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Hashimoto H, Irizato N, Takemoto O, Chiba Y. Intracranial volumetric evaluation in postnatally repaired myelomeningocele infants. Childs Nerv Syst 2024; 40:2851-2858. [PMID: 38714605 PMCID: PMC11322201 DOI: 10.1007/s00381-024-06444-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/01/2024] [Indexed: 05/10/2024]
Abstract
INTRODUCTION Most myelomeningocele (MMC) cases present with ventriculomegaly or hydrocephalus, yet a comprehensive volumetric assessment of MMC intracranial structures is lacking. This study aimed to provide baseline data on intracranial structural volumes immediately after birth in MMC infants who underwent repair surgeries after birth (postnatal repair). METHODS In this retrospective single-center study, we analyzed 52 MMC infants undergoing postnatal repair, utilizing head computed tomography scans at birth for volumetric assessment. Intracranial volume (ICV), lateral ventricles volume (LVV), choroid plexus volume (CPV), and posterior cranial fossa volume (PCFV) were measured. Hydrocephalus was classified into no hydrocephalus, progressive hydrocephalus, and hydrocephalus at birth. Comparative analysis employed the Wilcoxon rank-sum test. Receiver operating characteristic (ROC) analysis discriminated cases with and without ventriculoperitoneal shunt (VPS). RESULTS The median values were 407.50 mL for ICV, 33.18 mL for LVV, 0.67 mL for CPV, and 21.35 mL for PCFV. Thirty-seven cases (71.15%) underwent VPS. ROC analysis revealed an LVV cut-off value of 6.74 mL for discriminating cases with and without VPS. Progressive hydrocephalus showed no significant difference in ICV but significantly larger LVV compared to no hydrocephalus. Hydrocephalus at birth demonstrated statistically larger ICV and LVV compared to the other two types. CONCLUSION Baseline volumetric data were provided, and volumetric analysis exhibited statistical differences among three hydrocephalus types. These findings enhance our understanding of intracranial volumetric changes in MMC, facilitating more objective assessments of MMC cases.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Izumi, Osaka, 594-1101, Japan.
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Suita, 565-0871, Osaka, Japan.
| | - Naoki Irizato
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Izumi, Osaka, 594-1101, Japan
| | - Osamu Takemoto
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Izumi, Osaka, 594-1101, Japan
| | - Yasuyoshi Chiba
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Izumi, Osaka, 594-1101, Japan
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Zaksaite T, Loveday C, Edginton T, Spiers HJ, Smith AD. Hydrocephalus: A neuropsychological and theoretical primer. Cortex 2023; 160:67-99. [PMID: 36773394 DOI: 10.1016/j.cortex.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Hydrocephalus is a common neurological condition, the hallmark feature of which is an excess in production, or accumulation, of cerebrospinal fluid in the ventricles. Although it is associated with diffuse damage to paraventricular brain areas, patients are broadly typified by a particular pattern of cognitive impairments that include deficits in working memory, attention, and spatial abilities. There have, however, been relatively few neuropsychological accounts of the condition. Moreover, theories of the relationship between aetiology and impairment appear to have emerged in isolation of each other, and proffer fundamentally different accounts. In this primer, we aim to provide a comprehensive and contemporary overview of hydrocephalus for the neuropsychologist, covering cognitive sequelae and theoretical interpretations of their origins. We review clinical and neuropsychological assays of cognitive profiles, along with the few studies that have addressed more integrative behaviours. In particular, we explore the distinction between congenital or early-onset hydrocephalus with a normal-pressure variant that can be acquired later in life. The relationship between these two populations is a singularly interesting one in neuropsychology since it can allow for the examination of typical and atypical developmental trajectories, and their interaction with chronic and acute impairment, within the same broad neurological condition. We reflect on the ramifications of this for our subject and suggest avenues for future research.
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Affiliation(s)
- Tara Zaksaite
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Catherine Loveday
- School of Social Sciences, University of Westminster, 115 New Cavendish St, London W1W 6UW, UK
| | - Trudi Edginton
- Department of Psychology, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Hugo J Spiers
- Department of Experimental Psychology, Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK
| | - Alastair D Smith
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK; Brain Research and Imaging Centre, University of Plymouth, 7 Derriford Rd, Plymouth, PL6 8BU, UK.
