tremor genesis.


Assuntos
Potenciais de Ação/fisiologia , Gânglios da Base/fisiopatologia , Neurônios/fisiologia , Doença de Parkinson/fisiopatologia , Núcleos Ventrais do Tálamo/fisiopatologia , Idoso , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/cirurgia , Estimulação Encefálica Profunda/instrumentação , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/cirurgia , Núcleos Ventrais do Tálamo/diagnóstico por imagem , Núcleos Ventrais do Tálamo/cirurgia
10.
World Neurosurg ; 117: 298-300, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29929034

RESUMO

BACKGROUND: Cerebral cavernous malformations (CCMs) are present in up to 0.5% of the general population. Although CCMs have been considered congenital lesions, numerous reports have observed de novo formations in patients with the familial form of CCM and in patients after cranial radiotherapy. Outside of these circumstances, there is scant evidence as to the potential etiologies of CCM. CASE DESCRIPTION: We present a 48-year-old woman with a medical history of endometrial hyperplasia concomitant endometrial polyps demonstrating a large de novo CCM, which grew to a large size in a period of 20 months. A previous magnetic resonance imaging scan showed no abnormalities. This CCM exhibited aggressive biological behavior characterized by recurrent overt bleeding and seizure. Histopathologic analysis confirmed the diagnosis of CCM. Here, we discuss the growth mechanisms of these lesions. CONCLUSIONS: Given the patient's medical history and imaging findings, we propose that de novo CCMs can arise directly from angiogenic proliferation, secondary to BCL-2 overexpression from underlying causes. We hypothesize that inappropriate secretion of estrogen could have set off a genetic cascade with attendant endothelial proliferation. Thus, female hormones may play an important role in influencing the biological behavior of CCMs. The relationship between estrogen and CCM needs further investigation.


Assuntos
Gânglios da Base/cirurgia , Neoplasias Encefálicas/cirurgia , Craniotomia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/patologia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/fisiopatologia , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Hemangioma Cavernoso do Sistema Nervoso Central/fisiopatologia , Humanos , Pessoa de Meia-Idade
11.
Clin Neurol Neurosurg ; 169: 41-48, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29625339

RESUMO

OBJECTIVES: Surgical treatment is widely used for haematoma removal in spontaneous intracerebral haemorrhage (ICH) patients, but there is controversy about the selection of surgical methods. The CT angiography (CTA) spot sign has been proven to be a promising factor predicting haematoma expansion and is recommended as an entry criterion for haemostatic therapy in patients with ICH. This trial was designed to evaluate the clinical efficacy of two surgical methods (haematoma removal by craniotomy and craniopuncture combined with urokinase infusion) for patients in the early stage (≤6h from symptom onset) of spontaneous ICH with a moderate haematoma volume (30 ml - 60 ml). PATIENTS AND METHODS: From January 2012 to July 2017, 196 eligible patients treated in our institution were enrolled according to the inclusion criteria. The patients were divided into the CTA spot sign positive type and CTA spot sign negative type according to the presence or absence of the CTA spot sign. For each type, the patients were randomly assigned to two groups, i.e., the craniotomy group, in which patients underwent craniotomy with haematoma removal, and the craniopuncture group, in which patients underwent minimally invasive craniopuncture combined with urokinase infusion therapy. Neurological function was evaluated with the Scandinavian Stroke Scale (SSS) at day 14. The disability level and the activities of daily living were assessed using a modified Rankin Scale (mRS) and Barthel Index (BI) at day 90. Case fatalities were recorded at day 14 and 90. Complications were recorded during hospitalization. RESULTS: For the CTA spot sign positive type, the craniotomy group had a higher SSS than that in the craniopuncture group (P < 0.05) at day 14. The rebleeding rate was higher in the craniopuncture group than that in the craniotomy group (P < 0.05) during hospitalization. The craniotomy group had a lower mRS than that in the craniopuncture group (P < 0.01) and had a higher BI than that in the craniopuncture group (P < 0.05) at day 90. There was no statistically significant difference in the fatality rate between the two groups. For the CTA spot sign negative type, there were no significant differences in the SSS, mRS, BI, fatality rate and complication rate between the two groups. CONCLUSION: ICH can be divided into the CTA spot sign positive and negative type according to the presence or absence of the CTA spot sign. For the CTA spot sign positive type, patients can benefit from craniotomy with haematoma removal, which can reduce the postoperative rebleeding rate and improve the prognosis. For the CTA spot sign negative type, both craniotomy and craniopuncture are applicable. Considering simple procedure and minor surgical injury, craniopuncture can be a more reasonable choice.


