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1.
Rinsho Shinkeigaku ; 60(8): 543-548, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641631

RESUMO

We describe an additional patient with spastic paraplegia 48 (SPG48). A 52-year-old woman with gradually increasing gait disturbance was admitted to our hospital. When she was 47 years old, acquaintances noted a shuffling gait. Gait worsening was evident at 48 years. Spastic gait was apparent at 50, and she required a walking stick at 54. Her elder brother had similar gait disturbance. No consanguinity was known. Neurologic examination at 52 disclosed spasticity and moderate weakness in the lower limbs. Spasticity and brisk reflexes in all limbs. Laboratory studies including HTLV-1 titer detected no abnormalities. MRI demonstrated mild corpus callosum narrowing and prominent anterior periventricular hyperintensities in fluid attenuation inversion recovery images. In limb muscles, electromyography (EMG) showed a chronic neurogenic pattern including reduced interference. Gene analysis identified compound homozygosity in exon 7 of adaptor-related protein complex 5 subunit zeta 1 (AP5Z1), including a novel frameshift mutation, c.1662_1672del;p.Glu554Hfs*15 in the patient, and a heterozygous missense mutation in asymptomatic family members, including her mother, two siblings, and a daughter. The frameshift mutation is considered a pathogenic variant according to American College of Medical Genetics and Genomics standards and guidelines. Based on clinical features, imaging findings and genetic abnormalities, we diagnosed this patient with SPG48. Mutations in AP5Z1, which encodes the ζ subunit of AP-5, underlie SPG48. The AP-5 adaptor protein complex, which is mutated in SPG48, binds to both spastizin and spatacsin. While hereditary spastic paraplegias generally are clinically and genetically heterogenous, SPG48, SPG11, and SPG15 are clinically similar.


Assuntos
Proteínas Adaptadoras de Transporte Vesicular/genética , Mutação da Fase de Leitura , Paraparesia Espástica/genética , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Genes Recessivos , Homozigoto , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica/complicações
2.
Bratisl Lek Listy ; 121(6): 437-443, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484709

RESUMO

OBJECTIVES: The ependymal lining of the human brain ventricular system displays distinct structural differences and functional heterogeneity among individual ependymal cells (ECs). To date, multi-ciliated ECs (E1 cells), bi-ciliated ECs (E2 cells), uni-ciliated ECs (E3 cells), ECs without cilia, and ECs with cytoplasmic protrusions have been described in human brain ventricles. METHOD: Using scanning electron microscopy (SEM), we evaluated ependymal samples from 6 defined regions of the third ventricle from 9 human brains. These regions were strictly defined according to the periventricular structures they neighbour with. RESULTS: We observed different structures on the apical surface of the ECs. Various ECs differed from each other by the presence of microvilli, secretory bodies, and a variable number of cilia, which led us to divide the ECs into several exactly specified types according to their apical morphology. CONCLUSION: We found all types of ECs in every examined region with a predominance of particular types of apical surface of ECs in the individual areas (Tab. 4, Fig. 7, Ref. 22).


Assuntos
Epêndima , Terceiro Ventrículo , Ventrículos Cerebrais , Cílios , Epêndima/diagnóstico por imagem , Humanos , Microscopia Eletrônica de Varredura , Terceiro Ventrículo/diagnóstico por imagem
3.
Zhonghua Wai Ke Za Zhi ; 58(6): 469-474, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498488

RESUMO

Objective: To analyze the prognosis factors of cerebrospinal fluid (CSF) spread after surgery in glioblastoma (GBM) patients when tumors progressed and the effect factors on prognosis. Methods: A retrospective study was conducted on 124 patients who were pathologically diagnosed as glioblastoma after surgery, and found tumor progressed during regularly follow-up at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University between January 2009 and August 2017.There were 82 males and 42 females, aged 47.9 years(range: 19 to 75 years) .Patients were divided into local recurrence group(96 cases) and CSF spread group (28 cases) .Clinical data were recorded in detail and compared by independent sample t test or χ(2) test.Kaplan-Meier survival curves was used to demonstrated the distribution of progression free survival (PFS) overall survival (OS) and post progression survival (PPS), and differences between local recurrence and CSF spread groups were assessed by Log-rank test.Cox proportion hazard regression analysis was used to identify independent prognostic factors. Results: Logistics regression analysis showed ventricle entry was the only prognosis factor of CSF spread (OR=2.667, 95% CI: 1.128 to 6.304, P=0.025).No significant distinction was observed in PFS between CSF spread group and local recurrence group(7.0 months vs.9.3 months, P=0.066).However, OS and PPS were substantially shortened in CSF spread group (13.0 months vs.23.0 months, P=0.011; 6.0 months vs.11.0 months, P=0.022, respectively).Mutations of isocitrate dehydrogenase gene, distant spread, gross-total resection, Ki-67 index>30% were independent prognostic factors of GBM patients. Conclusions: Ventricle entry is a prognosis factor for CSF spread, after which the median OS and PPS are markedly diminished.However, ventricle entry is not independent prognosis factor shortening survival.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias do Ventrículo Cerebral/secundário , Ventrículos Cerebrais/patologia , Líquido Cefalorraquidiano , Glioblastoma/secundário , Adulto , Idoso , Neoplasias Encefálicas/cirurgia , Análise Fatorial , Feminino , Glioblastoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Estudos Retrospectivos , Adulto Jovem
4.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32381625

