1
|
Groulx-Boivin E, Paquette M, Khairy M, Beltempo M, Dudley R, Ferrand A, Guillot M, Bizgu V, Garfinkle J. Spontaneous resolution of post-hemorrhagic ventricular dilatation in preterm newborns and neurodevelopment. Pediatr Res 2023; 94:1428-1435. [PMID: 37179437 DOI: 10.1038/s41390-023-02647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND We investigated the temporal evolution of post-hemorrhagic ventricular dilatation (PHVD) and compared neurodevelopmental impairments (NDI) in newborns with (Group 1) spontaneous resolution of PHVD, (Group 2) persistent PHVD without neurosurgical intervention, and (Group 3) progressive PHVD receiving neurosurgical intervention. METHODS A multicenter retrospective cohort study of newborns born at ≤34 weeks with PHVD (ventricular index [VI] >97th centile for gestational age and anterior horn width [AHW] >6 mm) from 2012 to 2020. Severe NDI was defined as global developmental delay or cerebral palsy GMFCS III-V at 18 months. RESULTS Of 88 survivors with PHVD, 39% had a spontaneous resolution, 17% had persistent PHVD without intervention, and 44% had progressive PHVD receiving intervention. The median time between PHVD diagnosis and spontaneous resolution was 14.0 days (IQR 6.8-32.3) and between PHVD diagnosis and first neurosurgical intervention was 12.0 days (IQR 7.0-22.0). Group 1 had smaller median maximal VI (1.8, 3.4, 11.1 mm above p97; p < 0.001) and AHW (7.2, 10.8, 20.3 mm; p < 0.001) than Groups 2 and 3. Neurodevelopmental outcome data were available for 82% of survivors. Group 1 had reduced severe NDI compared to Group 3 (15% vs 66%; p < 0.001). CONCLUSION Newborns with PHVD without spontaneous resolution are at higher risk for impairments despite neurosurgical interventions, which may be due to larger ventricular dilatation. IMPACT The natural evolution of post-hemorrhagic ventricular dilatation (PHVD) and developmental implications of spontaneous resolution are not well established. In this study, approximately one in three newborns with PHVD experienced spontaneous resolution and this subset of newborns had reduced rates of neurodevelopmental impairments. More prominent ventricular dilatation was associated with reduced rates of spontaneous resolution and increased rates of severe neurodevelopmental impairment among newborns with PHVD. Understanding clinically relevant time points in the evolution of PHVD and predictors of spontaneous resolution may help inform the discussion around the optimal timing for intervention and allow for more precise prognostication in this population.
Collapse
Affiliation(s)
- Emilie Groulx-Boivin
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Mariane Paquette
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - May Khairy
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Roy Dudley
- Department of Pediatric Surgery, Division of Neurosurgery, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Amaryllis Ferrand
- Division of Neonatology, Department of Pediatrics, McGill University, Jewish General Hospital, Montréal, QC, Canada
| | - Mireille Guillot
- Department of Pediatrics, Université Laval, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada
| | - Victoria Bizgu
- Division of Neonatology, Department of Pediatrics, McGill University, Jewish General Hospital, Montréal, QC, Canada
| | - Jarred Garfinkle
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada.
| |
Collapse
|
2
|
Triplett RL, Smyser CD. Neuroimaging of structural and functional connectivity in preterm infants with intraventricular hemorrhage. Semin Perinatol 2022; 46:151593. [PMID: 35410714 PMCID: PMC9910034 DOI: 10.1016/j.semperi.2022.151593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Preterm infants with intraventricular hemorrhage (IVH) are known to have some of the worst neurodevelopmental outcomes in all of neonatal medicine, with a growing body of evidence relating these outcomes to underlying disruptions in brain structure and function. This review begins by summarizing state-of-the-art neuroimaging techniques delineating structural and functional connectivity (diffusion and resting state functional MRI) and their application in infants with IVH, including unique technical challenges and emerging methods. We then review studies of altered structural and functional connectivity, highlighting the role of IVH severity and location. We subsequently detail investigations linking structural and functional findings in infancy to later outcomes in early childhood. We conclude with future directions including methodologic considerations for prospective and potentially interventional studies designed to mitigate disruptions to underlying structural and functional connections and improve neurodevelopmental outcomes in this high-risk population.
