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Hoz SS, Ismail M, Palmisciano P, Al-Khazaali YM, Saleh SA, Muthana A, Forbes JA, Prestigiacomo CJ, Zuccarello M, Andaluz N. Cortical incisions and transcortical approaches for intra-axial and intraventricular lesions: A scoping review. Surg Neurol Int 2024; 15:82. [PMID: 38628541 PMCID: PMC11021096 DOI: 10.25259/sni_58_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/11/2024] [Indexed: 04/19/2024] Open
Abstract
Background Transcortical approaches, encompassing various surgical corridors, have been employed to treat an array of intraparenchymal or intraventricular brain pathologies, including tumors, vascular malformations, infections, intracerebral hematomas, and epileptic surgery. Designing cortical incisions relies on the lesion location and characteristics, knowledge of eloquent functional anatomy, and advanced imaging such as tractography. Despite their widespread use in neurosurgery, there is a noticeable lack of systematic studies examining their common lobe access points, associated complications, and prevalent pathologies. This scoping review assesses current evidence to guide the selection of transcortical approaches for treating a variety of intracranial pathologies. Methods A scoping review was conducted using the PRISMA-ScR guidelines, searching PubMed, EMBASE, Scopus, and Web of Science. Studies were included if ≥5 patients operated on using transcortical approaches, with reported data on clinical features, treatments, and outcomes. Data analysis and synthesis were performed. Results A total of 50 articles encompassing 2604 patients were included in the study. The most common primary pathology was brain tumors (60.6%), particularly gliomas (87.4%). The transcortical-transtemporal approach was the most frequently identified cortical approach (70.48%), and the temporal lobe was the most accessed brain lobe (55.68%). The postoperative course outcomes were reported as good (55.52%), poor (28.38%), and death (14.62%). Conclusion Transcortical approaches are crucial techniques for managing a wide range of intracranial lesions, with the transcortical-transtemporal approach being the most common. According to the current literature, the selective choice of cortical incision and surgical corridor based on the lesion's pathology and anatomic-functional location correlates with acceptable functional outcomes.
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Affiliation(s)
- Samer S. Hoz
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, United States
| | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
| | | | - Saleh A. Saleh
- Department of Neurosurgery, University of Baghdad, Baghdad, Iraq
| | - Ahmed Muthana
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Jonathan A. Forbes
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
| | | | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Sahrizan NSA, Manan HA, Abdul Hamid H, Abdullah JM, Yahya N. Functional Alteration in the Brain Due to Tumour Invasion in Paediatric Patients: A Systematic Review. Cancers (Basel) 2023; 15:cancers15072168. [PMID: 37046828 PMCID: PMC10093754 DOI: 10.3390/cancers15072168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Working memory, language and speech abilities, motor skills, and visual abilities are often impaired in children with brain tumours. This is because tumours can invade the brain's functional areas and cause alterations to the neuronal networks. However, it is unclear what the mechanism of tumour invasion is and how various treatments can cause cognitive impairment. Therefore, this study aims to systematically evaluate the effects of tumour invasion on the cognitive, language, motor, and visual abilities of paediatric patients, as well as discuss the alterations and modifications in neuronal networks and anatomy. The electronic database, PubMed, was used to find relevant studies. The studies were systematically reviewed based on the type and location of brain tumours, cognitive assessment, and pre- and post-operative deficits experienced by patients. Sixteen studies were selected based on the inclusion and exclusion criteria following the guidelines from PRISMA. Most studies agree that tumour invasion in the brain causes cognitive dysfunction and alteration in patients. The effects of a tumour on cognition, language, motor, and visual abilities depend on the type of tumour and its location in the brain. The alteration to the neuronal networks is also dependent on the type and location of the tumour. However, the default mode network (DMN) is the most affected network, regardless of the tumour type and location.Furthermore, our findings suggest that different treatment types can also contribute to patients' cognitive function to improve or deteriorate. Deficits that persisted or were acquired after surgery could result from surgical manipulation or the progression of the tumour's growth. Meanwhile, recovery from the deficits indicated that the brain has the ability to recover and reorganise itself.
