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Guenette JP, Qin L. Time-Saving 3D MR Imaging Protocols with Millimeter and Submillimeter Isotropic Spatial Resolution for Face and Neck Imaging as Implemented at a Single-Site Major Referral Center. AJNR Am J Neuroradiol 2024; 45:737-742. [PMID: 38296468 PMCID: PMC11288581 DOI: 10.3174/ajnr.a8184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/26/2024] [Indexed: 04/04/2024]
Abstract
MR imaging has become the routine technique for staging nasopharyngeal carcinoma, evaluating perineural tumor spread, and detecting cartilage invasion in laryngeal carcinoma. However, these protocols traditionally require in the range of 25 to 35 minutes of acquisition time. 3D sequences offer the potential advantage of time savings through the acquisition of 1-mm or submillimeter resolution isotropic data followed by multiplanar reformats that require no further imaging time. We have iteratively optimized vendor product 3D T1-weighted MR imaging sequences for morphologic face and neck imaging, reducing the average acquisition time of our 3T protocols by 9 minutes 57 seconds (40.9%) and of our 1.5T protocols by 9 minutes 5 seconds (37.0%), while simultaneously maintaining or improving spatial resolution. This clinical report describes our experience optimizing and implementing commercially available 3D T1-weighted MR imaging pulse sequence protocols for clinical face and neck MR imaging examinations using illustrative cases. We provide protocol details to allow others to replicate our implementations, and we report challenges we faced along with our solutions.
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Affiliation(s)
- Jeffrey P Guenette
- From the Division of Neuroradiology (J.P.G.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lei Qin
- Department of Imaging (L.Q.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Detailed imaging of abducens nerve anatomy using contrast-enhanced 3D-TOF MR angiography. Clin Imaging 2021; 79:330-336. [PMID: 34399289 DOI: 10.1016/j.clinimag.2021.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Cranial nerves (CNs), particularly CN IV and VI are difficult to visualize with conventional MRI techniques, particularly within the cavernous sinus region. The aim of this study was to evaluate the capacity of high-resolution contrast enhanced 3D time-of-flight (TOF) MR angiography using new generation 3 T imaging technology to provide detailed visualization of CN VI anatomy, particularly within the cavernous sinus and petroclival regions. METHODS Two neuroradiologists conducted bilateral evaluation of CN VI visibility in 23 patients for nerve segments located in the petroclival segment (dural cave and Dorello's canal), and three divisions of the cavernous sinus. All images were collected using contrast enhanced TOF MR angiography using a new generation 3 T machine. RESULTS Of the CN VI segments assessed, average visibility of CN VI was best achieved in Dorello's canal. Overall visibility of CN VI within the regions inspected was best achieved in the axial view, with the exception of the dural cave, which was best assessed using the coronal view. We also identified strong agreement in assessment of nerve visibility between the two reviewers. We also identified a putative CN6 duplication and a small schwannoma, highlighting the fidelity of our approach. CONCLUSION Contrast enhanced 3D TOF MR angiography can visualize CN VI anatomy, particularly within the petrocavernosal region and cavernous sinus with simultaneous visualization of arterial and venous structures. This cannot be easily achieved using traditional MRI techniques. This imaging technique might be used with new generation machines to evaluate CN VI anatomy and pathologies within the petrocavernosal region and cavernous sinus, especially relating to vascular pathologies.
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Ipsalali HO, Ciftci AC, Kilic D, Sendemir G, Seyhan S, Kaya I, Ortug G. Variations of the 6 th cranial nerve (nervus abducens) in the petroclival region: A microsurgical study. Morphologie 2019; 103:103-109. [PMID: 30713002 DOI: 10.1016/j.morpho.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 11/28/2022]
Abstract
The aim of this study is to present the variations of nervus abducens in localization and number as it pierces the clival dura mater. The calvaria of 16 cadaveric heads were removed by making horizontal incisions from Glabella to Inion in both sides of the head. The dura mater was dissected. Cerebrum and cerebellum were taken out by obtuse dissection. Dissections of cavernous sinus were made under the stereomicroscope and the findings were photographed. Out of 16 specimens, one of them was excluded. Fifteen heads were bilaterally analyzed. Analysis of these nerves presented four different variations. Variation types a classified CN VI as a single trunk and entering a single dural pore with 77% occurrence. Variation type b classified CN VI with two branches running in the petroclival region and entering a single dural pore with 10% occurrence. Variation type c classified CN VI as 2 trunks and entering 2 separate but close dural pores with 10% occurrence. Variation type d classified CN VI with 2 distinct trunks and 2 branches entering 2 separate but close dural pores with 3% occurrence. CN VI plays a major role in the clinic of the eye. Due to its intracranial and extracranial course, injuries to the head and to the nerve may result in malfunctioning of the lateral muscles of the eye. Therefore, the variations of branching, relations and its course were analyzed.