RESUMO

BACKGROUND: Intraventricular hemorrhage (IVH) disproportionately affects black neonates. Other conditions that are more common in black neonates, including low birth weight and preterm delivery, have been linked with residential racial segregation (RRS). In this study, we investigated the association between RRS and IVH. METHODS: A retrospective cohort of neonates born between 24 and 32 weeks' gestation was constructed by using birth certificates linked to medical records from California, Missouri, and Pennsylvania between 1995 and 2009. Dissimilarity, a measure of RRS indicating the proportion of minorities in the census tract of the mother in comparison to the larger metropolitan area, was linked to patient data, yielding a cohort of 70 775 infants. Propensity score analysis matched infants born to mothers living in high segregation to those living in less segregated areas on the basis of race, sociodemographic factors, and medical comorbidities to compare the risk of developing IVH. RESULTS: Infants born to mothers in the most segregated quartile had a greater risk of developing IVH compared with those in the lowest quartile (12.9% vs 10.4%; P < .001). In 17 918 pairs matched on propensity scores, the risk of developing IVH was greater in the group exposed to a segregated environment (risk ratio = 1.08, 95% confidence interval: 1.01-1.15). This effect was stronger for black infants alone (risk ratio = 1.16; 95% confidence interval: 1.03-1.30). CONCLUSIONS: RRS is associated with an increased risk of IVH in preterm neonates, but the effect size varies by race. This association persists after balancing for community factors and birth weight, representing a novel risk factor for IVH.


Assuntos
Grupo com Ancestrais do Continente Africano , Hemorragia Cerebral/epidemiologia , Doenças do Prematuro/epidemiologia , Recém-Nascido Prematuro/fisiologia , Segregação Social/tendências , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/economia , Ventrículos Cerebrais/diagnóstico por imagem , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/economia , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
5.
Stroke ; 51(4): 1120-1127, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078498

RESUMO

Background and Purpose- Definitions of significant hematoma expansion traditionally focus on changes in intraparenchymal volume. The presence of intraventricular hemorrhage (IVH) is a predictor of poor outcome, but current definitions of hematoma expansion do not include IVH expansion. We evaluated whether including IVH expansion to current definitions of hematoma expansion improves the ability to predict 90-day outcome. Methods- Using data from the PREDICT-ICH study (Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT), we compared a standard definition of hematoma expansion (≥6 mL or ≥33%) to revised definitions that includes new IVH development or expansion (≥6 mL or ≥33% or any IVH; ≥6 mL or ≥33% or IVH expansion ≥1 mL). The primary outcome was poor clinical outcome (modified Rankin Scale score, 4-6) at 90 days. Diagnostic accuracy measures were calculated for each definition, and C statistics for each definition were compared using nonparametric methods. Results- Of the 256 patients eligible for primary analysis, 127 (49.6%) had a modified Rankin Scale score of 4 to 6. Sensitivity and specificity for the standard definition (n=80) were 45.7% (95% CI, 36.8-54.7) and 82.9% (95% CI, 75.3-88.9), respectively. The revised definition, ≥6 mL or ≥33% or any IVH (n=113), possessed a sensitivity of 63.8% (95% CI, 54.8-72.1) and specificity of 75.2% (95% CI, 66.8-82.4). Overall accuracy was significantly improved with the revised definition (P=0.013) and after adjusting for relevant covariates, was associated with a 2.55-fold increased odds (95% CI, 1.31-4.94) of poor outcome at 90 days. A second revised definition, ≥6 mL or ≥33% or IVH expansion ≥1 mL, performed similarly (sensitivity, 56.7% [95% CI, 47.6-65.5]; specificity, 78.3% [95% CI, 40.2-85.1]; aOR, 2.40 [95% CI, 1.23-4.69]). Conclusions- In patients with mild-to-moderate ICH, including IVH expansion to the definition of hematoma expansion improves sensitivity with only minimal decreases to specificity and improves overall prediction of 90-day outcome.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/epidemiologia , Tomografia Computadorizada por Raios X/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
6.
Eur J Paediatr Neurol ; 25: 106-112, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32014392

