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1.
Brain Tumor Pathol ; 37(4): 159-164, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32754892

RESUMO

We report a case of 33-year-old Japanese male who presented with a headache and visual disturbances. Magnetic resonance imaging revealed a large tumor in the left frontal lobe, measuring 7 cm in diameter, which was diagnosed as supratentorial anaplastic ependymoma accompanied by extensive desmoplasia. The patient underwent a gross total resection. Histologically, the tumor cells had oval or short, spindle-shaped nuclei, and proliferating cells in perivascular pseudorosettes with anucleate zones and mitotic figures. Desmoplasia with abundant collagen fibers among the tumor cells was detected at numerous sites, and perinuclear dot- or ring-like immunoreactivity for epithelial membrane antigen was identified. Five years and six months after the initial procedure, a small recurrent tumor was identified at the removal site. The patient underwent a second total resection. The histology of the resected tumor showed decreased collagen production and more apparent anaplastic features as compared to those of the initial tumor. In addition to the histological findings, molecular examinations revealed ependymoma, RELA fusion positive. Although not commonly observed, this case suggests that desmoplasia could be associated with ependymomas, including RELA fusion-positive variant. Moreover, our findings indicate that high-grade ependymoma requires careful, long-term follow-up even if gross total resection is performed.


Assuntos
Ependimoma/genética , Ependimoma/patologia , Fusão Gênica/genética , Neoplasias Supratentoriais/genética , Neoplasias Supratentoriais/patologia , Fator de Transcrição RelA/genética , Adulto , Ependimoma/diagnóstico , Ependimoma/cirurgia , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Lobo Frontal/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia , Procedimentos Neurocirúrgicos , Neoplasias Supratentoriais/diagnóstico , Neoplasias Supratentoriais/cirurgia
2.
J UOEH ; 42(2): 217-222, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32507845

RESUMO

Cerebral cavernous angiomas are vascular anomalies with dilated spaces. We report the case of rare double cavernous angiomas causing higher brain dysfunction. A 74-year-old man exhibited cognitive dysfunction. Magnetic resonance imaging showed two tumors with hemorrhage in the left frontal lobe. Preoperative diagnosis was hemorrhage caused by cavernous angiomas. A 3D model of the double cavernous angioma was made to confirm their association with cortical veins and tumors. Tumors were removed using a single small corticotomy. This is the first report of a rare double cavernous angioma and the 3D printed model facilitated removal of the tumors.


Assuntos
Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Procedimentos Neurocirúrgicos/métodos , Impressão Tridimensional , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino
3.
World Neurosurg ; 139: 588-591, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32344145

RESUMO

BACKGROUND: Orbital compartment syndrome (OCS) is a rare post operative complication of Neurosurgery. It presents typically acutely with loss of vision, loss of pupillary reaction, and limitation of extraocular movement. The etiology of OCS is most typically associated with increased pressure from a mass lesion in the orbit compromising the blood supply of orbital structures. Emergent bedside decompression of the orbit by lateral canthotomy is indicated to quickly treat OCS in an attempt to save visual acuity and extraocular function. CASE DESCRIPTION: We report a 76-year-old male patient whose magnetic resonance imaging of the brain demonstrated an anterior right frontal broad dural-based homogenously enhancing mass measuring 6.0 × 3.1 × 6.3 cm after he presented with 1-year of progressive cognitive dysfunction. A right-sided pterional craniotomy and resection of mass was performed under general anesthesia, with an uncomplicated intraoperative course. Postoperatively, the right eye was noted to have an afferent pupillary defect, complete ophthalmoplegia, ptosis, and significant resistance to retropulsion. Emergent ophthalmologic consultation confirmed the ocular examination, and the diagnosis of right OCS was suspected. A right lateral canthotomy and cantholysis was performed by the ophthalmologist at the bedside. The fundoscopic retinal evaluation was normal. Noncontrast computed tomography of the head demonstrated expected postoperative changes and mild edema of the right frontal lobe without evidence of acute hemorrhage. There was no retro-orbital hematoma, but the right extra-ocular muscles appeared edematous compared to the left. No light perception and ophthalmoplegia continued in the right eye. CONCLUSIONS: This case demonstrates that although very rare, OCS can occur without compression of the eye or an intra-orbital mass. Visual loss is a devastating complication. Constant vigilance to ensure adequate arterial and venous supply to the orbit, with great care to prevent external compression on the eye, hopefully, will continue to make this complication rare.