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Affiliation(s)
- Nur Shaheera Aidilla Sahrizan
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hanani Abdul Manan
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hamzaini Abdul Hamid
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Jafri Malin Abdullah
- Jabatan Neurosains, Pusat Pengajian Sains Perubatan, Jalan Hospital USM, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Brain and Behaviour Cluster, Pusat Pengajian Sains Perubatan, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Department of Neurosciences & Brain Behaviour Cluster, Hospital Universiti Sains Malaysia, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
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Chen W, Wu Q, Chen L, Zhou J, Chen HH, Xu XQ, Wu FY, Hu H. Aberrant brain voxel-wise resting state fMRI in patients with thyroid-associated ophthalmopathy. J Neuroimaging 2021; 31:773-783. [PMID: 33817897 DOI: 10.1111/jon.12858] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Although ophthalmic complaints were mostly mentioned in thyroid-associated ophthalmopathy (TAO), emotional and psychological disturbances are increasingly concerned. We aimed to investigate the brain functional alteration in TAO patients by using resting-state functional MRI (rs-fMRI) with the fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and degree centrality (DC) methods. METHODS Twenty-one consecutive TAO patients and 21 healthy controls (HCs) underwent rs-fMRI scans. The fALFF, ReHo, and DC values were compared between groups. RESULTS Compared with HCs, TAO group showed decreased fALFF values in bilateral calcarine/left lingual gyrus and left middle occipital gyrus (MOG). Moreover, TAO group had decreased ReHo values in left MOG/inferior occipital gyrus/fusiform gyrus, while increased ReHo values in bilateral middle frontal gyrus (MFG)/superior frontal gyrus (SFG) than HCs. TAO group also showed decreased DC values in bilateral postcentral gyrus (PoCG)/precentral gyrus/superior parietal lobule and supplementary motor area, and increased DC values in left SFG/MFG and MFG. In TAO patients, ReHo value in left MOG was positively correlated with visual acuity (r = 0.524, p = 0.021), while ReHo values in bilateral MFGs were negatively correlated with cognitive scores (left/right: r = -0.476/-0.527, p = 0.039/0.020). DC value in left PoCG was negatively correlated with disease duration (r = -0.492, p = 0.033). CONCLUSIONS Our findings indicated that TAO patients had brain functional alterations in the visual network, executive control network, sensorimotor network, and attention network, which may reflect potential visual and cognitive dysfunctions.
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Affiliation(s)
- Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Milton CK, Palejwala AH, O'Connor KP, McCoy TM, Conner AK, Glenn CA. Diffusion Tensor Imaging Tractography for Fornix Identification in Intraventricular Tumor Surgery: A Case Series. NEUROSURGERY OPEN 2020. [DOI: 10.1093/neuopn/okaa005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
BACKGROUND
The proximity of intraventricular or periventricular tumors to critical white matter structures, such as the fornix, poses an operative challenge. In order to avoid significant neurological morbidity, deliberate selection of surgical approach is necessary when planning resection of tumors in this region. We report our initial experience with fornix modeling as an adjunct to standard navigational techniques across multiple pathologies.
OBJECTIVE
To report the feasibility of using diffusion tensor imaging (DTI) fornix modeling as an adjunct to standard navigational techniques for surgical treatment of intraventricular and periventricular tumors involving the fornix.
METHODS
Between July 2018 and August 2019, DTI tractography was performed on 12 patients with intraventricular or periventricular tumors involving the fornix. DTI fornix modeling was performed and included as part of the intraoperative navigation in all cases.
RESULTS
The patient group was composed of 6 males and 6 females. The fornix model was delineated in all cases using DTI tractography as described. The mean patient age was 45.7 yr. The 2 most-common tumor pathologies represented in our patient cohort included meningioma and cranipharyngioma, both found in 2 patients. A glioneuronal tumor, low-grade glioma, ependymoma, subependymoma, mixed germ-cell tumor, pituitary adenoma, and renal cell carcinoma metastasis were found in 1 patient each. Case examples of fornix modeling that may be incorporated into standard neuronavigation are presented. No patient experienced new or worsening post-operative memory deficits.