RESUMO

OBJECTIVES: To systematically investigate chromosomal abnormalities and copy number variants (CNVs) in fetuses with different types of ventriculomegaly (VM) by karyotyping and/or chromosomal microarray analysis (CMA). METHODS: This retrospective study included 312 fetuses diagnosed with VM. Amniotic fluid and umbilical blood samples were collected by amniocentesis and cordocentesis, respectively, and subjected to karyotyping and/or CMA. Subgroup analysis by VM type, including mild VM (MVM) and severe VM (SVM), unilateral and bilateral VM, isolated VM (IVM), and non-isolated VM (NIVM), was performed. RESULTS: The detection rate of chromosomal abnormalities was 12.1% (34/281) by karyotyping and 20.6% when CMA was additionally performed (P < 0.05). Abnormalities were identified by CMA in 17.4% (38/218) of fetuses and pathogenic CNVs in 5.0% (11/218). Notably, CMA detected CNVs in 10.6% (23/218) of fetuses with normal karyotypes. The incidence of chromosomal abnormalities by karyotyping was higher in bilateral than in unilateral VM (20.5% versus 6.5%), whereas the incidence detected by CMA was higher in NIVM than in IVM (21.4% versus 10.3%; both P < 0.05). In NIVM, CMA provided an additional detection rate of 11.4% (16/140) and a detection rate of 10.0% for pathogenic CNVs and aneuploidies. Central nervous system (CNS) abnormalities were the most common other ultrasonic abnormalities. CONCLUSIONS: CMA is highly recommended for prenatal diagnosis of fetal VM together with karyotyping, especially in fetuses with bilateral VM and NIVM with abnormal CNS findings. Further study is necessary to explore the relationships between genotypes and phenotypes to facilitate prenatal diagnosis of fetal VM.


Assuntos
Ventrículos Cerebrais/anormalidades , Malformações do Sistema Nervoso/diagnóstico , Malformações do Sistema Nervoso/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Diagnóstico Pré-Natal/métodos , Aberrações Cromossômicas , Variações do Número de Cópias de DNA , Feminino , Feto/anormalidades , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Cariotipagem/métodos , Malformações do Sistema Nervoso/complicações , Gravidez , Estudos Retrospectivos
7.
PLoS One ; 15(2): e0227349, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097426

RESUMO

OBJECTIVE: The amount of extravasated blood is an established surrogate marker for subarachnoid hemorrhage (SAH) severity, which varies in different experimental SAH (eSAH) models. A comprehensive eSAH grading system would allow a more reliable correlation of outcome parameters with SAH severity. The aim of this study was to define a severity score for eSAH related to the Fisher-Score in humans. MATERIAL AND METHODS: SAH was induced in 135 male rats using the modified double hemorrhage model. A sham group included 8 rats, in which saline solution instead of blood was injected. Histological analysis with HE(hematoxylin-eosin)-staining for the visualization of blood was performed in all rats on day 5. The amount and distribution of blood within the subarachnoid space and ventricles (IVH) was analyzed. RESULTS: The mortality rate was 49.6% (71/143). In all except five SAH rats, blood was visible within the subarachnoid space. As expected, no blood was detected in the sham group. The following eSAH severity score was established (ESAS-score): grade I: no SAH visible; grade II: local or diffuse thin SAH, no IVH; grade III: diffuse / thick layers of blood, no IVH; grade IV: additional IVH. Grade I was seen in five rats (7.9%), grade II in 28.6% (18/63), grade III in 41.3% (26/63) and grade IV in 22.2% (14/63) of the rats with eSAH. CONCLUSION: The double hemorrhage model allows the induction of a high grade SAH in more than 60% of the rats, making it suitable for the evaluation of outcome parameters in severe SAH.