Assuntos
Neoplasias Encefálicas/cirurgia , Síndromes Compartimentais/cirurgia , Craniotomia/métodos , Lobo Frontal/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Órbita/cirurgia , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/etiologia , Descompressão Cirúrgica/métodos , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/complicações , Meningioma/diagnóstico por imagem , Órbita/diagnóstico por imagem
4.
Acta Neurol Scand ; 142(3): 216-220, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32198926

RESUMO

BACKGROUND: During the latest decades, the hypothesis that the subjective experience of free will is determined by preconscious activity in the dominant dorsal medial frontal cortex (dMFC) has repeatedly challenged our commonly held concepts of moral responsibility. AIMS OF THE STUDY: To investigate whether dMFC activity determines the sense of free will and to investigate the effects of resections in this area on quality of life (QoL). METHODS: A cohort of nine patients affected by transient declines in speech and movement skills after surgery involving the left dMFC answered questions about their post-operative, subjective experiences of volition in relation to symptoms. In eight cases, resections were performed as part of glioma surgery, and in the ninth case, a meningioma adjacent to the dMFC was resected. In addition, a QoL questionnaire was administrated before and after surgery. RESULTS: None of the patients perceived the transient disabilities related to surgery as associated with a loss or absence of volition. No declines in QoL were detected after surgery. Two QoL domains showed improved function (motor dysfunction and future uncertainty). CONCLUSIONS: The subjective sense of volition is not contingent on dMFC activity. Surgical resections of this area are not typically associated with declines in QoL.


Assuntos
Neoplasias Encefálicas/psicologia , Neoplasias Encefálicas/cirurgia , Lobo Frontal/cirurgia , Glioma/psicologia , Glioma/cirurgia , Adulto , Idoso , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/epidemiologia , Transtornos dos Movimentos/etiologia , Complicações Pós-Operatórias/psicologia , Desempenho Psicomotor , Qualidade de Vida , Distúrbios da Fala/epidemiologia , Distúrbios da Fala/etiologia , Inquéritos e Questionários , Volição
5.
World Neurosurg ; 138: 205-213, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32084617

RESUMO

BACKGROUND: Management of cerebral amyloidomas has lacked consensus owing to their rarity. We present a case and review 39 reported cases of amyloidomas in the literature, comparing their initial presentation, imaging characteristics, treatment, and progression. CASE DESCRIPTION: A 56-year-old woman presented with a history of intractable headaches and progressive speech difficulty. Imaging demonstrated a 1.7 × 2.6 cm left frontal subcortical hemorrhagic mass with an associated developmental venous anomaly, characteristics initially suggestive of a cavernous malformation. Diffusion tractography imaging was employed to avoid interference with the intact arcuate fasciculus and corticospinal tracts to minimize neurologic deficits. CONCLUSIONS: To our knowledge, this is the first documented case of the use of diffusion tractography in preoperative planning for cerebral amyloidoma resection. Our systematic review of 39 reported cases of amyloidomas in the literature provided insight regarding how these rare lesions have manifested and progressed and further understanding of current theories regarding their etiology and pathophysiology. Cerebral amyloidomas are rare, localized, proteinaceous aggregates with variable presentation and prognosis and no apparent relationship to systemic amyloidosis. Biopsy may be useful in determination of progression. Diffusion tractography is a valuable tool for minimizing complications associated with resection.


Assuntos
Amiloidose/cirurgia , Encefalopatias/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/métodos , Feminino , Lobo Frontal/patologia , Lobo Frontal/cirurgia , Humanos , Pessoa de Meia-Idade
6.
Neurol Med Chir (Tokyo) ; 60(1): 17-25, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31801933