Collapse
Affiliation(s)
- Regina L Triplett
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA; Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA.
| |
Collapse
|
3
|
Pierre WC, Zhang E, Londono I, De Leener B, Lesage F, Lodygensky GA. Non-invasive in vivo MRI detects long-term microstructural brain alterations related to learning and memory impairments in a model of inflammation-induced white matter injury. Behav Brain Res 2022; 428:113884. [DOI: 10.1016/j.bbr.2022.113884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/18/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022]
|
4
|
Adam R, Ghahari D, Morton JB, Eagleson R, de Ribaupierre S. Brain Network Connectivity and Executive Function in Children with Previous Infantile Hydrocephalus. Brain Connect 2022; 12:784-798. [PMID: 35302386 DOI: 10.1089/brain.2021.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Infantile hydrocephalus is a condition in which there is an abnormal build-up of cerebrospinal fluid in the ventricles within the first few months of life, which puts pressure on surrounding brain tissues. Compression of the developing brain increases the risk of secondary brain injury and cognitive disabilities. METHODS In this study, we used diffusion-weighted imaging and resting-state functional MRI to investigate the effects of ventricle dilatation on structural and functional brain networks in children with shunted infantile hydrocephalus and examined how these brain changes may impact executive function. RESULTS We found that children with hydrocephalus have altered structural and functional connectivity between and within large-scale networks. Moreover, hyperconnectivity between the ventral attention and default mode network in children with hydrocephalus correlated with reduced executive function scores. Compared to typically developing age-matched control participants, our patient population also had lower fractional anisotropy in posterior white matter. DISCUSSION Overall, these findings suggest that infantile hydrocephalus has long-term effects on brain network connectivity, white matter development, and executive function in children at school-age. Future work will examine the relationship between ventricular volumes prior to shunt placement in infancy and brain network development throughout childhood.
Collapse
Affiliation(s)
- Ramina Adam
- University of Western Ontario, 6221, 1151 Richmond Street, London, Canada, N6A 3K7;
| | | | | | - Roy Eagleson
- University of Western Ontario, 6221, London, Canada;
| | | |
Collapse
|
5
|
Garcia-Bonilla M, Castaneyra-Ruiz L, Zwick S, Talcott M, Otun A, Isaacs AM, Morales DM, Limbrick DD, McAllister JP. Acquired hydrocephalus is associated with neuroinflammation, progenitor loss, and cellular changes in the subventricular zone and periventricular white matter. Fluids Barriers CNS 2022; 19:17. [PMID: 35193620 PMCID: PMC8864805 DOI: 10.1186/s12987-022-00313-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Hydrocephalus is a neurological disease with an incidence of 80-125 per 100,000 births in the United States. Neuropathology comprises ventriculomegaly, periventricular white matter (PVWM) alterations, inflammation, and gliosis. We hypothesized that hydrocephalus in a pig model is associated with subventricular and PVWM cellular alterations and neuroinflammation that could mimic the neuropathology described in hydrocephalic infants. METHODS Hydrocephalus was induced by intracisternal kaolin injections in 35-day old female pigs (n = 7 for tissue analysis, n = 10 for CSF analysis). Age-matched sham controls received saline injections (n = 6). After 19-40 days, MRI scanning was performed to measure the ventricular volume. Stem cell proliferation was studied in the Subventricular Zone (SVZ), and cell death and oligodendrocytes were examined in the PVWM. The neuroinflammatory reaction was studied by quantifying astrocytes and microglial cells in the PVWM, and inflammatory cytokines in the CSF. RESULTS The expansion of the ventricles was especially pronounced in the body of the lateral ventricle, where ependymal disruption occurred. PVWM showed a 44% increase in cell death and a 67% reduction of oligodendrocytes. In the SVZ, the number of proliferative cells and oligodendrocyte decreased by 75% and 57% respectively. The decrease of the SVZ area correlated significantly with ventricular volume increase. Neuroinflammation occurred in the hydrocephalic pigs with a significant increase of astrocytes and microglia in the PVWM, and high levels of inflammatory interleukins IL-6 and IL-8 in the CSF. CONCLUSION The induction of acquired hydrocephalus produced alterations in the PVWM, reduced cell proliferation in the SVZ, and neuroinflammation.