Assuntos
Ventrículos Cerebrais/patologia , Hemorragia Subaracnóidea/patologia , Espaço Subaracnóideo/patologia , Animais , Modelos Animais de Doenças , Masculino , Ratos Sprague-Dawley , Hemorragia Subaracnóidea/sangue
8.
Nat Commun ; 11(1): 912, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32060266

RESUMO

Progressive ventricular enlargement, a key feature of several neurologic and psychiatric diseases, is mediated by unknown mechanisms. Here, using murine models of 22q11-deletion syndrome (22q11DS), which is associated with schizophrenia in humans, we found progressive enlargement of lateral and third ventricles and deceleration of ciliary beating on ependymal cells lining the ventricular walls. The cilia-beating deficit observed in brain slices and in vivo is caused by elevated levels of dopamine receptors (Drd1), which are expressed in motile cilia. Haploinsufficiency of the microRNA-processing gene Dgcr8 results in Drd1 elevation, which is brought about by a reduction in Drd1-targeting microRNAs miR-382-3p and miR-674-3p. Replenishing either microRNA in 22q11DS mice normalizes ciliary beating and ventricular size. Knocking down the microRNAs or deleting their seed sites on Drd1 mimicked the cilia-beating and ventricular deficits. These results suggest that the Dgcr8-miR-382-3p/miR-674-3p-Drd1 mechanism contributes to deceleration of ciliary motility and age-dependent ventricular enlargement in 22q11DS.


Assuntos
Ventrículos Cerebrais/metabolismo , Cílios/fisiologia , MicroRNAs/genética , Esquizofrenia/genética , Animais , Deleção Cromossômica , Cílios/genética , Feminino , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , MicroRNAs/metabolismo , Proteínas de Ligação a RNA/genética , Proteínas de Ligação a RNA/metabolismo , Receptores Dopaminérgicos/genética , Receptores Dopaminérgicos/metabolismo , Esquizofrenia/metabolismo , Esquizofrenia/fisiopatologia
9.
Clin Anat ; 33(3): 446-457, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31944414

RESUMO

Anatomic connections between the cerebral lateral and third ventricles have been mischaracterized since Monro's original erroneous description of his eponymous foramina (FoMs) as being only one T-shaped passage. Accurate knowledge of the in vivo three-dimensional (3D) configuration of FoM has important clinical neuroendoscopic, neurosurgical, and neuroimaging implications. We retrospectively analyzed volumetric high-resolution brain magnetic resonance imaging of 100 normal individuals to characterize the normal spatial anatomy and morphometry for each FoM. We measured the true anatomical 3D angulations of FoMs relative to standard neuroimaging orthogonal planes, and their minimum width, depth, and distance between the medial borders of bilateral FoMs. The right and left FoMs were separate, distinct, and in a V-shaped configuration. Each FoM was a round, oval, or crescent-shaped canal-like passage with well-defined borders formed by the semicircular concavity of the ipsilateral forniceal column. The plane of FoM was angled on average 56.8° ± 9.1° superiorly from the axial plane, 22.5° ± 10.7° laterally, and 37.0° ± 6.9° anteriorly from the midsagittal plane; all these angles changing significantly with increasing age. The mean narrowest diameter of FoM was 2.8 ± 1.2 mm, and its depth was 2.5 ± 0.2 mm. Thus, the true size and orientation of FoM differs from that depicted on standard neuroimaging. Notably, in young subjects, FoM has a diameter smaller than its depth, a configuration akin to a short, small canal. We propose that the eponym "Monro" no longer be associated with this structure, and the term "foramen" be abandoned. Instead, FoM should be more appropriately renamed as the "interventricular canaliculus," or IVC, for short.


Assuntos
Ventrículos Cerebrais/anatomia & histologia , Ventrículos Cerebrais/diagnóstico por imagem , Imagem por Ressonância Magnética , Terminologia como Assunto , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
AJNR Am J Neuroradiol ; 41(1): 57-63, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31924603