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Affiliation(s)
- H O Ipsalali
- School of Medicine, Bahcesehir University Istanbul, Turkey
| | - A C Ciftci
- School of Medicine, Bahcesehir University Istanbul, Turkey
| | - D Kilic
- School of Medicine, Bahcesehir University Istanbul, Turkey
| | - G Sendemir
- School of Medicine, Bahcesehir University Istanbul, Turkey
| | - S Seyhan
- School of Medicine, Bahcesehir University Istanbul, Turkey
| | - I Kaya
- School of Medicine, Bahcesehir University Istanbul, Turkey
| | - G Ortug
- Department of Anatomy-Chair, School of Medicine, Bahcesehir University, Istanbul, Turkey.
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Adachi K, Hasegawa M, Tateyama S, Kawazoe Y, Hirose Y. Surgical Strategy for and Anatomic Locations of Petroapex and Petroclival Meningiomas Based on Evaluation of the Feeding Artery. World Neurosurg 2018; 116:e611-e623. [DOI: 10.1016/j.wneu.2018.05.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
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Wang JMH, Edwards BA, Loukas M, Oskouian RJ, Tubbs RS. Supernumerary Abducens Nerves: A Comprehensive Review. World Neurosurg 2017; 112:39-45. [PMID: 29158094 DOI: 10.1016/j.wneu.2017.11.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Branching and/or replication of the abducens nerve is not an uncommon occurrence. Although numerous variations have been documented, the rarest forms are duplicated or triplicated nerves, where multiple nerve roots originate from the brainstem, travel intracranially, and attach to the lateral rectus as separate entities. METHODS We conducted a systematic literature search on the topic of supernumerary abducens nerve, using PubMed and Google Scholar. RESULTS After screening, 16 studies were included: 11 cadaveric studies and 6 case reports. CONCLUSIONS In this paper, we review the literature on variations found, discuss current hypotheses and clinical relevance, and propose future studies. Neurosurgeons should be aware of such nerve variants when viewing imaging or operating in the regions traversed by the abducens nerve.
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Affiliation(s)
- Joy M H Wang
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies.
| | - Bryan Adam Edwards
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
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Preoperative simulation of the running course of the abducens nerve in a large petroclival meningioma: a case report and literature review. Neurosurg Rev 2017; 40:339-343. [DOI: 10.1007/s10143-017-0816-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/21/2016] [Accepted: 01/18/2017] [Indexed: 12/22/2022]
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Yamasaki F, Akiyama Y, Tsumura R, Kolakshyapati M, Adhikari RB, Takayasu T, Nosaka R, Kurisu K. Post-traumatic Unilateral Avulsion of the Abducens Nerve with Damage to Cranial Nerves VII and VIII: Case Report. NMC Case Rep J 2016; 3:81-83. [PMID: 28664004 PMCID: PMC5386172 DOI: 10.2176/nmccrj.cr.2015-0272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/22/2016] [Indexed: 11/20/2022] Open
Abstract
Traumatic injuries of the abducens nerve as a consequence of facial and/or head trauma occur with or without associated cervical or skull base fracture. This is the first report on unilateral avulsion of the abducens nerve in a 29-year-old man with severe right facial trauma. In addition, he exhibited mild left facial palsy, and moderate left hearing disturbance. Magnetic resonance imaging (MRI) using fast imaging employing steady-state acquisition (FIESTA) revealed avulsion of left sixth cranial nerve. We recommend thin-slice MR examination in patients with abducens palsy after severe facial and/or head trauma.
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Affiliation(s)
- Fumiyuki Yamasaki
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Akiyama
- Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Ryu Tsumura
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.,Department of Emergency and Critical Care Medicine, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Manish Kolakshyapati
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Rupendra Bahadur Adhikari
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Ryo Nosaka
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Özgür A, Esen K, Kara E, Temel GO. Visualization of the Abducens Nerve in its Petroclival Segment Using Contrast-Enhanced FIESTA MRI: The Size of the Petroclival Venous Confluence Affects Detectability. Clin Neuroradiol 2015; 27:97-103. [DOI: 10.1007/s00062-015-0415-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/15/2015] [Indexed: 11/30/2022]
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Sectional anatomy of the abducens nerve: according to 3D-SPACE magnetic resonance sequences correlated with cryosectional specimens. Surg Radiol Anat 2015; 37:921-9. [DOI: 10.1007/s00276-015-1452-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
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High-Resolution CISS MR Imaging With and Without Contrast for Evaluation of the Upper Cranial Nerves. Neuroimaging Clin N Am 2014; 24:17-34. [DOI: 10.1016/j.nic.2013.03.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bae YJ, Kim JH, Choi BS, Jung C, Kim E. Brainstem pathways for horizontal eye movement: pathologic correlation with MR imaging. Radiographics 2013; 33:47-59. [PMID: 23322826 DOI: 10.1148/rg.331125033] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Horizontal eye movements are conducted by the medial rectus and the lateral rectus muscles, which are innervated by the oculomotor nerve (cranial nerve III) and the abducens nerve (cranial nerve VI), respectively. The oculomotor and the abducens nuclei are interconnected by a tract in the brainstem named the medial longitudinal fasciculus (MLF). Through the MLF, the actions of the oculomotor and the abducens nuclei are coordinated, generating conjugate horizontal eye movements. The disorders of horizontal eye movement that are caused by brainstem lesions are classified into three groups: (a) lateral gaze palsy, (b) internuclear ophthalmoplegia, and (c) one-and-a-half syndrome. Lateral gaze palsy is caused by a lesion involving the paramedian pontine reticular formation (PPRF) or the abducens nucleus. Internuclear ophthalmoplegia occurs as a result of a lesion involving the MLF. One-and-a-half syndrome is a combination of lateral gaze palsy and internuclear ophthalmoplegia and is caused by a lesion involving both (a) the ipsilateral PPRF or the ipsilateral abducens nucleus and (b) the ipsilateral MLF. The pathologic lesions depicted on magnetic resonance images were topographically well correlated with the brainstem pathways and each type of horizontal eye movement disorder. Most of the lesions were tiny acute infarctions and were found in the most posterior region of the pons, which corresponded to the location of the brainstem pathways. Therefore, awareness of the brainstem pathways controlling horizontal eye movement is important to avoid missing a small pontine lesion.
