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Leavitt L, Baohan A, Heller H, Kozanno L, Frosch MP, Dunn G. Surgical management of an abscess of the insula. Surg Neurol Int 2022; 13:591. [PMID: 36600730 PMCID: PMC9805647 DOI: 10.25259/sni_871_2022] [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: 09/20/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Mass lesions within the insular are diagnostically and surgically challenging due to the numerous critical cortical, subcortical, and vascular structures surrounding the region. Two main surgical techniques - the transsylvian approach and the transcortical approach - provide access to the insular cortex. Of the range of pathologies encountered, abscesses in the insula are surprisingly rare. Case Description A 34-year-old patient was admitted for surgical resection of a suspected high-grade glioma in the insula of the dominant hemisphere. A rapid clinical decline prompted emergent neurosurgical intervention using a transsylvian approach. Surprisingly, abundant purulent material was encountered on entering the insular fossa. Pathological analysis confirmed an insular abscess, although a source of infection could not be identified. The patient required a second evacuation for reaccumulation of the abscess and adjuvant corticosteroids for extensive cerebral edema. Conclusion An abscess located in the insular cortex is an incredibly rare occurrence. Surgical management using the transsylvian approach is one option to approach this region. Familiarity with this approach is thus extremely beneficial in situations requiring emergent access to the dominant insula when awake mapping is not feasible. In addition, treatment of abscesses with adjuvant corticosteroids is indicated when extensive, life-threatening cerebral edema is present.
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Affiliation(s)
- Lydia Leavitt
- Department of Neurosurgery, University of Illinois College of Medicine, Rockford, Illinois
| | - Amy Baohan
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Howard Heller
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Liana Kozanno
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Matthew P. Frosch
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Gavin Dunn
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States.,Corresponding author: Gavin Dunn, Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
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Li Y, Hou Y, Li Q, Tang J, Lu J. Optimized Tractography Mapping and Quantitative Evaluation of Pyramidal Tracts for Surgical Resection of Insular Gliomas: a Correlative Study with Diffusion Tensor Imaging–Derived Metrics and Patient Motor Strength. J Digit Imaging 2022; 35:356-364. [PMID: 35064370 PMCID: PMC8921407 DOI: 10.1007/s10278-021-00578-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
We investigate the correlation between diffusion tensor imaging (DTI)-derived metric statistics and motor strength grade of insular glioma patients after optimizing the pyramidal tract (PT) delineation. Motor strength grades of 45 insular glioma patients were assessed. All the patients underwent structural and diffusion MRI examination before and after surgery. We co-registered pre- and post-op datasets, and a two-tensor unscented Kalman filter (UKF) algorithm was employed to delineate bilateral PTs after DWI pre-processing. The tractography results were voxelized, and their labelmaps were cropped according to the location of frontal and insular parts of the lesion. Both the whole and cropped labelmaps were used as regions of interest to analyze fractional anisotropy (FA) and Trace statistics; hence, their ratios were calculated (lesional side tract/contralateral normal tract). The combination of DWI pre-processing and two-tensor UKF algorithm successfully delineated bilateral PTs of all the patients. It effectively accomplished both full fiber delineation within the edema and an extensive lateral fanning that had a favorable correspondence to the bilateral motor cortices. Before surgery, correlations were found between patients' motor strength grades and ratios of PT volume and FA standard deviation (SD). Nearly 3 months after surgery, correlations were found between motor strength grades and the ratios of metric statistics as follows: whole PT volume, whole mean FA, and FA SD. We substantiated the correlation between DTI-derived metric statistics and motor strength grades of insular glioma patients. Moreover, we posed a workflow for comprehensive pre- and post-op DTI quantitative research of glioma patients.
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Affiliation(s)
- Ye Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China
| | - Yuanzheng Hou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China
| | - Qiongge Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China.
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China.