Collapse
Affiliation(s)
- Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Leandro Castaneyra-Ruiz
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Sarah Zwick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Michael Talcott
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.,Division of Comparative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Ayodamola Otun
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Alberta, T2N 2T9, Canada
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| |
Collapse
|
6
|
Isaacs AM, Neil JJ, McAllister JP, Dahiya S, Castaneyra-Ruiz L, Merisaari H, Botteron HE, Alexopoulos D, George A, Sun P, Morales DM, Shimony JS, Strahle J, Yan Y, Song SK, Limbrick DD, Smyser CD. Microstructural Periventricular White Matter Injury in Post-hemorrhagic Ventricular Dilatation. Neurology 2022; 98:e364-e375. [PMID: 34799460 PMCID: PMC8793106 DOI: 10.1212/wnl.0000000000013080] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/15/2021] [Accepted: 11/12/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The neurologic deficits of neonatal post-hemorrhagic hydrocephalus (PHH) have been linked to periventricular white matter injury. To improve understanding of PHH-related injury, diffusion basis spectrum imaging (DBSI) was applied in neonates, modeling axonal and myelin integrity, fiber density, and extrafiber pathologies. Objectives included characterizing DBSI measures in periventricular tracts, associating measures with ventricular size, and examining MRI findings in the context of postmortem white matter histology from similar cases. METHODS A prospective cohort of infants born very preterm underwent term equivalent MRI, including infants with PHH, high-grade intraventricular hemorrhage without hydrocephalus (IVH), and controls (very preterm [VPT]). DBSI metrics extracted from the corpus callosum, corticospinal tracts, and optic radiations included fiber axial diffusivity, fiber radial diffusivity, fiber fractional anisotropy, fiber fraction (fiber density), restricted fractions (cellular infiltration), and nonrestricted fractions (vasogenic edema). Measures were compared across groups and correlated with ventricular size. Corpus callosum postmortem immunohistochemistry in infants with and without PHH assessed intra- and extrafiber pathologies. RESULTS Ninety-five infants born very preterm were assessed (68 VPT, 15 IVH, 12 PHH). Infants with PHH had the most severe white matter abnormalities and there were no consistent differences in measures between IVH and VPT groups. Key tract-specific white matter injury patterns in PHH included reduced fiber fraction in the setting of axonal or myelin injury, increased cellular infiltration, vasogenic edema, and inflammation. Specifically, measures of axonal injury were highest in the corpus callosum; both axonal and myelin injury were observed in the corticospinal tracts; and axonal and myelin integrity were preserved in the setting of increased extrafiber cellular infiltration and edema in the optic radiations. Increasing ventricular size correlated with worse DBSI metrics across groups. On histology, infants with PHH had high cellularity, variable cytoplasmic vacuolation, and low synaptophysin marker intensity. DISCUSSION PHH was associated with diffuse white matter injury, including tract-specific patterns of axonal and myelin injury, fiber loss, cellular infiltration, and inflammation. Larger ventricular size was associated with greater disruption. Postmortem immunohistochemistry confirmed MRI findings. These results demonstrate DBSI provides an innovative approach extending beyond conventional diffusion MRI for investigating neuropathologic effects of PHH on neonatal brain development.