RESUMO

BACKGROUND AND PURPOSE: Imaging evaluation of ventriculostomy tubes, despite the frequency of malfunction, has remained inadequate due to the absence of a systematic way of assessing the catheter itself. In this retrospective review, we assessed the utility of high-resolution 3D MR imaging techniques, including CISS and volumetric interpolated breath-hold examination sequences, in the evaluation of ventriculostomy catheters. MATERIALS AND METHODS: We performed a retrospective review of 23 clinical MR imaging cases of shunted hydrocephalus spanning a 3-year period, all depicting ventriculostomy catheters. The MR imaging examinations included isotropic CISS and volumetric interpolated breath-hold examination sequences performed with and without contrast. These were independently evaluated by 2 neuroradiologists with respect to the catheter course, side hole position, relationship of the side holes to the ventricles, patency, and the presence or absence of intraluminal debris. RESULTS: The catheter tip was best seen on isotropic CISS sequences reformatted in an oblique plane, and side holes were visualized as CSF signal defects along the catheter wall in 10/23 (43%) cases. The relationship of the catheter side holes to the ventricles was seen in 47% of cases and was best visualized on the coronal CISS sequences. Catheter patency was confirmed in 12/23 (52%) cases, while the other 48% were notable for T2 hypointense filling defects compatible with luminal obstruction. Enhancement of some of these filling defects on imaging is suggestive of choroid plexus ingrowth rather than debris. CONCLUSIONS: High-resolution 3D MR imaging using isotropic CISS sequences allows systematic evaluation of catheter positioning, patency, and potential etiologic differentiation of filling defects when shunt dysfunction is suspected.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Imageamento Tridimensional/métodos , Neuroimagem/métodos , Ventriculostomia/métodos , Adulto , Idoso , Cateteres/efeitos adversos , Falha de Equipamento , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ventriculostomia/efeitos adversos
11.
World Neurosurg ; 133: e121-e128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476469

RESUMO

BACKGROUND: Primary intraventricular hemorrhage (PIVH) is rare, and causes, characteristics, and outcomes remain unknown in children. METHODS: We retrospectively analyzed the clinical characteristics of patients 1 month to 21 years of age who were admitted to the hospital with PIVH over a 7-year period. PIVH was defined as bleeding confined to the ventricular system without parenchymal or subarachnoid hemorrhage involvement. RESULTS: Of 18 included patients, 55.6% were female, and mean age was 13.8 ± 6.0 years. The most common presenting symptoms were headache (77.8%) and vomiting (33.3%). In 15 patients (83.3%), known etiologies were diagnosed, including arteriovenous malformations (66.7%), moyamoya disease (11.1%), and aneurysms (5.6%). Idiopathic PIVH was the diagnosis in 3 patients (16.7%). Surgery was performed in 15 patients (83.3%), and 3 patients (16.7%) received conservative treatment. Four patients (28.6%) had an unfavorable outcome at discharge, and 3 patients (16.7%) had an unfavorable outcome at the 3-month follow-up. Higher Graeb score was associated with an unfavorable outcome in both short-term and long-term follow-up. CONCLUSIONS: Arteriovenous malformations were diagnosed in most pediatric patients with PIVH. Specific surgical treatment of underlying etiologies should be required to increase clinical improvement. Children with a higher Graeb score at admission tended to have poor early and late outcomes.


Assuntos
Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/irrigação sanguínea , Adolescente , Malformações Arteriovenosas/complicações , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Criança , Pré-Escolar , Feminino , Cefaleia/etiologia , Humanos , Lactente , Recém-Nascido , Aneurisma Intracraniano/complicações , Masculino , Doença de Moyamoya/complicações , Estudos Retrospectivos , Resultado do Tratamento , Vômito/etiologia , Adulto Jovem
12.
Br J Radiol ; 93(1106): 20190398, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31825670

RESUMO

OBJECTIVE: CT is the mainstay imaging modality for assessing change in ventricular volume in patients with ventricular shunts or external ventricular drains (EVDs). We evaluated the performance of a novel fully automated CT registration and subtraction method to improve reader accuracy and confidence compared with standard CT. METHODS: In a retrospective evaluation of 49 ventricular shunt or EVD patients who underwent sequential head CT scans with an automated CT registration tool (CT CoPilot), three readers were assessed on their ability to discern change in ventricular volume between scans using standard axial CT images versus reformats and subtraction images generated by the registration tool. The inter-rater reliability among the readers was calculated using an intraclass correlation coefficient (ICC). Bland-Altman tests were performed to determine reader performance compared to semi-quantitative assessment using the bifrontal horn and third ventricular width. McNemar's test was used to determine whether the use of the registration tool increased the reader's level of confidence. RESULTS: Inter-rater reliability was higher when using the output of the registration tool (single measure ICC of 0.909 with versus 0.755 without the tool). Agreement between the readers' assessment of ventricular volume change and the semi-quantitative assessment improved with the registration tool (limits of agreement 4.1 vs 4.3). Furthermore, the tool improved reader confidence in determining increased or decreased ventricular volume (p < 0.001). CONCLUSION: Automated CT registration and subtraction improves the reader's ability to detect change in ventricular volume between sequential scans in patients with ventricular shunts or EVDs. ADVANCES IN KNOWLEDGE: Our automated CT registration and subtraction method may serve as a promising generalizable tool for accurate assessment of change in ventricular volume, which can significantly affect clinical management.