RESUMO

Although extensive frontal lobectomy (eFL) is a common surgical procedure for intractable frontal lobe epilepsy (FLE), there have been very few reports regarding surgical techniques for eFL. This article provides step-by-step descriptions of our surgical technique for non-lesional FLE. Sixteen patients undergoing eFL were included in this study. The goals were to maximize gray matter removal, including the orbital gyrus and subcallosal area, and to spare the primary motor and premotor cortexes and anterior perforated substance. The eFL consists of three steps: (1) positioning, craniotomy, and exposure; (2) lateral frontal lobe resection; and (3), resection of the rectus gyrus and orbital gyrus. Resection ahead of bregma allows preservation of motor and premotor area function. To remove the orbital gyrus preserving anterior perforated substance, it is essential to visualize the olfactory trigone beneath the pia. It is important to observe the surface of the contralateral medial frontal lobe for complete removal of the subcallosal area of the frontal lobe. Thirteen patients (81.25%) became seizure-free and three patients (18.75%) continued to have seizures. None of the patients showed any complications. The eFL is a good surgical technique for the treatment of intractable non-lesional FLE. For treatment of epilepsy by eFL, it is important to resect the non-eloquent area of the frontal lobe as much as possible with preservation of the eloquent cortex.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia do Lobo Frontal/cirurgia , Lobo Frontal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Criança , Craniotomia/métodos , Eletroencefalografia , Epilepsia do Lobo Frontal/diagnóstico por imagem , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/fisiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Tratamentos com Preservação do Órgão , Posicionamento do Paciente , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Adulto Jovem
7.
World Neurosurg ; 135: e447-e451, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843723

RESUMO

BACKGROUND: Slit ventricles can be a challenging target during shunt catheter insertion. Traditionally, the frontal approach has been considered optimal for small ventricles. At this center, routine use of electromagnetic (EM) stereotactic guidance (Stealth, Medtronic, Dublin, Ireland) has enabled a parietooccipital (P-O) burr hole approach to the frontal horns. We compare shunt placement and revisions required for patients with slit ventricles who had shunts inserted via a P-O approach versus frontal shunt. METHODS: We studied a retrospective cohort of patients with slit ventricles and a ventricular shunt inserted using EM guidance between 2012 and 2018. Slitlike ventricles were defined as the widest point of the lateral ventricle <3 mm. Outcome measures included placement accuracy and survival using the Kaplan-Meier curve. Optimal final catheter tip location was considered to be the frontal horn of the ipsilateral lateral ventricle. RESULTS: Eighty-two patients (77 female, 5 male) aged 34.9 ± 10.8 years (mean ± standard deviation) had ventricular shunts inserted for idiopathic intracranial hypertension (n = 63), chiari/syrinx (n = 8), congenital (n = 10), and pseudomeningocele (n = 1). Of those identified, 35 had primary P-O shunts and 46 had frontal shunts. Overall, 94% of cases had the catheter tip sitting in the frontal horn. The P-O approach was just as accurate as the frontal approach. Eight P-O shunts and 9 frontal shunts required revision over a 60-month period. There was no significant different in shunt survival between the 2 approaches (P = 0.37). CONCLUSIONS: EM-guided placement has enabled the P-O approach to be as safe and with equivalent survival to frontal approach. The accuracy of shunt placement between the 2 approaches was similar.


Assuntos
Craniotomia/métodos , Derivação Ventriculoperitoneal/métodos , Adulto , Ventrículos Cerebrais/cirurgia , Feminino , Lobo Frontal/cirurgia , Humanos , Masculino , Lobo Occipital/cirurgia , Lobo Parietal/cirurgia , Resultado do Tratamento , Retroversão Uterina
8.
World Neurosurg ; 134: e937-e943, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31734424