Collapse
Affiliation(s)
- Albert M Isaacs
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO.
| | - Jeffrey J Neil
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - James P McAllister
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Sonika Dahiya
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Leandro Castaneyra-Ruiz
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Harri Merisaari
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Haley E Botteron
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Dimitrios Alexopoulos
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Ajit George
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Peng Sun
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Diego M Morales
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Joshua S Shimony
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Jennifer Strahle
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Sheng-Kwei Song
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - David D Limbrick
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Christopher D Smyser
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
7
|
Largent A, De Asis-Cruz J, Kapse K, Barnett SD, Murnick J, Basu S, Andersen N, Norman S, Andescavage N, Limperopoulos C. Automatic brain segmentation in preterm infants with post-hemorrhagic hydrocephalus using 3D Bayesian U-Net. Hum Brain Mapp 2022; 43:1895-1916. [PMID: 35023255 PMCID: PMC8933325 DOI: 10.1002/hbm.25762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Post‐hemorrhagic hydrocephalus (PHH) is a severe complication of intraventricular hemorrhage (IVH) in very preterm infants. PHH monitoring and treatment decisions rely heavily on manual and subjective two‐dimensional measurements of the ventricles. Automatic and reliable three‐dimensional (3D) measurements of the ventricles may provide a more accurate assessment of PHH, and lead to improved monitoring and treatment decisions. To accurately and efficiently obtain these 3D measurements, automatic segmentation of the ventricles can be explored. However, this segmentation is challenging due to the large ventricular anatomical shape variability in preterm infants diagnosed with PHH. This study aims to (a) propose a Bayesian U‐Net method using 3D spatial concrete dropout for automatic brain segmentation (with uncertainty assessment) of preterm infants with PHH; and (b) compare the Bayesian method to three reference methods: DenseNet, U‐Net, and ensemble learning using DenseNets and U‐Nets. A total of 41 T2‐weighted MRIs from 27 preterm infants were manually segmented into lateral ventricles, external CSF, white and cortical gray matter, brainstem, and cerebellum. These segmentations were used as ground truth for model evaluation. All methods were trained and evaluated using 4‐fold cross‐validation and segmentation endpoints, with additional uncertainty endpoints for the Bayesian method. In the lateral ventricles, segmentation endpoint values for the DenseNet, U‐Net, ensemble learning, and Bayesian U‐Net methods were mean Dice score = 0.814 ± 0.213, 0.944 ± 0.041, 0.942 ± 0.042, and 0.948 ± 0.034 respectively. Uncertainty endpoint values for the Bayesian U‐Net were mean recall = 0.953 ± 0.037, mean negative predictive value = 0.998 ± 0.005, mean accuracy = 0.906 ± 0.032, and mean AUC = 0.949 ± 0.031. To conclude, the Bayesian U‐Net showed the best segmentation results across all methods and provided accurate uncertainty maps. This method may be used in clinical practice for automatic brain segmentation of preterm infants with PHH, and lead to better PHH monitoring and more informed treatment decisions.