Assuntos
Tomografia Computadorizada por Raios X/métodos , Derivação Ventriculoperitoneal , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Automação , Ventrículos Cerebrais/diagnóstico por imagem , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventriculostomia/métodos , Adulto Jovem
13.
Neurology ; 94(5): e549-e556, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-31748251

RESUMO

OBJECTIVE: To compare the clinical utility of volume-based ratios with the standard linear ratio of Evans index (EI) by examining their associations with gait, cognition, and other patient and imaging variables. METHODS: From MRI scans of 1,774 participants in the Mayo Clinic Study of Aging, we calculated 3 ventricle size measures: Evan index (frontal horn width divided by widest width of skull inner table), total ventricular volume, and frontal horn volume as ratios of total intracranial volume. Gait was measured by a timed 25-foot walk and cognition by a composite of psychometric tests. We also evaluated variables associated with the measures of ventricular size. Further, we evaluated gait and cognition associations with MRI of extraventricular findings seen in normal-pressure hydrocephalus: disproportionate enlargement of subarachnoid space (DESH) and focal sulcal dilations (FSD). RESULTS: Ventricular volume measures had stronger association with gait and cognition measures than EI. In decreasing order of strength of association with ventricle size were DESH, FSD, white matter hyperintensity volume ratio, age, male sex, cortical thickness, and education. Modest evidence was observed that FSD was associated with future decline in gait and cognition. CONCLUSION: Ventricular volume measures are clinically more useful than EI in indicating current and future gait and cognition. Multiple factors are associated with ventricle volume size, including FSD and DESH, suggesting that changes in CSF dynamics may go beyond simple ventriculomegaly.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Cognição/fisiologia , Marcha/fisiologia , Idoso , Idoso de 80 Anos ou mais , Apolipoproteína E4 , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Ventrículos Cerebrais/patologia , Escolaridade , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Tamanho do Órgão , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
14.
World Neurosurg ; 134: e453-e459, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669244

RESUMO

BACKGROUND: Endoscopic access to the third ventricle is limited by the confinements of the foramen of Monro and can be aided by opening of the choroidal fissure. OBJECTIVE: We describe the endoscopic transforaminal transchoroidal (ETTC) approach to the third ventricle with opening of the choroidal fissure to enlarge the posterior foramen of Monro for treatment of various third ventricular diseases. METHODS: We completed a retrospective review of a prospectively collected database at 3 tertiary academic facilities. The search included patients who underwent endoscopic transcranial procedures between 2005 and 2018. All 13 patients included in this study were treated using the ETTC approach for lesions in the third ventricle using a rigid 6-mm working endoscope. RESULTS: There were 7 women and 6 men with a mean age of 44 years (standard deviation, 16 years). Third ventricular diseases included colloid cyst, craniopharyngioma, anaplastic astrocytoma, subependymal giant cell astrocytoma, metastatic lung adenocarcinoma, and lymphoma. Resection was complete in 7 patients and near complete in 4. Two patients had biopsy of a thalamic tumor and third ventriculostomy. The mean follow-up time was 44 months (standard deviation, 36 months; range, 9-121 months). There were no intraoperative or postoperative complications related to the approach. CONCLUSIONS: ETTC approach is a safe and effective method for enlargement of the foramen of Monro. The approach improves maneuverability of the endoscope and allows a broad range of movement and increased angulation within the foramen of Monro. Attention to anatomy is paramount to avoid injury to the venous structures and fornix.


Assuntos
Ventrículos Cerebrais/cirurgia , Plexo Corióideo/cirurgia , Cistos Coloides/cirurgia , Craniofaringioma/cirurgia , Neuroendoscopia/métodos , Terceiro Ventrículo/cirurgia , Adulto , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Plexo Corióideo/diagnóstico por imagem , Cistos Coloides/diagnóstico por imagem , Craniofaringioma/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Terceiro Ventrículo/diagnóstico por imagem , Adulto Jovem
15.
World Neurosurg ; 136: 382-389.e6, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31698131