RESUMO

BACKGROUND: Brain mapping by direct electrical stimulation during awake craniotomy is now a standard procedure that reduces the risk of permanent neurologic deficits. Virtual reality technology immerses the patient in a virtually controlled, interactive world, offering a unique opportunity to develop innovative tasks for perioperative mapping of complex cognitive functions. The objective of this prospective single-center study was to evaluate the tolerance and safety of a virtual reality headset (VRH) and immersive virtual experiences in patients undergoing awake craniotomy and brain mapping by direct electrical stimulation. METHODS: The study included 30 patients with a brain tumor near the language area. Language mapping was performed with a naming task, DO 80, presented on a digital tablet and then in two-dimensional and three-dimensional formats through a VRH. During wound closure, different virtual reality experiences were proposed to the patient, offering different types of virtual motion or interaction with an avatar piloted by a neuropsychologist. RESULTS: Two patients could not use the VRH owing to technical issues. No procedure was aborted, no patient experienced virtual reality sickness and all patients reported they would repeat the procedure. Despite a high rate of intraoperative focal seizures, there was no argument to attribute the seizures to VRH use. CONCLUSIONS: This study shows that it is possible during awake brain surgery to immerse the patient in a virtual environment and to interact with the patient, opening the field of new brain mapping procedures for complex cognitive functions.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/cirurgia , Encéfalo/cirurgia , Glioma/cirurgia , Idioma , Procedimentos Neurocirúrgicos/métodos , Realidade Virtual , Vigília , Adulto , Idoso , Astrocitoma/cirurgia , Encéfalo/fisiologia , Córtex Cerebral/fisiologia , Córtex Cerebral/cirurgia , Estimulação Elétrica/métodos , Feminino , Lobo Frontal/fisiologia , Lobo Frontal/cirurgia , Glioblastoma/cirurgia , Humanos , Complicações Intraoperatórias , Monitorização Neurofisiológica Intraoperatória/métodos , Masculino , Pessoa de Meia-Idade , Oligodendroglioma/cirurgia , Lobo Parietal/fisiologia , Lobo Parietal/cirurgia , Estudos Prospectivos , Convulsões , Lobo Temporal/fisiologia , Lobo Temporal/cirurgia , Adulto Jovem
9.
World Neurosurg ; 133: 55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562962

RESUMO

Laughter has a major role in daily social interactions; consequently, its biologic bases have been previously studied. Nevertheless, its cerebral representation remains unclear. The most accepted hypothesis has postulated that laughter has 2 components: mirth, related to the temporal and frontal neocortical areas, and motor aspect, related to the limbic system and brainstem. Furthermore, in prior studies, laughter has been elicited during electric stimulation with depth electrodes in the supplementary motor area and the cingulum. This Video 1 reports resection of a right superior frontal gyrus diffuse astrocytoma (isocitrate dehydrogenase mutant, World Health Organization grade II) with awake intraoperative electric cortical and subcortical stimulation mapping. Diffusion tensor imaging (DTI) tractography, including all the tracts in relation to the tumor, was obtained preoperatively and postoperatively. Stimulation of the cingulum medially and inferiorly to the tumor elicited a patient's smile and laugh without mirth or merriment. Also, this point correlated with the reconstructed cingulum in the intraoperatively navigated DTI tractography. In conclusion, these findings support the anatomic subdivision of the laughter's mechanism and the role of the cingulum in its motor component. Furthermore, smiles and laughter could be useful functional landmarks to identify the cingulum during subcortical mapping. Although it remains unclear whether pursuing resection beyond this point would have caused permanent postoperative deficits, considering laughter's role in social interaction and other emotion-processing functions associated with the cingulum, in the future it could be potentially considered a functional limit of the resection of intrinsic tumors.


Assuntos
Astrocitoma/cirurgia , Neoplasias Encefálicas/cirurgia , Giro do Cíngulo/fisiopatologia , Riso/fisiologia , Sorriso/fisiologia , Astrocitoma/patologia , Astrocitoma/fisiopatologia , Mapeamento Encefálico , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/fisiopatologia , Estimulação Elétrica , Lobo Frontal/patologia , Lobo Frontal/fisiopatologia , Lobo Frontal/cirurgia , Humanos
10.
World Neurosurg ; 133: 42-48, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550542

RESUMO

BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) is being used for different purposes in patients with brain tumors. However, the procedure requires a positive electrophysiological response. For patients with negative response in rest conditions, active motor threshold (AMT) may be used. However, sometimes it is difficult to obtain AMT measures owing to inability of the patient to sustain steady muscle contraction. Herein, we describe a simple method by using a hand dynamometer to obtain AMT measures during nTMS session. CASE DESCRIPTION: A woman aged 68 years underwent total removal of a right frontal lobe oligodendroglioma World Health Organization grade II 15 years ago. Cranial magnetic resonance imaging during follow-up revealed local recurrence. In the postoperative period, she developed left upper limb paresis. A postoperative nTMS session was performed for motor electrophysiological evaluation. However, using the standard technique for AMT measurement, the patient was unable to perform sustained muscle contraction as required. A hand dynamometer was used. It allowed sustained muscle contraction for AMT measurement. A counter force for the index finger flexion, the hand support to stabilize hand joints, and a numerical screen serving for both the examiner and the patient as a feedback parameter may explain the success obtained with this simple device. CONCLUSIONS: Although more studies are necessary to validate the method, the hand dynamometer should be considered for patients unable to sustain muscle contraction during AMT measurement.