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Weiss A, Di Carlo DT, Di Russo P, Weiss F, Castagna M, Cosottini M, Perrini P. Microsurgical anatomy of the amygdaloid body and its connections. Brain Struct Funct 2021; 226:861-874. [PMID: 33528620 DOI: 10.1007/s00429-020-02214-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/30/2020] [Indexed: 12/14/2022]
Abstract
The amygdaloid body is a limbic nuclear complex characterized by connections with the thalamus, the brainstem and the neocortex. The recent advances in functional neurosurgery regarding the treatment of refractory epilepsy and several neuropsychiatric disorders renewed the interest in the study of its functional Neuroanatomy. In this scenario, we felt that a morphological study focused on the amygdaloid body and its connections could improve the understanding of the possible implications in functional neurosurgery. With this purpose we performed a morfological study using nine formalin-fixed human hemispheres dissected under microscopic magnification by using the fiber dissection technique originally described by Klingler. In our results the amygdaloid body presents two divergent projection systems named dorsal and ventral amygdalofugal pathways connecting the nuclear complex with the septum and the hypothalamus. Furthermore, the amygdaloid body is connected with the hippocampus through the amygdalo-hippocampal bundle, with the anterolateral temporal cortex through the amygdalo-temporalis fascicle, the anterior commissure and the temporo-pulvinar bundle of Arnold, with the insular cortex through the lateral olfactory stria, with the ambiens gyrus, the para-hippocampal gyrus and the basal forebrain through the cingulum, and with the frontal cortex through the uncinate fascicle. Finally, the amygdaloid body is connected with the brainstem through the medial forebrain bundle. Our description of the topographic anatomy of the amygdaloid body and its connections, hopefully represents a useful tool for clinicians and scientists, both in the scope of application and speculation.
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Affiliation(s)
- Alessandro Weiss
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. .,, Pisa, Italy.
| | - Davide Tiziano Di Carlo
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Paolo Di Russo
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Weiss
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Maura Castagna
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mirco Cosottini
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Paolo Perrini
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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López-Elizalde R, Campero A, Sánchez-Delgadillo T, Lemus-Rodríguez Y, López-González MI, Godínez-Rubí M. Anatomy of the olfactory nerve: A comprehensive review with cadaveric dissection. Clin Anat 2017; 31:109-117. [DOI: 10.1002/ca.23003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/16/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022]
Affiliation(s)
- R. López-Elizalde
- Servicio de Neurocirugía, Hospital General Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; Guadalajara Jalisco 45100 Mexico
| | - A. Campero
- Servicio de Neurocirugía, Hospital Padilla; Buenos Aires Argentina
| | - T. Sánchez-Delgadillo
- Servicio de Neurocirugía, Hospital General Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; Guadalajara Jalisco 45100 Mexico
| | - Y. Lemus-Rodríguez
- Módulo de Cirugía Cerebrovascular, Centro Médico 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; Ciudad de México Mexico
| | - MI. López-González
- Laboratorio de Investigación en Patología, Departamento de Microbiología y Patología; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Guadalajara Jalisco Mexico
| | - M. Godínez-Rubí
- Servicio de Neurocirugía, Hospital General Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; Guadalajara Jalisco 45100 Mexico
- Laboratorio de Investigación en Patología, Departamento de Microbiología y Patología; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Guadalajara Jalisco Mexico
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Ajler P, Bravo MC, Garategui L, Goldschmidt E, Isolan G, Campero Á. [Microsurgical approach to the ambient cistern]. Surg Neurol Int 2016; 7:S861-S867. [PMID: 27999709 PMCID: PMC5154204 DOI: 10.4103/2152-7806.194493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/31/2016] [Indexed: 12/02/2022] Open
Abstract
Objetivo: Describir paso a paso el abordaje a la cisterna ambiens por la vía suboccipital retrosigmoidea supracerebelosa infratentorial (SRSI). Descripción: El abordaje SRSI se realiza de la misma manera que el abordaje suboccipital retrosigmoideo (SR), utilizado habitualmente para acceder a la patología del ángulo pontocerebeloso, con las siguientes modificaciones: (1) utilizamos siempre la posición semisentado, (2) la craneotomia-craniectomia debe exponer el seno transverso y extenderse 5 cm medialmente hacia el inion, (3) al realizar la apertura dural es necesario rebatir la duramadre junto con el seno transverso hacia cefálico con puntos de tracción, (4) bajo magnificación con microscopio quirúrgico se debe realizar la apertura de la cisterna cerebelobulbar para drenar líquido cefalorraquídeo, (5) en el plano supracerebeloso es fundamental cortar las bridas aracnoidales y de ser necesario debemos coagular y cortar las venas puente, todas estas maniobras sumadas al efecto de la gravedad brindan mayor apertura del corredor supracerebeloso. Conclusión: El abordaje a la cisterna ambiens por la vía SRSI es una opción segura para el acceso de patologías tumorales que se alojan en esta zona con un componente predominantemente infratentorial.