Collapse
Affiliation(s)
- Axel Largent
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Josepheen De Asis-Cruz
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Kushal Kapse
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Scott D Barnett
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Jonathan Murnick
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Sudeepta Basu
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Nicole Andersen
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Stephanie Norman
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Nickie Andescavage
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA.,Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA.,Departments of Radiology and Pediatrics, George Washington University, Washington, District of Columbia, USA.,Neurology School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| |
Collapse
|
8
|
Pan S, Ye D, Yue Y, Yang L, Pacia CP, DeFreitas D, Esakky P, Dahiya S, Limbrick DD, Rubin JB, Chen H, Strahle JM. Leptomeningeal disease and tumor dissemination in a murine diffuse intrinsic pontine glioma model: implications for the study of the tumor-cerebrospinal fluid-ependymal microenvironment. Neurooncol Adv 2022; 4:vdac059. [PMID: 35733516 PMCID: PMC9209751 DOI: 10.1093/noajnl/vdac059] [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] [Indexed: 12/14/2022] Open
Abstract
Background Leptomeningeal disease and hydrocephalus are present in up to 30% of patients with diffuse intrinsic pontine glioma (DIPG), however there are no animal models of cerebrospinal fluid (CSF) dissemination. As the tumor-CSF-ependymal microenvironment may play an important role in tumor pathogenesis, we identified characteristics of the Nestin-tumor virus A (Nestin-Tva) genetically engineered mouse model that make it ideal to study the interaction of tumor cells with the CSF and its associated pathways with implications for the development of treatment approaches to address CSF dissemination in DIPG. Methods A Nestin-Tva model of DIPG utilizing the 3 most common DIPG genetic alterations (H3.3K27M, PDGF-B, and p53) was used for this study. All mice underwent MR imaging and a subset underwent histopathologic analysis with H&E and immunostaining. Results Tumor dissemination within the CSF pathways (ventricles, leptomeninges) from the subependyma was present in 76% (25/33) of mice, with invasion of the choroid plexus, disruption of the ciliated ependyma and regional subependymal fluid accumulation. Ventricular enlargement consistent with hydrocephalus was present in 94% (31/33). Ventricle volume correlated with region-specific transependymal CSF flow (periventricular T2 signal), localized anterior to the lateral ventricles. Conclusions This is the first study to report CSF pathway tumor dissemination associated with subependymal tumor in an animal model of DIPG and is representative of CSF dissemination seen clinically. Understanding the CSF-tumor-ependymal microenvironment has significant implications for treatment of DIPG through targeting mechanisms of tumor spread within the CSF pathways.
Collapse
Affiliation(s)
- Shelei Pan
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Dezhuang Ye
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Yimei Yue
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Lihua Yang
- Department of Pediatrics, Washington University in St. Louis, St Louis, Missouri, USA
| | - Christopher P Pacia
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Dakota DeFreitas
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Prabagaran Esakky
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Joshua B Rubin
- Department of Pediatrics, Washington University in St. Louis, St Louis, Missouri, USA
| | - Hong Chen
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| |
Collapse
|
9
|
Otun A, Morales DM, Garcia-Bonilla M, Goldberg S, Castaneyra-Ruiz L, Yan Y, Isaacs AM, Strahle JM, McAllister JP, Limbrick DD. Biochemical profile of human infant cerebrospinal fluid in intraventricular hemorrhage and post-hemorrhagic hydrocephalus of prematurity. Fluids Barriers CNS 2021; 18:62. [PMID: 34952604 PMCID: PMC8710025 DOI: 10.1186/s12987-021-00295-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have a complex pathophysiology involving inflammatory response, ventricular zone and cell–cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. Methods CSF samples were obtained from lumbar punctures of control infants and infants with IVH prior to the development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Frontal occipital horn ratio (FOR) was measured for estimating the degree of ventriculomegaly. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. Results CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p = 0.012 − < 0.0001), LGIVH (p = 0.023 − < 0.0001), and HGIVH (p = 0.015 − 0.0003), while magnesium and calcium levels were higher compared to control (p = 0.031) and LGIVH (p = 0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p = 0.0009 and 0.0006 respectively) and LGIVH (p = 0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r, p = 0.55,0.0015), potassium (r, p = 0.51,0.0041), chloride (r, p = 0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p = 0.012), total nucleated cells (p = 0.0005), and percent monocyte (p = 0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p = 0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p = 0.025 − 0.0008) in the whole cohort. Conclusions CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00295-8.