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Affiliation(s)
- Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Korea
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3D T2-weighted turbo spin-echo MR sequence for identifying cerebrospinal fluid leak after endoscopic endonasal pituitary surgery. Acta Neurochir (Wien) 2012; 154:1499-503. [PMID: 22669202 DOI: 10.1007/s00701-012-1404-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/21/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to assess the efficacy of MR images with 3D T2-weighted turbo spin-echo (3D T2-TSE) sequences for early identification of postoperative cerebrospinal fluid (CSF) leaks. METHODS We analyzed the medical records and radiological reports for 72 consecutive patients who underwent an endoscopic endonasal approach for sellar and parasellar lesions between April 2009 and December 2010. Patients were 38 men and 34 women with a mean age of 46.4 years. All underwent MR scanning within 2 postoperative days, which included 3D T2-TSE sequences as well as a conventional T2-weighted (T2W) protocol. Sequence accuracy in predicting postoperative CSF leaks was assessed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS A postoperative CSF leak was confirmed in 6 of 72 patients (8.3 %). On immediate postoperative MR images, 39 patients were suspicious for CSF leaks on conventional T2W sequences, while 18 patients on 3D T2-TSE. The 3D T2-TSE imaging had superior specificity and PPV (50 % vs. 81.8 %, 15.4 % vs. 33.3 %), while there was no difference in sensitivity and NPV compared with conventional T2W sequences. CONCLUSION Compared to the conventional T2W protocol, MR imaging with the 3D T2-TSE protocol provides differential images around the sellar area with improved specificity and PPV for the detection of postoperative CSF leaks.
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Joo W, Yoshioka F, Funaki T, Rhoton AL. Microsurgical anatomy of the abducens nerve. Clin Anat 2012; 25:1030-42. [DOI: 10.1002/ca.22047] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/08/2012] [Accepted: 01/23/2012] [Indexed: 11/11/2022]
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Hermier M, Leal P, Salaris S, Froment JC, Sindou M. Imagerie anatomique des nerfs crâniens. Neurochirurgie 2009; 55:162-73. [DOI: 10.1016/j.neuchi.2009.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 01/16/2009] [Indexed: 11/17/2022]
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A comparative study of thin-layer cross-sectional anatomic morphology and CT images of the basal cistern and its application in acute craniocerebral traumas. Surg Radiol Anat 2008; 31:129-38. [DOI: 10.1007/s00276-008-0417-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
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Casselman J, Mermuys K, Delanote J, Ghekiere J, Coenegrachts K. MRI of the Cranial Nerves—More than Meets the Eye: Technical Considerations and Advanced Anatomy. Neuroimaging Clin N Am 2008; 18:197-231, preceding x. [PMID: 18466829 DOI: 10.1016/j.nic.2008.02.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim JH, Hwang JM. Normal abduction in a patient with duplicated abducens nerve. KOREAN JOURNAL OF OPHTHALMOLOGY 2006; 19:305-6. [PMID: 16491823 DOI: 10.3341/kjo.2005.19.4.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To our knowledge, there has been no report of ophthalmologic findings related with a duplicated abducens nerve in the ophthalmic literature. This study reports such findings. METHODS An ophthalmologic examination was performed in one patient with a duplicated abducens nerve, revealed with thin-sectioned magnetic resonance imaging (MRI) across the brainstem level. RESULTS The MRI disclosed a duplicated left abducens nerve. The patient was orthotropic in five cardinal positions, and her ductions and versions were full. CONCLUSIONS One patient with a duplicated abducens nerve showed orthotropia and normal ocular movement.
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Affiliation(s)
- Jae Hyoung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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