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Affiliation(s)
- Pablo Ajler
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Michael Cruz Bravo
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Lucas Garategui
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ezequiel Goldschmidt
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo Isolan
- Centro Avançado de Neurologia e Neurocirurgia (CEANNE), Graduate Course in surgery, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Álvaro Campero
- Servicio de Neurocirugía, Hospital Padilla, Tucumán, Argentina
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Burks JD, Bonney PA, Conner AK, Glenn CA, Briggs RG, Battiste JD, McCoy T, O'Donoghue DL, Wu DH, Sughrue ME. A method for safely resecting anterior butterfly gliomas: the surgical anatomy of the default mode network and the relevance of its preservation. J Neurosurg 2016; 126:1795-1811. [DOI: 10.3171/2016.5.jns153006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGliomas invading the anterior corpus callosum are commonly deemed unresectable due to an unacceptable risk/benefit ratio, including the risk of abulia. In this study, the authors investigated the anatomy of the cingulum and its connectivity within the default mode network (DMN). A technique is described involving awake subcortical mapping with higher attention tasks to preserve the cingulum and reduce the incidence of postoperative abulia for patients with so-called butterfly gliomas.METHODSThe authors reviewed clinical data on all patients undergoing glioma surgery performed by the senior author during a 4-year period at the University of Oklahoma Health Sciences Center. Forty patients were identified who underwent surgery for butterfly gliomas. Each patient was designated as having undergone surgery either with or without the use of awake subcortical mapping and preservation of the cingulum. Data recorded on these patients included the incidence of abulia/akinetic mutism. In the context of the study findings, the authors conducted a detailed anatomical study of the cingulum and its role within the DMN using postmortem fiber tract dissections of 10 cerebral hemispheres and in vivo diffusion tractography of 10 healthy subjects.RESULTSForty patients with butterfly gliomas were treated, 25 (62%) with standard surgical methods and 15 (38%) with awake subcortical mapping and preservation of the cingulum. One patient (1/15, 7%) experienced postoperative abulia following surgery with the cingulum-sparing technique. Greater than 90% resection was achieved in 13/15 (87%) of these patients.CONCLUSIONSThis study presents evidence that anterior butterfly gliomas can be safely removed using a novel, attention-task based, awake brain surgery technique that focuses on preserving the anatomical connectivity of the cingulum and relevant aspects of the cingulate gyrus.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dee H. Wu
- 4Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Kim SH, Kim JS, Kim HY, Lee SI. Transsylvian-Transinsular Approach for Deep-Seated Basal Ganglia Hemorrhage: An Experience at a Single Institution. J Cerebrovasc Endovasc Neurosurg 2015; 17:85-92. [PMID: 26157687 PMCID: PMC4495086 DOI: 10.7461/jcen.2015.17.2.85] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 08/26/2014] [Accepted: 03/31/2015] [Indexed: 12/05/2022] Open
Abstract
Objective Treatment of spontaneous intracerebral hemorrhage (ICH) remains controversial. However, an extensive hemorrhage with a poor mental status is suitable for surgical evacuation. Our experience with the transsylvian-transinsular (TS-TI) microsurgical approach for deep-seated basal ganglia (BG) ICH was investigated. Material and Methods A retrospective review was conducted on 86 patients with BG ICH who underwent an operation at the Department of Neurosurgery of our Hospital from September 2011 to October 2014. Thirteen patients underwent craniotomy and the TS-TI microsurgical approach for hematoma evacuation. Twenty-seven patients underwent conventional craniotomy with the trans-cortical transtemporal (TC-TT) approach, and 46 patients underwent a burrhole operation and hematoma drainage using a frameless stereotaxic device (ST). Results The average age distribution was similar. The preoperative Glasgow coma scale (GCS) was similar for the TC-TT and TS-TI groups. The pre-operative hematoma levels were higher in the TC-TT (109.4 ± 48.6 mL) and TS-TI (96.0 ± 39.0 mL) groups than in the ST group (46.5 ± 23.5 mL). The hematoma removal rate was 77% in the TC-TT group, 88% in the TS-TI group, and 34% in the ST group. The mean maintenance period of a hematoma catheter was 3.6 days in the ST group. The clinical outcome showed correlation with the preoperative neurological symptoms. Conclusion The TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.