Collapse
Affiliation(s)
- Ayodamola Otun
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Seth Goldberg
- Department of Nephrology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | | | - Yan Yan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| |
Collapse
|
10
|
Riva-Cambrin J, Kulkarni AV, Burr R, Rozzelle CJ, Oakes WJ, Drake JM, Alvey JS, Reeder RW, Holubkov R, Browd SR, Cochrane DD, Limbrick DD, Naftel R, Shannon CN, Simon TD, Tamber MS, McDonald PJ, Wellons JC, Luerssen TG, Whitehead WE, Kestle JRW. Impact of ventricle size on neuropsychological outcomes in treated pediatric hydrocephalus: an HCRN prospective cohort study. J Neurosurg Pediatr 2021:1-12. [PMID: 34767531 DOI: 10.3171/2021.8.peds21146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In pediatric hydrocephalus, shunts tend to result in smaller postoperative ventricles compared with those following an endoscopic third ventriculostomy (ETV). The impact of the final treated ventricle size on neuropsychological and quality-of-life outcomes is currently undetermined. Therefore, the authors sought to ascertain whether treated ventricle size is associated with neurocognitive and academic outcomes postoperatively. METHODS This prospective cohort study included children aged 5 years and older at the first diagnosis of hydrocephalus at 8 Hydrocephalus Clinical Research Network sites from 2011 to 2015. The treated ventricle size, as measured by the frontal and occipital horn ratio (FOR), was compared with 25 neuropsychological tests 6 months postoperatively after adjusting for age, hydrocephalus etiology, and treatment type (ETV vs shunt). Pre- and posttreatment grade point average (GPA), quality-of-life measures (Hydrocephalus Outcome Questionnaire [HOQ]), and a truncated preoperative neuropsychological battery were also compared with the FOR. RESULTS Overall, 60 children were included with a mean age of 10.8 years; 17% had ≥ 1 comorbidity. Etiologies for hydrocephalus were midbrain lesions (37%), aqueductal stenosis (22%), posterior fossa tumors (13%), and supratentorial tumors (12%). ETV (78%) was more commonly used than shunting (22%). Of the 25 neuropsychological tests, including full-scale IQ (q = 0.77), 23 tests showed no univariable association with postoperative ventricle size. Verbal learning delayed recall (p = 0.006, q = 0.118) and visual spatial judgment (p = 0.006, q = 0.118) were negatively associated with larger ventricles and remained significant after multivariate adjustment for age, etiology, and procedure type. However, neither delayed verbal learning (p = 0.40) nor visual spatial judgment (p = 0.22) was associated with ventricle size change with surgery. No associations were found between postoperative ventricle size and either GPA or the HOQ. CONCLUSIONS Minimal associations were found between the treated ventricle size and neuropsychological, academic, or quality-of-life outcomes for pediatric patients in this comprehensive, multicenter study that encompassed heterogeneous hydrocephalus etiologies.
Collapse
Affiliation(s)
- Jay Riva-Cambrin
- 1Department of Clinical Neurosciences, Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Abhaya V Kulkarni
- 2Department of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Robert Burr
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Curtis J Rozzelle
- 3Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama
| | - W Jerry Oakes
- 3Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama
| | - James M Drake
- 2Department of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Jessica S Alvey
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Ron W Reeder
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Richard Holubkov
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Samuel R Browd
- 5Department of Neurological Surgery, Seattle Children's Hospital, Seattle, Washington
| | - D Douglas Cochrane
- 6Division of Pediatric Neurosurgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - David D Limbrick
- 7Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri
| | - Robert Naftel
- 8Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis N Shannon
- 8Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tamara D Simon
- 9Department of Pediatrics, University of Southern California, Los Angeles, California; and
| | - Mandeep S Tamber
- 6Division of Pediatric Neurosurgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Patrick J McDonald
- 6Division of Pediatric Neurosurgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - John C Wellons
- 8Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas G Luerssen
- 10Department of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | - William E Whitehead