Assuntos
Gânglios da Base/diagnóstico por imagem , Gânglios da Base/cirurgia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Craniotomia/métodos , Punções/métodos , Idoso , Angiografia por Tomografia Computadorizada/normas , Craniotomia/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punções/normas , Resultado do Tratamento
12.
Artigo em Russo | MEDLINE | ID: mdl-29543219

RESUMO

We describe two cases of surgical treatment of well-circumscribed basal ganglia tumors. The choice of a neurosurgical approach to a deep tumor was based on the MR tractography data and depended on the course and dislocation extent of the corticospinal tract. MR tractography provides information on the course and dislocation or destruction extent of the corticospinal tract running in the internal capsule and brainstem and clarifies the exact location of a tumor within the basal ganglia. This information promotes the choice of an optimal approach for radical resection of well-circumscribed tumor, leading to improvement in neurological symptoms and patient's quality of life.


Assuntos
Gânglios da Base , Neoplasias Encefálicas , Gânglios da Base/patologia , Gânglios da Base/cirurgia , Neoplasias Encefálicas/cirurgia , Imagem de Tensor de Difusão , Humanos , Tratos Piramidais , Qualidade de Vida
13.
World Neurosurg ; 112: 182-185, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29382620

RESUMO

BACKGROUND: Brain abscesses are well-known to neurologic surgeons with well-recognized presentations, which include seizures, neurologic deficit, and headache. Rare symptoms may lead to a delay in diagnosis, which can be life threatening in the setting of a brain abscess. CASE DESCRIPTION: We present the case of a 46-year-old male with intractable hiccups found to have an abscess of the right basal ganglia. The brain abscess was treated by frameless stereotactic-guided aspiration. The patient's hiccups improved after surgical aspiration and medical management. CONCLUSIONS: A comprehensive literature review confirmed brain abscess as a rare cause of intractable hiccups. In addition, there are few reports of lesions of the basal ganglia causing intractable hiccups. Aspiration and medical therapy resulted in resolution of the hiccups. Knowledge of the hiccup reflex arc and unusual presentation of basal ganglia lesions may shorten time to diagnosis.


Assuntos
Gânglios da Base/cirurgia , Abscesso Encefálico/complicações , Infecções Bacterianas do Sistema Nervoso Central/complicações , Infecções por Haemophilus/complicações , Soluço/etiologia , Anti-Infecciosos/uso terapêutico , Gânglios da Base/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Ceftriaxona/uso terapêutico , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico por imagem , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Infecções Bacterianas do Sistema Nervoso Central/cirurgia , Infecções por Haemophilus/diagnóstico por imagem , Infecções por Haemophilus/tratamento farmacológico , Infecções por Haemophilus/cirurgia , Haemophilus parainfluenzae/isolamento & purificação , Soluço/diagnóstico por imagem , Soluço/tratamento farmacológico , Soluço/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento
14.
World Neurosurg ; 112: 143-147, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29410036

RESUMO

BACKGROUND: Penetrating brain injury (PBI) caused by a nail gun is an extremely rare neurosurgical emergency that poses a challenge for neurosurgeons because of its rarity and complexity. CASE DESCRIPTION: Here we present 3 cases of PBI caused by a nail gun. In the first case, the nail entered through the right parietal bone and lodged in the right parietal lobe and basal ganglia. In the second case, the nail entered through the right occipital bone and lodged in the right occipital lobe. In the third case, the nail entered through the right parietal bone and lodged in the right frontal and parietal lobes. All patients underwent surgical removal of the nail. The first patient presented with reduced left-side strength, whereas the second and third patients were neurologically intact on presentation. CONCLUSIONS: PBI caused by a nail gun can present with differing clinical manifestations, and most cases require immediate surgery. A rational management strategy should provide a good postoperative prognosis with minimal neurologic deficits in these patients.


Assuntos
Gânglios da Base/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Procedimentos Neurocirúrgicos/métodos , Osso Parietal/cirurgia , Lobo Parietal/cirurgia , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/lesões , Feminino , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osso Parietal/diagnóstico por imagem , Osso Parietal/lesões , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/lesões , Prognóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Prog Neurol Surg ; 33: 62-79, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29332074

RESUMO

Since its introduction, diffusion tensor imaging (DTI) has become an important tool in neuroscience given its unprecedented ability to image brain white matter in vivo. The interest in understanding the mechanisms of action of Deep Brain Stimulation in different targets and indications, together with the constant drive towards the improvement in long-term clinical outcomes, has found a logical complement in the application of tractography in this field. Diffusion tensor imaging has been traditionally associated with an increased susceptibility to MRI artifacts, and expensive computational resources. Recent advances have however improved these restrictions, allowing for countless applications in Neurosurgery, as demonstrated by the large number of original research papers published in the last decade. In this chapter, we review the current status of the implementation of DTI during DBS of the basal ganglia, discussing the findings, potential challenges and the expected improvements in surgical outcomes deriving by the routine use of tractography in functional neurosurgery.