CONCLUSION
DTI tractography for fornix identification is a useful adjunct to standard navigational techniques employed in surgical resection of forniceal involving tumors.
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Affiliation(s)
- Camille K Milton
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ali H Palejwala
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kyle P O'Connor
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Tressie M McCoy
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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He J, Li Z, Yu Y, Lu Z, Li Z, Gong J. Cognitive function assessment and comparison on lateral ventricular tumors resection by the frontal transcortical approach and anterior transcallosal approach respectively in children. Neurosurg Rev 2019; 43:619-632. [PMID: 30815764 DOI: 10.1007/s10143-019-01088-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
Currently, there are few studies on cognitive impairment caused by neurosurgery, and there have been no studies on cognitive impairment after resection of lateral ventricular tumors in children. Previously, our research team has reported that the frontal transcortical approach can impair cognitive function. In this study, we explored which functions would be damaged by the transcallosal approach and compared the cognitive function changes caused by the two surgical approaches, so as to provide a theoretical basis for the selection of pre-operative surgical approaches. The authors prospectively collected pediatric patients with lateral ventricular tumors who had undergone surgical resection through the frontal transcortical approach and anterior transcallosal approach in Beijing Tiantan Hospital from November 2012 to May 2017. The inclusion criteria according to the Children Wechsler Scale requirements and clinical performance were formulated. Wechsler Intelligence Scale for Children®-fourth edition: Chinese version (WISC-IV) was adopted for general intelligence and cognitive function assessment in the study. In addition, the resting-state functional magnetic resonance imaging (resting-state fMRI) and diffusion tensor imaging (DTI) were carried out to measure the level of co-activation and to explore the functional connectivity between the brain regions at the pre-operative period and 6-month follow-up in post-operation. A total of 30 patients were enrolled. Gross total resection was achieved in all patients, and no severe post-operative complications were observed. The frontal transcortical approach was applied in 19 patients, and the transcallosal approach was conducted for 11 patients. Compared with the pre-operative indices of WISC-IV, patients generally had a lower level of indices of the WISC-IV in post-operation. In patients accepting lateral ventricular tumors resection through the anterior transcallosal approach, the total IQ was declined to M = 84.82, SD = 8.072 from M = 93.27, SD = 6.635 within the 6-month convalescence. The data of working memory (t = - 2.990, p = 0.002) and total IQ (t = - 2.205, p = 0.028) pre- and post-operative showed statistical significance. But in the comparison of two surgical approaches, it was found that IQ had no statistical difference in WISC-IV tasks data. Previous studies suggest that the frontal transcortical approach impair perceptual reasoning, processing speed, and IQ, while this study indicates that the anterior transcallosal approach impairs patients' working memory and IQ. Both approaches make equal damage to IQ. Through comparing the two surgical approaches, it can be known that the anterior transcallosal approach cannot replace the frontal transcortical approach. The protection of cognitive function should be considered as one of the bases for neurosurgeons to select the operative approach before the operation. However, in an actual situation, the specific approach should be carefully selected by comprehensive consideration.
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Affiliation(s)
- Jintao He
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100160, China
| | - Zhicen Li
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100160, China
| | - Yaxiong Yu
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100160, China
| | - Zheng Lu
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100160, China
| | - Zhi Li
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100160, China
| | - Jian Gong
- Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100160, China. .,Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100160, China.
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Liu W, Tang J, Van Halm-Lutterodt N, Luo S, Li C. History and current state of pediatric neurosurgery at Beijing Tiantan Hospital Neurosurgery Center. Childs Nerv Syst 2018. [PMID: 29520436 DOI: 10.1007/s00381-018-3755-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Wei Liu
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jie Tang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China
| | - Nicholas Van Halm-Lutterodt
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China.,Department of Orthopedics and Neurosurgery, University of Southern California, Los Angeles, CA, 90089, USA
| | - Shiqi Luo
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China.
| | - Chunde Li
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China.
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