- 10Department of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | - John R W Kestle
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| |
Collapse
|
11
|
Leijser LM, Scott JN, Roychoudhury S, Zein H, Murthy P, Thomas SP, Mohammad K. Post-hemorrhagic ventricular dilatation: inter-observer reliability of ventricular size measurements in extremely preterm infants. Pediatr Res 2021; 90:403-410. [PMID: 33184496 DOI: 10.1038/s41390-020-01245-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Post-hemorrhagic ventricular dilatation (PHVD) in preterm infants can be assessed with ventricular size indices from cranial ultrasound. We explored inter-observer reliability of these indices for prediction of severe PHVD. METHODS For all 139 infants with IVH, serial neonatal ultrasound at 3 time points (days 4-7, day 14, 36 weeks PMA) were assessed independently by 3 observers with differing levels of training/experience. Ventricular index (VI), anterior horn width (AHW), and fronto-temporal horn ratio (FTHR) were measured and used to diagnose PHVD. For all, inter-observer reliability and predictive values for receipt of surgical intervention were calculated. RESULTS Inter-observer reliability for all observers varied from poor to excellent, with higher reliability for VI/AHW (ICC 0.49-0.84/0.51-0.81) than FTHR (0.41-0.82), particularly from the second week. Good-excellent inter-expertise reliability was found between observers with ample experience/training (0.65-0.99), particularly for VI and AHW, while poor-moderate when comparing with an inexperienced observer (0.28-0.88). Slightly higher predictive value for PHVD intervention (n = 12) was found for AHW (AUC 0.86-0.96) than for VI and FTHR (0.80-0.96/0.80-0.95). CONCLUSIONS AHW and VI are highly reproducible in experienced hands compared to FTHR, with AHW from the second week onwards being the strongest predictor for receiving surgical intervention for severe PHVD. AHW may aid in early PHVD diagnosis and decision-making on intervention. IMPACT While ventricular size indices from serial cUS are superior to clinical signs of increased intracranial pressure to assess PHVD, questions remained on their inter-observer reproducibility and reliability to predict severity of PHVD. AHW and VI are highly reproducible when performed by experienced clinicians. AHW from the second week of birth is the strongest predictor of PHVD onset and severity. AHW, combined with VI, may aid in early PHVD diagnosis and decision-making on need for surgical intervention. Consistent use of these indices has the potential to improve PHVD management and therewith the long-term outcomes in preterm infants.
Collapse
Affiliation(s)
- Lara M Leijser
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
| | - James N Scott
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Smita Roychoudhury
- Department of Pediatrics, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Hussein Zein
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Prashanth Murthy
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Sumesh P Thomas
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Khorshid Mohammad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | | |
Collapse
|
12
|
Dunn JF, Isaacs AM. The impact of hypoxia on blood-brain, blood-CSF, and CSF-brain barriers. J Appl Physiol (1985) 2021; 131:977-985. [PMID: 34264124 DOI: 10.1152/japplphysiol.00108.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The blood-brain barrier (BBB), blood-cerebrospinal fluid (CSF) barrier (BCSFB), and CSF-brain barriers (CSFBB) are highly regulated barriers in the central nervous system comprising complex multicellular structures that separate nerves and glia from blood and CSF, respectively. Barrier damage has been implicated in the pathophysiology of diverse hypoxia-related neurological conditions, including stroke, multiple sclerosis, hydrocephalus, and high-altitude cerebral edema. Much is known about the damage to the BBB in response to hypoxia, but much less is known about the BCSFB and CSFBB. Yet, it is known that these other barriers are implicated in damage after hypoxia or inflammation. In the 1950s, it was shown that the rate of radionucleated human serum albumin passage from plasma to CSF was five times higher during hypoxic than normoxic conditions in dogs, due to BCSFB disruption. Severe hypoxia due to administration of the bacterial toxin lipopolysaccharide is associated with disruption of the CSFBB. This review discusses the anatomy of the BBB, BCSFB, and CSFBB and the impact of hypoxia and associated inflammation on the regulation of those barriers.