Assuntos
Lobo Frontal/fisiopatologia , Córtex Motor/fisiopatologia , Contração Muscular/fisiologia , Dinamômetro de Força Muscular , Recidiva Local de Neoplasia/fisiopatologia , Oligodendroglioma/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Idoso , Mapeamento Encefálico , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Humanos , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Oligodendroglioma/diagnóstico por imagem , Oligodendroglioma/cirurgia
11.
Neurosurg Rev ; 43(2): 537-545, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30415305

RESUMO

We have previously revealed that identification of the frontal language area (FLA) can be difficult in patients with dominant frontal glioma involving the pars triangularis (PT). The present study added new cases and performed additional analyses. We noticed a new finding that the presence of extension to the pars orbitalis (POr) was associated with negative response to the FLA. The aim of the present study was to evaluate the impact of PT involvement with extension to the POr on the failure to identify the FLA. From 2000 to 2017, awake craniotomy was performed on 470 patients. Of these patients, the present study included 148 consecutive patients with frontal glioma on the dominant side. We evaluated whether tumors involved the PT or extended to the POr. Thirty one of 148 patients showed involvement of the PT, and we examined the detailed characteristics of these 31 patients. The rate of negative response for the FLA was 61% in patients with involvement of the PT. In 31 patients with frontal glioma involving the PT, univariate analyses showed significant correlation between extension to the POr and failure to identify the FLA (P = 0.0070). Similarly, multivariate analysis showed only extension to the POr correlated significantly with failure to identify the FLA (P = 0.0129). We found new evidence that extension to the POr which impacts connectivity between the PT and POr correlated significantly with negative response to the FLA of patients with dominant frontal glioma.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Área de Broca/patologia , Lobo Frontal/patologia , Glioma/patologia , Glioma/cirurgia , Idioma , Vias Neurais/patologia , Vias Neurais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Idoso , Mapeamento Encefálico , Área de Broca/cirurgia , Craniotomia , Feminino , Lobo Frontal/cirurgia , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Vigília , Adulto Jovem
12.
J Neurointerv Surg ; 12(2): 186-191, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31320549

RESUMO

BACKGROUND: Patients with intracranial arteriovenous malformations (AVMs) are at increased risk of seizures. OBJECTIVE: To identify MRI characteristics of unruptured intracranial AVMs associated with seizures at presentation. MATERIALS AND METHODS: A retrospective review was completed of patients diagnosed with unruptured intracranial AVMs on MRI between January 1, 2000 and December 31, 2016. Two blinded reviewers assessed demographics, lesion locality, and imaging and architectural characteristics of AVMs and surrounding parenchyma, including, but not limited to, AVM location, venous drainage pattern, venous varix, thrombosed venous varix, long draining vein, AVM-related gliosis, peri-AVM edema, and peri-AVM T2* signal. Findings were statistically analyzed for correlation with seizure using Student's t-test for continuous variables and Χ2 test for categorical variables. RESULTS: Of 165 included patients, 57/165 (34.5%) patients were imaged as part of an investigation for seizures. Patients with seizures more commonly had peri-AVM edema (36.8%, compared with 11.1% of non-seizure patients, p<0.0001), peri-AVM T2* blooming (28.1% vs 7.4%; p=0.029), a venous pouch/varix (61.4% vs 31.5%, p=0.0003), long draining vein (91.2% vs 55.6%, p<0.0001), and larger size based on Spetzler-Martin grade categorization (p=0.006). By location, AVMs located in the frontal lobe, primary motor cortex, and primary sensory cortex were associated with seizures (p=0.004, p=0.001, and p=0.006, respectively); temporal lobe location was not associated with seizures (p=0.459). CONCLUSIONS: Certain MRI characteristics of unruptured intracranial AVMs are associated with seizures. Such correlations may assist in identifying the pathophysiological mechanisms by which AVMs cause seizures.


Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Convulsões/diagnóstico por imagem , Convulsões/etiologia , Adolescente , Adulto , Fístula Arteriovenosa/cirurgia , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Radiocirurgia/métodos , Estudos Retrospectivos , Convulsões/cirurgia , Método Simples-Cego , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/cirurgia , Adulto Jovem
13.
Neurosurg Focus ; 47(6): E15, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31786561

RESUMO

Resting-state functional MRI (rs-fMRI) is a well-established method for studying intrinsic connectivity and mapping the topography of functional networks in the human brain. In the clinical setting, rs-fMRI has been used to define functional topography, typically language and motor systems, in the context of preoperative planning for neurosurgery. Intraoperative mapping of critical speech and motor areas with electrocortical stimulation (ECS) remains standard practice, but preoperative noninvasive mapping has the potential to reduce operative time and provide functional localization when awake mapping is not feasible. Task-based fMRI has historically been used for this purpose, but it can be limited by the young age of the patient, cognitive impairment, poor cooperation, and need for sedation. Resting-state fMRI allows reliable analysis of all functional networks with a single study and is inherently independent of factors affecting task performance. In this review, the authors provide a summary of the theory and methods for resting-state network mapping. They provide case examples illustrating clinical implementation and discuss limitations of rs-fMRI and review available data regarding performance in comparison to ECS. Finally, they discuss novel opportunities for future clinical applications and prospects for rs-fMRI beyond mapping of regions to avoid during surgery but, instead, as a tool to guide novel network-based therapies.


Assuntos
Mapeamento Encefálico/métodos , Imagem por Ressonância Magnética/métodos , Rede Nervosa/diagnóstico por imagem , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Conectoma/métodos , Estimulação Elétrica , Reações Falso-Negativas , Reações Falso-Positivas , Previsões , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Glioblastoma/diagnóstico por imagem , Glioblastoma/cirurgia , Humanos , Achados Incidentais , Masculino , Oligodendroglioma/diagnóstico por imagem , Oligodendroglioma/cirurgia , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/cirurgia , Adulto Jovem
14.
Epileptic Disord ; 21(5): 453-457, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31708491

RESUMO

When performing pre-surgical evaluation of patients with refractory epilepsy, the analysis of seizure semiology is one of the key elements used to generate a hypothesis about the location of the epileptogenic zone. Ictal kissing is a very rarely observed ictal automatism described in patients with temporal lobe epilepsy. We present a 62-year-old man who was referred to our epilepsy centre for comprehensive evaluation. During prolonged video-EEG monitoring, six focal-onset hyperkinetic seizures were registered. In five seizures, the patient repeatedly produced sonorous kisses "into the air". Initial ictal EEG pattern consisted of rhythmic theta or alpha activity at the right fronto-polar and fronto-medial electrodes. MRI depicted focal cortical dysplasia located in the right prefrontal medial cortex. This case suggests that ictal kissing can also occur in the setting of right frontal lobe epilepsy; we therefore believe that this observation expands the anatomo-clinical correlation for this rare ictal automatism. [Published with video sequences].


Assuntos
Epilepsia do Lobo Frontal/fisiopatologia , Epilepsia do Lobo Frontal/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Lobo Frontal/cirurgia , Automatismo/fisiopatologia , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia/métodos , Epilepsia do Lobo Frontal/diagnóstico , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/fisiopatologia , Lobo Frontal/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Convulsões/diagnóstico , Convulsões/fisiopatologia , Convulsões/cirurgia
16.
World Neurosurg ; 129: 140-142, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426248

RESUMO

Supratentorial neurenteric cyst is a rare entity. They are usually isointense to slightly hyperintense on T1W images and hyperintense on T2-weighted/fluid attenuated inversion recovery images. There was a diagnostic dilemma in this case due to the cerebrospinal fluid intensity of the cyst on magnetic resonance imaging. Postoperative residual lesion predisposes to hemorrhage and seizures.