Assuntos
Gânglios da Base/cirurgia , Estimulação Encefálica Profunda/métodos , Imagem de Tensor de Difusão/métodos , Transtornos dos Movimentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Imagem de Tensor de Difusão/normas , Humanos , Procedimentos Neurocirúrgicos/normas
16.
J Neurosurg ; 129(3): 752-769, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29271710

RESUMO

OBJECTIVE The purpose of this study was to describe in detail the cortical and subcortical anatomy of the central core of the brain, defining its limits, with particular attention to the topography and relationships of the thalamus, basal ganglia, and related white matter pathways and vessels. METHODS The authors studied 19 cerebral hemispheres. The vascular systems of all of the specimens were injected with colored silicone, and the specimens were then frozen for at least 1 month to facilitate identification of individual fiber tracts. The dissections were performed in a stepwise manner, locating each gray matter nucleus and white matter pathway at different depths inside the central core. The course of fiber pathways was also noted in relation to the insular limiting sulci. RESULTS The insular surface is the most superficial aspect of the central core and is divided by a central sulcus into an anterior portion, usually containing 3 short gyri, and a posterior portion, with 2 long gyri. It is bounded by the anterior limiting sulcus, the superior limiting sulcus, and the inferior limiting sulcus. The extreme capsule is directly underneath the insular surface and is composed of short association fibers that extend toward all the opercula. The claustrum lies deep to the extreme capsule, and the external capsule is found medial to it. Three fiber pathways contribute to form both the extreme and external capsules, and they lie in a sequential anteroposterior disposition: the uncinate fascicle, the inferior fronto-occipital fascicle, and claustrocortical fibers. The putamen and the globus pallidus are between the external capsule, laterally, and the internal capsule, medially. The internal capsule is present medial to almost all insular limiting sulci and most of the insular surface, but not to their most anteroinferior portions. This anteroinferior portion of the central core has a more complex anatomy and is distinguished in this paper as the "anterior perforated substance region." The caudate nucleus and thalamus lie medial to the internal capsule, as the most medial structures of the central core. While the anterior half of the central core is related to the head of the caudate nucleus, the posterior half is related to the thalamus, and hence to each associated portion of the internal capsule between these structures and the insular surface. The central core stands on top of the brainstem. The brainstem and central core are connected by several white matter pathways and are not separated from each other by any natural division. The authors propose a subdivision of the central core into quadrants and describe each in detail. The functional importance of each structure is highlighted, and surgical approaches are suggested for each quadrant of the central core. CONCLUSIONS As a general rule, the internal capsule and its vascularization should be seen as a parasagittal barrier with great functional importance. This is of particular importance in choosing surgical approaches within this region.


Assuntos
Córtex Cerebral/anatomia & histologia , Córtex Cerebral/cirurgia , Cérebro/anatomia & histologia , Cérebro/cirurgia , Microcirurgia/métodos , Gânglios da Base/anatomia & histologia , Gânglios da Base/cirurgia , Mapeamento Encefálico , Tronco Encefálico/anatomia & histologia , Tronco Encefálico/cirurgia , Núcleo Caudado/anatomia & histologia , Núcleo Caudado/cirurgia , Artérias Cerebrais/anatomia & histologia , Artérias Cerebrais/cirurgia , Veias Cerebrais/anatomia & histologia , Veias Cerebrais/cirurgia , Dominância Cerebral/fisiologia , Substância Cinzenta/anatomia & histologia , Substância Cinzenta/cirurgia , Humanos , Vias Neurais/anatomia & histologia , Vias Neurais/cirurgia , Tubérculo Olfatório/anatomia & histologia , Tubérculo Olfatório/cirurgia , Tálamo/cirurgia , Substância Branca/anatomia & histologia , Substância Branca/cirurgia
17.
Prog Neurol Surg ; 30: 186-203, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29241175

RESUMO

Management of deep-seated and midline gliomas originating from thalamus, hypothalamus, basal ganglia, and brainstem presents significant challenges. Aggressive resection of such tumors is frequently impossible due to excessive morbidity and mortality rates; thus, combinations of both surgical and non-surgical treatment options should be always considered. In each individual case, there should be reasonable clinical judgment with regard to the optimal outcome providing the best possible prognosis for the patient, with high quality of life and minimal risk of complications.