Collapse
Affiliation(s)
- Jeff F Dunn
- Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Albert M Isaacs
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
13
|
El-Dib M, Limbrick DD, Inder T, Whitelaw A, Kulkarni AV, Warf B, Volpe JJ, de Vries LS. Management of Post-hemorrhagic Ventricular Dilatation in the Infant Born Preterm. J Pediatr 2020; 226:16-27.e3. [PMID: 32739263 PMCID: PMC8297821 DOI: 10.1016/j.jpeds.2020.07.079] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Mohamed El-Dib
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - David D Limbrick
- Department of Neurological Surgery, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO
| | - Terrie Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew Whitelaw
- Neonatal Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Abhaya V Kulkarni
- Department of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Warf
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Joseph J Volpe
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, the Netherlands; University Medical Center Utrecht, Utrecht Brain Center, the Netherlands
| |
Collapse
|
14
|
Isaacs AM, Han RH, Smyser CD, Limbrick DD, Shimony JS. Semi-automated segmentation of the lateral periventricular regions using diffusion magnetic resonance imaging. MethodsX 2020; 7:101023. [PMID: 32983918 PMCID: PMC7492999 DOI: 10.1016/j.mex.2020.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/04/2020] [Indexed: 12/02/2022] Open
Abstract
The lateral ventricular perimeter (LVP) of the brain is a critical region because in addition to housing neural stem cells required for brain development, it facilitates cerebrospinal fluid (CSF) bulk flow and functions as a blood-CSF barrier to protect periventricular white matter (PVWM) and other adjacent regions from injurious toxins. LVP injury is common, particularly among preterm infants who sustain intraventricular hemorrhage or post hemorrhagic hydrocephalus and has been associated with poor neurological outcomes. Assessment of the LVP with diffusion MRI has been challenging, primarily due to issues with partial volume artifacts since the LVP region is in close proximity to CSF and other structures of varying signal intensities that may be inadvertently included in LVP segmentation. This research method presents:•A novel MATLAB-based method to segment a homogenous LVP layer using high spatial resolution parameters (voxel size 1.2 × 1.2 × 1.2 mm3) to only capture the innermost layer of the LVP.•The segmented LVP is averaged from three contiguous axial slices to increase signal to noise ratio and reduce the effect of any residual volume averaging effect and eliminates manual and inter/intrarater-related errors.
Collapse
Affiliation(s)
- Albert M. Isaacs
- Department of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Rowland H. Han
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D. Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - David D. Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
15
|
Gano D, Cowan FM, de Vries LS. Cerebral palsy after very preterm birth - an imaging perspective. Semin Fetal Neonatal Med 2020; 25:101106. [PMID: 32317152 DOI: 10.1016/j.siny.2020.101106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neonatal brain imaging undoubtedly can provide the most accurate information from which to determine whether cerebral palsy is likely to affect an individual infant born preterm. The sensitivity and specificity of that information is different between cranial ultrasound and MRI, depending on what approaches and sequences are used and the timing of the examinations. In this chapter we highlight the changing incidence of different patterns of brain injury in the preterm newborn and present a comparison of cranial ultrasound and MRI for predicting cerebral palsy in preterm infants affected by the commoner intracranial pathologies.
Collapse
Affiliation(s)
- Dawn Gano
- Department of Neurology, University of California, San Francisco, CA, United States
| | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
| |
Collapse
|
16
|
Keep RF, Jones HC, Drewes LR. This was the year that was: brain barriers and brain fluid research in 2019. Fluids Barriers CNS 2020; 17:20. [PMID: 32138786 PMCID: PMC7059280 DOI: 10.1186/s12987-020-00181-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This editorial highlights advances in brain barrier and brain fluid research published in 2019, as well as addressing current controversies and pressing needs. Topics include recent advances related to: the cerebral endothelium and the neurovascular unit; the choroid plexus, arachnoid membrane; cerebrospinal fluid and the glymphatic hypothesis; the impact of disease states on brain barriers and brain fluids; drug delivery to the brain; and translation of preclinical data to the clinic. This editorial also mourns the loss of two important figures in the field, Malcolm B. Segal and Edward G. Stopa.
Collapse
Affiliation(s)
- Richard F. Keep
- Department of Neurosurgery, University of Michigan, R5018 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI 48109-2200 USA
| | | | - Lester R. Drewes
- Department of Biomedical Sciences, University of Minnesota Medical School Duluth, Duluth, MN 55812 USA
| |
Collapse
|