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Affiliation(s)
- Seung Hwan Kim
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung Soo Kim
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hae Yu Kim
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sun-Il Lee
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Dreessen de Gervai P, Sboto-Frankenstein UN, Bolster RB, Thind S, Gruwel MLH, Smith SD, Tomanek B. Tractography of Meyer's Loop asymmetries. Epilepsy Res 2014; 108:872-82. [PMID: 24725809 DOI: 10.1016/j.eplepsyres.2014.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/24/2014] [Accepted: 03/16/2014] [Indexed: 11/20/2022]
Affiliation(s)
- Patricia Dreessen de Gervai
- National Research Council Institute for Biodiagnostics, Magnetic Resonance Technology, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada
| | | | - R Bruce Bolster
- National Research Council Institute for Biodiagnostics, Magnetic Resonance Technology, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada; Biopsychology Program, Department of Psychology, University of Winnipeg, 515 Portage Avenue, Winnipeg, MB R3B 2E9, Canada
| | - Sunny Thind
- National Research Council Institute for Biodiagnostics, Magnetic Resonance Technology, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada
| | - Marco L H Gruwel
- National Research Council Aquatic and Crop Resource Development, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada
| | - Stephen D Smith
- National Research Council Institute for Biodiagnostics, Magnetic Resonance Technology, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada; Biopsychology Program, Department of Psychology, University of Winnipeg, 515 Portage Avenue, Winnipeg, MB R3B 2E9, Canada
| | - Boguslaw Tomanek
- Alberta Innovates Technology Futures, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada; Multimodal and Functional Imaging Group, Central Europe Institute of Technology, Kamenice 753, Brno CZ-62500, Czech Republic
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Axer H, Klingner CM, Prescher A. Fiber anatomy of dorsal and ventral language streams. BRAIN AND LANGUAGE 2013; 127:192-204. [PMID: 22632814 DOI: 10.1016/j.bandl.2012.04.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 04/05/2012] [Accepted: 04/23/2012] [Indexed: 06/01/2023]
Abstract
Recent advances in neuroimaging have led to new insights into the organization of language related networks. Increasing evidence supports the model of dorsal and ventral streams of information flow between language-related areas. Therefore, a review of the descriptions of language-related fiber anatomy in the human and monkey brain was performed. In addition, case studies of macroscopical fiber dissection and polarized light imaging (PLI) with special focus on the ventral stream were done. Several fiber structures can be identified to play a role in language, i.e. the arcuate fasciculus as a part of the superior longitudinal fasciculus, the middle longitudinal fasciculus, the inferior fronto-occipital fasciculus, and extreme and external capsules. Substantial differences between human and monkey fiber architecture have been identified. Despite inconsistencies based on different terminologies used, there can be no doubt that dorsal and ventral language streams have a clear correlation in the structure of white matter tracts.
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Affiliation(s)
- Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
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