RESUMO

OBJECTIVE: To explore whether endoscopy surgery (ES) and extraventricular drainage (EVD) combined with intraventricular fibrinolytic (IVF) are superior to EVD alone in patients with intraventricular hemorrhage (IVH) and to determine which procedure is more suitable in such patients. METHODS: We searched the following databases: PubMed, MEDLINE, Ovid, Embase, and Cochrane Library. Randomized controlled trials and nonrandomized studies comparing ≥2 different interventions in patients with IVH were included. The quality of the included studies was assessed. Pairwise and network meta-analysis were performed using software Stata 13.0 and Revman 5.3. RESULTS: Compared with the EVD-alone intervention, the ES regimen, EVD combined with urokinase (UK), and EVD combined with recombinant tissue plasminogen activator (rt-PA) regimens all resulted in better survival and prognosis in patients with IVH. For both survival rate and prognosis, the order from best to worst was ES, EVD combined with UK, EVD combined with rt-PA, and EVD-alone. However, EVD combined with IVF had a high risk of intracranial rebleeding; the order of intracranial rebleeding risk from lowest to highest was ES, EVD-alone, EVD combined with rt-PA, and EVD combined with UK. The risk of intracranial infection in EVD combined with rt-PA was lower than that of EVD-alone, but EVD combined with UK also had a higher risk than did EVD-alone. The risk of intracranial infection from lowest to the highest was ES, EVD combined with rt-PA, EVD-alone, and EVD combined with UK. CONCLUSIONS: Our analysis showed that ES is more suitable for patients with IVH. ES not only improved the survival and prognosis but also had the lowest risk of ventriculoperitoneal shunt and intracranial rebleeding or infection.


Assuntos
Ventrículos Cerebrais/cirurgia , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Humanos , Metanálise em Rede , Segurança do Paciente
16.
Glia ; 68(2): 435-450, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31626379

RESUMO

Postnatal subventricular zone (SVZ) neural stem cells generate forebrain glia, namely astrocytes and oligodendrocytes. The cues necessary for this process are unclear, despite this phase of brain development being pivotal in forebrain gliogenesis. Galectin-3 (Gal-3) is increased in multiple brain pathologies and thereby regulates astrocyte proliferation and inflammation in injury. To study the function of Gal-3 in inflammation and gliogenesis, we carried out functional studies in mouse. We overexpressed Gal-3 with electroporation and using immunohistochemistry surprisingly found no inflammation in the healthy postnatal SVZ. This allowed investigation of inflammation-independent effects of Gal-3 on gliogenesis. Loss of Gal-3 function via knockdown or conditional knockout reduced gliogenesis, whereas Gal-3 overexpression increased it. Gal-3 overexpression also increased the percentage of striatal astrocytes generated by the SVZ but decreased the percentage of oligodendrocytes. These novel findings were further elaborated with multiple analyses demonstrating that Gal-3 binds to the bone morphogenetic protein receptor one alpha (BMPR1α) and increases bone morphogenetic protein (BMP) signaling. Conditional knockout of BMPR1α abolished the effect of Gal-3 overexpression on gliogenesis. Gain-of-function of Gal-3 is relevant in pathological conditions involving the human forebrain, which is particularly vulnerable to hypoxia/ischemia during perinatal gliogenesis. Hypoxic/ischemic injury induces astrogliosis, inflammation and cell death. We show that Gal-3 immunoreactivity was increased in the perinatal human SVZ and striatum after hypoxia/ischemia. Our findings thus show a novel inflammation-independent function for Gal-3; it is necessary for gliogenesis and when increased in expression can induce astrogenesis via BMP signaling.


Assuntos
Astrócitos/metabolismo , Galectina 3/metabolismo , Ventrículos Laterais/citologia , Neuroglia/metabolismo , Animais , Diferenciação Celular/fisiologia , Movimento Celular/fisiologia , Ventrículos Cerebrais/citologia , Regulação da Expressão Gênica , Isquemia/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Células-Tronco Neurais/metabolismo , Neurogênese/fisiologia , Oligodendroglia/metabolismo
17.
World Neurosurg ; 135: 228-232, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863895