Assuntos
Encefalopatias/patologia , Lobo Frontal/patologia , Defeitos do Tubo Neural/patologia , Adulto , Encefalopatias/cirurgia , Feminino , Lobo Frontal/cirurgia , Humanos , Defeitos do Tubo Neural/cirurgia
17.
Can J Neurol Sci ; 46(5): 585-590, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290387

RESUMO

Psychosurgery refers to the surgical interruption of the white matter fibres joining the frontal cortex to the remainder of the cortical mantle and to the thalamus, in an attempt to mitigate the manifestations of psychosis. It reached its heyday following World War Two and was abandoned with the introduction of major tranquilisers such as chlorpromazine. Wilder Penfield, unlike most of his contemporaries, had a jaundiced view of psychosurgery. This paper addresses Penfield's early experience with experimental, penetrating brain trauma and with the surgical resection of frontal, epileptogenic lesions, which explain his antagonism towards psychosurgery.


Assuntos
Psicocirurgia/história , Canadá , Lobo Frontal/cirurgia , História do Século XX , Humanos
18.
J Comput Assist Tomogr ; 43(5): 686-689, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31356520

RESUMO

BACKGROUND: The Mount Fuji sign (MFS) is a radiological sign on computed tomographic scans depicting air between the frontal lobes. Air in this location indicates tension pneumocephalus (TP), considered a neurosurgical emergency.We evaluate the correlation between the MFS and perioperative mortality attributed to TP in nonagenarians who have undergone evacuation of chronic subdural hemorrhage (cSDH). MATERIALS AND METHODS: We retrospectively reviewed the records of nonagenarians who had cSDH evacuation between 2006 and 2015. Postoperative computed tomographic images were evaluated for findings consistent with the MFS. RESULTS: Of 45 patients, 15 patients (33%) had radiological MFS, and 3 patients (20%) with MFS required reoperation because of new blood collection. No patient required reoperation because of TP. Perioperative (30-day) mortality in patients demonstrating the MFS was 6.67% caused by cardiac arrhythmia versus 13.33% mortality in patients with no evidence of the MFS. CONCLUSION: Mount Fuji sign in nonagenarians after cSDH evacuation is not a specific sign of TP.


Assuntos
Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/cirurgia , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Hematoma Subdural Crônico/mortalidade , Humanos , Masculino , Pneumocefalia/mortalidade , Reoperação , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
19.
Clin Neuropathol ; 38(5): 233-237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347491

RESUMO

Pleomorphic liposarcoma is the rarest subtype of liposarcoma. Involvement of the central nervous system by pleomorphic liposarcoma is exceptional. We present a 62-year-old woman with an intraparenchymal mass involving the left frontoparietal lobes. Histologic examination demonstrated a mesenchymal neoplasm with a dense reticulin network and pleomorphic lipoblasts. Immunohistochemical stain for adipophilin highlighted intracytoplasmic vacuoles. MDM2 immunostain was negative. A diagnosis of pleomorphic liposarcoma was made. There was no evidence of an extracranial primary neoplasm by imaging or physical exam. Pleomorphic liposarcoma may rarely present as a solitary intracranial mass, an entity that must be entertained in the differential diagnosis of pleomorphic tumors involving the brain.
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Assuntos
Neoplasias Encefálicas/patologia , Lobo Frontal/patologia , Lipossarcoma/patologia , Lobo Parietal/patologia , Neoplasias Encefálicas/cirurgia , Feminino , Lobo Frontal/cirurgia , Humanos , Lipossarcoma/cirurgia , Pessoa de Meia-Idade , Lobo Parietal/cirurgia , Resultado do Tratamento
20.
Epileptic Disord ; 21(3): 278-282, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31225803

RESUMO

We report the case of a patient with epilepsy who described shame and embarrassment at the beginning of his seizures. Non-invasive and invasive presurgical investigations led to resection of the polar and ventromedial portions of the right frontal lobe. Following the surgery, the patient continued to have seizures, albeit only nocturnal and with no clear aura. Subsequent removal of the right anterior insula at the junction with the frontal operculum and the posterior orbitofrontal cortex led to seizure freedom, but the patient reported a loss of motivation and stamina and was declared unfit for work. The underlying network of negative moral emotions is briefly discussed.


Assuntos
Córtex Cerebral/cirurgia , Epilepsia do Lobo Frontal/cirurgia , Lobo Frontal/cirurgia , Convulsões/cirurgia , Adulto , Córtex Cerebral/fisiopatologia , Eletroencefalografia/métodos , Epilepsia do Lobo Frontal/diagnóstico , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Convulsões/diagnóstico , Resultado do Tratamento
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