Assuntos
Neoplasias Encefálicas/cirurgia , Estado Terminal/terapia , Glioma/cirurgia , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/cirurgia , Glioma/diagnóstico por imagem , Humanos , Microcirurgia/métodos , Tálamo/diagnóstico por imagem , Tálamo/cirurgia
18.
Annu Rev Neurosci ; 40: 453-477, 2017 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-28772097

RESUMO

Modern functional neurosurgery for movement disorders such as Parkinson's disease, tremor, and dystonia involves the placement of focal lesions or the application of deep brain stimulation (DBS) within circuits that modulate motor function. Precise targeting of these motor structures can be further refined by the use of electrophysiological approaches. In particular, microelectrode recordings enable the delineation of neuroanatomic structures. In the course of these operations, there is an opportunity not only to map basal ganglia structures but also to gain insights into how disturbances in neural activity produce movement disorders. In this review, we aim to highlight what the field has uncovered thus far about movement disorders through DBS. The work to date lays the foundation for future studies that will shed further light on dysfunctional circuits mediating diseases of the nervous system and how we might modulate these circuits therapeutically.


Assuntos
Gânglios da Base/fisiopatologia , Distúrbios Distônicos/fisiopatologia , Distúrbios Distônicos/terapia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Tremor/fisiopatologia , Tremor/terapia , Gânglios da Base/cirurgia , Estimulação Encefálica Profunda , Distúrbios Distônicos/cirurgia , Humanos , Procedimentos Neurocirúrgicos , Doença de Parkinson/cirurgia , Tremor/cirurgia
19.
Physiol Rep ; 5(12)2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28642341

RESUMO

Identification of brain structures traversed during implantation of deep brain-stimulating (DBS) electrodes into the subthalamic nucleus (STN-DBS) for the treatment of Parkinson's disease (PD) frequently relies on subjective correspondence between kinesthetic response and multiunit activity. However, recent work suggests that local field potentials (LFP) could be used as a more robust signal to objectively differentiate subcortical structures. The goal of this study was to analyze the spectral properties of LFP collected during STN-DBS in order to objectively identify commonly traversed brain regions and improve our understanding of aberrant oscillations in the PD-related pathophysiological cortico-basal ganglia network. In 21 PD patients, LFP were collected and analyzed during STN-DBS implantation surgery. Spectral power for delta-, theta-, alpha-, low-beta-, and high-beta-frequency bands was assessed at multiple depths throughout the subcortical structures traversed on the trajectory to the ventral border of STN. Similar to previous findings, beta-band oscillations had an increased magnitude within the borders of the motor-related area of STN, however, across several subjects, we also observed increased high-beta magnitude within the borders of thalamus. Comparing across all patients using relative power, we observed a gradual increase in the magnitude of both low- and high-beta-frequency bands as the electrode descended from striatum to STN. These results were also compared with frequency bands below beta, and similar trends were observed. Our results suggest that LFP signals recorded during the implantation of a DBS electrode evince distinct oscillatory signatures that distinguish subcortical structures.


Assuntos
Gânglios da Base/fisiopatologia , Ondas Encefálicas , Estimulação Encefálica Profunda/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Doença de Parkinson/fisiopatologia , Núcleo Subtalâmico/fisiopatologia , Idoso , Gânglios da Base/cirurgia , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/cirurgia , Núcleo Subtalâmico/cirurgia
20.
World Neurosurg ; 101: 57-68, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28147238

RESUMO

BACKGROUND: Minimally invasive endoscopic hematoma evacuation is a promising treatment option for intracerebral hemorrhage. However, the technique still needs improvement. We report our clinical experience of using this technique to evacuate deep-seated basal ganglia hematomas. METHODS: The frontal approach was used in most patients. The preoperative and postoperative hematoma volumes, Glasgow Coma Scale, hematoma evacuation rate, 30-day mortality, and long-term outcome defined by the modified Rankin Scale were analyzed retrospectively. The surgical duration per milliliter of clot (DPM) was calculated. The learning curve for this technique was determined based on the relation between the DPM and evacuation rate per the number of cases experienced. RESULTS: A total of 24 patients were enrolled. The evacuation rate was 87% ± 10%. The average Glasgow Coma Scale score recovered from 8 to 13 after surgery. Twenty-one patients had follow-up data. The follow-up time was 13 ± 6 months. The 30-day mortality after surgery was zero. Forty-eight percent of patients (10/21) achieved a favorable outcome. The DPM (P = 0.92) and evacuation rate (P = 0.64) did not change substantially with the number of cases experienced. CONCLUSIONS: Endoscopic port surgery for hematoma evacuation via the frontal approach is a safe surgical option for deep-seated basal ganglia hematomas. This technique is minimally invasive and may be helpful to provide better long-term outcomes for selected patients. For neurosurgeons, the learning curve for this technique is steep, which implies that the skills needed for our technique can be easily acquired.


Assuntos
Gânglios da Base/cirurgia , Hematoma/patologia , Hematoma/cirurgia , Curva de Aprendizado , Neuroendoscopia/métodos , Resultado do Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Gânglios da Base/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Escala de Coma de Glasgow , Hematoma/diagnóstico por imagem , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Estudos Retrospectivos
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