RESUMO

BACKGROUND: Tension pneumoventricle is an extremely rare, but treatable, neurosurgical emergency. The prompt and accurate diagnosis of tension pneumoventricle requires vigilance for the detection of clinical signs, which should also be corroborated by the imaging findings. We have reported on the pathophysiology of tension pneumoventricle and its management. CASE DESCRIPTION: A 66-year-old woman had presented with a Rathke cleft cyst. The patient underwent transsphenoidal surgery (TSS), with no clinical cerebrospinal fluid leakage observed peri- or postoperatively. However, she developed an altered mental status 8 hours after surgery, and a computed tomography scan showed evidence of a tension pneumoventricle. The patient underwent emergent external ventricular drainage insertion and exploratory endoscopic TSS. A 1-way valve was observed during TSS, and the sella floor was packed with a fat graft for 1-way valve obliteration. The patient recovered well without neurologic deficits. No radiologic regrowth was noted at the 48-month follow-up examination. CONCLUSIONS: Tension pneumoventricle is an extremely rare, but life-threatening, complication of TSS. The development of tension pneumoventricle should be kept in mind even when the surgery has proceeded very smoothly. Sellar reconstruction will, theoretically, prevent this extremely rare complication but might increase the recurrence rate of Rathke cleft cysts. The related symptoms and signs should be recognized. Prompt recognition and treatment of this condition can be life-saving, and the long-term outcomes have generally been favorable if the condition has been recognized early.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Ventrículos Cerebrais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neuroendoscopia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/cirurgia , Sela Túrcica/cirurgia , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Imagem por Ressonância Magnética , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Osso Esfenoide , Tomografia Computadorizada por Raios X , Ventriculostomia
18.
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
19.
World Neurosurg ; 135: 253-258, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887463

RESUMO

BACKGROUND: Generally, enlargement of arachnoid cysts (ACs) has been found mostly in cases occurring during early childhood. Therefore, progressively enlarged ACs found to be symptomatic in elderly patients are extremely rare, and the mechanisms have remained unexplored. CASE DESCRIPTION: Our first patient was a 72-year-old woman with memory disturbance, who had presented with a large cyst beneath the right temporal convexity 9 years previously. The annual follow-up magnetic resonance imaging (MRI) studies had revealed that the cyst had progressively enlarged. In addition, her memory disturbance had become advanced. Endoscopic cyst fenestration was performed between the cyst and lateral ventricle, resulting in a reduction of her symptoms. Our second patient was a 79-year-old woman with unsteadiness, who had presented with a large cyst under the right parietal convexity 6 years previously. The annual follow-up MRI studies had shown that the cyst had gradually enlarged. She subsequently developed left hemiparesis. Because the pyramidal tract was located between the cyst and ventricle, a cyst-ventricle shunt was placed to allow the cystic fluid into the lateral ventricle, with complete resolution of her symptoms. In both cases, MRI showed obliteration of the subdural spaces around the cysts. Endoscopic observations revealed that the arachnoid membrane was lined under the surrounding brain, leading to the diagnosis of an AC. CONCLUSION: The establishment of stable communication between a cyst and the normal cerebrospinal fluid space is important to treat symptomatic ACs characterized by progressive enlargement, even in elderly patients. The 1-way entry of the cerebrospinal fluid into the cyst and the closure of the surrounding subdural space might result in AC enlargement internally.


Assuntos
Cistos Aracnóideos/cirurgia , Ventrículos Cerebrais/cirurgia , Drenagem/métodos , Neuroendoscopia/métodos , Idoso , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Transtornos da Memória/etiologia , Procedimentos Neurocirúrgicos , Paresia/etiologia , Lobo Parietal , Lobo Temporal
20.
J Neuropathol Exp Neurol ; 79(1): 113-117, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31794012

RESUMO

Hydrocephalus is a rare and devastating complication of mumps encephalitis. The histopathological correlates of mumps infection in central nervous system tissues are not well-characterized. We present the case of a 54-year-old patient who suffered long-term neuropsychiatric sequelae and hydrocephalus as a consequence of a childhood mumps infection. Brain autopsy revealed significant dilation of the lateral and third ventricles. Aqueductal stenosis was not observed on premortem imaging or on gross examination. Histology revealed loss of ependymal epithelium throughout the aqueduct and ventricular system. Macrophage conglomerates were identified within the cerebral aqueduct at the level of the pons in addition to subjacent periaqueductal gliosis and scattered Rosenthal fibers. Together, these findings support primary ependymal injury as a pathophysiological mechanism in the development of chronic hydrocephalus following mumps infection. Finally, we review the existing literature and discuss potential mechanisms of disease.


Assuntos
Encefalite/complicações , Encefalite/patologia , Hidrocefalia/etiologia , Hidrocefalia/patologia , Caxumba/complicações , Caxumba/patologia , Adolescente , Adulto , Encéfalo/patologia , Aqueduto do Mesencéfalo/patologia , Ventrículos Cerebrais/patologia , Criança , Pré-Escolar , Encefalite/psicologia , Epêndima/patologia , Evolução Fatal , Feminino , Gliose/patologia , Humanos , Hidrocefalia/psicologia , Lactente , Macrófagos/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Caxumba/psicologia , Ponte/patologia , Adulto Jovem
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