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Long-Term Intellectual and Fine Motor Outcomes in Spina Bifida Are Related to Myelomeningocele Repair and Shunt Intervention History. J Int Neuropsychol Soc 2020; 26:364-371. [PMID: 31729310 PMCID: PMC7125008 DOI: 10.1017/s1355617719001176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Lifespan outcomes of simultaneous versus sequential myelomeningocele repair and shunt placement or effects of repeated shunt revisions on specific domains of IQ or fine motor dexterity are largely unknown. The current study addressed these gaps in a large cohort of children and adults with spina bifida myelomeningocele (SBM). METHODS Participants between 7 and 44 years of age with SBM and shunted hydrocephalus were recruited from international clinics at two time points. Each participant completed a standardized neuropsychological evaluation that included estimates of IQ and fine motor dexterity. Simultaneous versus sequential surgical repair and number of shunt revisions were examined in relation to long-term IQ and fine motor scores. RESULTS Simultaneous myelomeningocele repair and shunting were associated with more frequent shunt revisions, as well as to lower Full Scale and verbal IQ scores, controlling for number of shunt revisions. More shunt revisions across study time points were associated with higher nonverbal IQ (NVIQ) scores. No effects were observed on fine motor dexterity. CONCLUSIONS Findings indicate generally greater influence of surgery type over shunt revision history on outcomes in well-managed hydrocephalus. Findings supported apparent, domain-specific benefits of sequential compared to simultaneous surgery across the lifespan in SBM. Higher NVIQ scores with greater number of additional shunt revisions across surgery type supported positive outcomes with effective surgical management for hydrocephalus.
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Swartwout MD, Cirino PT, Hampson AW, Fletcher JM, Brandt ME, Dennis M. Sustained attention in children with two etiologies of early hydrocephalus. Neuropsychology 2008; 22:765-75. [PMID: 18999350 PMCID: PMC2593153 DOI: 10.1037/a0013373] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Several studies have shown that children with spina bifida meningomyelocele (SBM) and hydrocephalus have attention problems on parent ratings and difficulties in stimulus orienting associated with a posterior brain attention system. Less is known about response control and inhibition associated with an anterior brain attention system. Using the Gordon Vigilance Task (Gordon, 1983), we studied error rate, reaction time, and performance over time for sustained attention, a key anterior attention function, in 101 children with SBM, 17 with aqueductal stenosis (AS; another condition involving congenital hydrocephalus), and 40 typically developing controls (NC). In SBM, we investigated the relation between cognitive attention and parent ratings of inattention and hyperactivity and explored the impact of medical variables. Children with SBM did not differ from AS or NC groups on measures of sustained attention, but they committed more errors and responded more slowly. Approximately one-third of the SBM group had attention symptoms, although parent attention ratings were not associated with task performance. Hydrocephalus does not account for the attention profile of children with SBM, which also reflects the distinctive brain dysmorphologies associated with this condition.
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Affiliation(s)
- Maegan D Swartwout
- Department of Psychology, University of Houston, Houston, TX 77204-5355, USA.
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Herweh C, Akbar M, Wengenroth M, Blatow M, Mair-Walther J, Rehbein N, Nennig E, Schenk JP, Heiland S, Stippich C. DTI of commissural fibers in patients with Chiari II-malformation. Neuroimage 2008; 44:306-11. [PMID: 18849000 DOI: 10.1016/j.neuroimage.2008.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 09/10/2008] [Accepted: 09/11/2008] [Indexed: 10/21/2022] Open
Abstract
Chiari II-malformation is a complex congenital deformity of the brain which is frequently associated with hydrocephalus. Abnormalities of the corpus callosum are known to occur in the majority of patients. The objective of the present study was to study the microstructure of the corpus callosum (CC) and the anterior commissure (AC) to differentiate between different mechanisms of damage to these structures. We investigated 6 patients with Chiari II-malformation and 6 well-matched healthy volunteers employing T1-weighted 3D imaging and diffusion tensor imaging (DTI) to determine the fractional anisotropy (FA) and cross-sectional area of the CC and AC, as well as with neuropsychological testing. Four patients showed hydrocephalus, two patients had callosal dysplasia and four had a hypoplastic CC. The callosal FA in the patients was significantly reduced which was less pronounced for the genu alone. The area of CC was also reduced in Chiari II-patients. There was a strong correlation between the size and FA of the CC in the patients. In contrast, the thickness of the AC was significantly increased and was associated with higher FA in the patients. In psychological tests all patients showed reduced verbal memory; all but one patient showed reduced IQ as well as impaired visuo-spatial performance, indicating deficits in tasks requiring parieto-occipital integration. The existence of callosal dysplasia in two patients, the diminished FA reduction in the genu and the correlation of the cross-sectional area and FA in the patients point to a developmental white matter damage beside that exerted by hydrocephalus alone.
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Affiliation(s)
- C Herweh
- Department of Neuroradiology, University of Heidelberg Medical School, Heidelberg, Germany.
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Akbas H, Sahin B, Eroglu L, Odaci E, Bilgic S, Kaplan S, Uzun A, Ergur H, Bek Y. Estimation of breast prosthesis volume by the Cavalieri principle using magnetic resonance images. Aesthetic Plast Surg 2004; 28:275-80. [PMID: 15529205 DOI: 10.1007/s00266-004-0022-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to search the accuracy and reproducibility of the Cavalieri method for the estimation of the breast prosthesis volume on magnetic resonance images (MRI). METHODS Nine breast prostheses were scanned in axial and coronal section planes by MRI. The consecutive sections in 5-mm thickness were taken, after which the volumes of the prostheses were measured and estimated by means of the fluid displacement technique and three-dimensional postprocessing software, respectively. The volumes of the prostheses also were estimated by three performers using the Cavalieri principle to check the accuracy and interobserver interrelation of the suggested technique RESULTS There were no significant differences between the Cavalieri estimate and the real volumes of the breast prostheses (p > 0.05), nor between the performers's volume estimates (p > 0.05). The orientation of the section planes did not affect the accuracy of the estimates (p > 0.05) CONCLUSIONS This report describes a rapid, simple, accurate, and practical technique for estimating the volume of the breast prostheses without changing the routine process in the clinics. It was concluded that the combination of MRI with the Cavalieri principle is a direct and accurate technique that can be applied safely for estimating the volume of the breast prosthesis in 4 min and 34 s per prosthesis.
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Affiliation(s)
- Hayati Akbas
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Ondokuz Mayis University, Medical School, 55030 Samsun, Turkey
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Sahin B, Alper T, Kökçü A, Malatyalioglu E, Kosif R. Estimation of the amniotic fluid volume using the Cavalieri method on ultrasound images. Int J Gynaecol Obstet 2003; 82:25-30. [PMID: 12834938 DOI: 10.1016/s0020-7292(03)00122-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Presently, a design-based and practical method for measuring amniotic fluid volume (AFV) for routine clinical examinations has not been proposed. In this study we describe a new method, which combines the Cavalieri method with ultrasound imaging to estimate AFV. METHODS We measured the AFVs of 14 women in the third trimester of pregnancy, and repeated our measurements three times for each woman. Parallel planimetric ultrasonographic images were obtained at every 2 cm along the longitudinal uterine axis. AFVs were calculated as the total of the multiples of the estimated cut surface areas by the section thickness. RESULTS The mean estimated AFV was 380.5 cm3. The coefficient of error of each measurement was calculated and the mean was 0.108. The coefficient of correlation between the amniotic fluid index and our AFV estimations was 0.87. CONCLUSIONS Design-based and efficient estimation of AFV is possible with the combination of consecutive ultrasound images and the Cavalieri method.
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Affiliation(s)
- B Sahin
- Department of Anatomy, Medical School, Ondokuz Mayis University, 55139, Samsun, Turkey.
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Abstract
RATIONALE AND OBJECTIVES There is no universally accepted way to estimate organ and tumor volumes, and manual tracing of the outline of an organ or tumor is tedious, time-consuming, and therefore not widely used. The authors developed a stereologic method for estimating organ and tumor volumes with a personal computer and evaluated its accuracy and efficiency with computed tomographic images. MATERIALS AND METHODS CT images were obtained of a 200-cm3 phantom sphere, a normal liver, a normal spleen, a brain tumor, and a large abdominopelvic tumor. Volumes were estimated with a computer program developed on a personal computer. The estimated volumes were compared with those found with the manual tracing method, which was used as a standard of reference. The time to complete each procedure was recorded. RESULTS When approximately 200 grid points were used, the volumes estimated with the computer were varied from the reference by 1.9%-4.5%. The volumes ranged from 51 to 2,679 cm3, and the time to estimate these ranged from 42 to 96 seconds. CONCLUSION Stereologic estimation of organ and tumor volumes from cross-sectional images with a personal computer can be accurate and efficient at a relatively low cost.
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Affiliation(s)
- S C Kao
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA
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