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Funaki T, Miyamoto S. Moyamoya Periventricular Choroidal Collateral Registry-A Multicenter Cohort Study of Moyamoya Disease with Choroidal Anastomosis: Study Protocol. Neurol Med Chir (Tokyo) 2024; 64:376-381. [PMID: 39245576 DOI: 10.2176/jns-nmc.2024-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Recent cohort studies on hemorrhagic and asymptomatic moyamoya disease have revealed that choroidal anastomosis, a type of fragile periventricular collateral pathway (periventricular anastomosis) typical of the disease, is an independent predictor of hemorrhagic stroke. However, treatment strategies for less-symptomatic nonhemorrhagic patients with choroidal anastomosis remain unclear. The Moyamoya Periventricular Choroidal Collateral (P-ChoC) Registry is an ongoing multicentered observational study that will test the hypothesis that extracranial-intracranial bypass prevents de novo hemorrhagic stroke in less symptomatic, nonhemorrhagic patients with choroidal anastomosis and may thus contribute to improving the prognosis of moyamoya disease. In this study, we report the study protocol of the moyamoya P-ChoC Registry and review the literature on choroidal anastomosis as a fragile collateral pathway.
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Affiliation(s)
- Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Susumu Miyamoto
- Moyamoya Disease Support Center, Kyoto University Hospital
- Stroke Support Center, Kyoto University Hospital
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2
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Djulejić V, Georgievski Brkić B, Marinković S, Blagojević V, Boljanović J. Microsurgical Anatomy of the Lateral Posterior Choroidal Artery and Its Thalamic Branches. World Neurosurg 2024:S1878-8750(24)01622-X. [PMID: 39305987 DOI: 10.1016/j.wneu.2024.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/12/2024] [Accepted: 09/13/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Only a few articles have been published about the lateral posterior choroidal artery (LPChA), and yet none of them contains data regarding the thalamic branches. METHODS The LPChA and its twigs of the 26 cerebral hemispheres were injected with a mixture of a 10% Indian ink and gelatin. Following fixation in a 10% formaldehyde solution, the vessels were micro dissected under the stereoscopic microscope. In addition, serial cerebral angiograms of the 168 patients were examined. RESULTS The LPChA, which was commonly singular or double and averaged 0.68 mm in diameter, most often originated from the P2 and P3 segments (76%) of the posterior cerebral artery (PCA). It always gave off the choroidal, pulvinar and typical thalamic branches, occasionally the parahippocampal (4%), hippocampal (8%), peduncular (8%), tegmental (12%), pretectal (4%), lateral geniculate (40%) and medial geniculate twigs (16%), and the forniceal, subependymal (100%), stria terminalis (32%), and caudate twigs (28%). The pulvinar and thalamic branches averaged almost 4 in number and 0.27 mm in diameter. They most often supplied the pulvinar nuclei, and occasionally portions of the mediodorsal, lateral dorsal, lateral posterior, ventral lateral, and the ventral posterior thalamic nuclei. Among the 168 serial cerebral angiograms, one presented the arteriovenous malformation of the LPChA, but no one showed an aneurysm. CONCLUSIONS This is the first description of the LPChA thalamic branches to date. Their microanatomic features are important for understanding the neurologic symptoms following vessels occlusion, for precise radiologic diagnoses, and for safe neurosurgical and endovascular interventions.
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Affiliation(s)
- Vuk Djulejić
- Faculty of Medicine, University of Belgrade, Institute of Anatomy, Belgrade, Serbia
| | - Biljana Georgievski Brkić
- Faculty of Medicine, and Sveti Sava Hospital, Department of Radiology, University of Kragujevac, Belgrade, Serbia
| | - Slobodan Marinković
- Faculty of Medicine, University of Belgrade, Institute of Anatomy, Belgrade, Serbia.
| | - Valentina Blagojević
- Faculty of Medicine, University of Belgrade, Institute of Anatomy, Belgrade, Serbia
| | - Jelena Boljanović
- Faculty of Medicine, University of Belgrade, Institute of Anatomy, Belgrade, Serbia
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3
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Smirnov M, Destrieux C, Maldonado IL. Cerebral white matter vasculature: still uncharted? Brain 2021; 144:3561-3575. [PMID: 34718425 DOI: 10.1093/brain/awab273] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/17/2021] [Accepted: 07/11/2021] [Indexed: 11/14/2022] Open
Abstract
White matter vasculature plays a major role in the pathophysiology of permanent neurological deficits following a stroke or progressive cognitive alteration related to small vessel disease. Thus, knowledge of the complex vascularization and functional aspects of the deep white matter territories is paramount to comprehend clinical manifestations of brain ischemia. This review provides a structured presentation of the existing knowledge of the vascularization of the human cerebral white matter from seminal historical studies to the current literature. First, we revisit the highlights of prenatal development of the endoparenchymal telencephalic vascular system that are crucial for the understanding of vessel organization in the adult. Second, we reveal the tangled history of debates on the existence, clinical significance, and physiological role of leptomeningeal anastomoses. Then, we present how conceptions on white matter vascularization transitioned from the mixed ventriculopetal/ventriculofugal theory, in which a low-flow area was interposed in between concurrent arterial flows, to the purely ventriculopetal theory. The latter model explains variable white matter sensitivity to ischemia by various organizations of ventriculopetal vessel terminals having different origin/length properties and interconnection patterns. Next, arteries supplying primarily the white matter are described according to their length and overall structure. Furthermore, the known distribution territories, to date, are studied in relation to primary anatomical structures of the human cerebral white matter, emphasizing the sparsity of the "ground-truth" data available in the literature. Finally, the implications for both large vessel occlusion and chronic small vessel disease are discussed, as well as the insights from neuroimaging. All things considered, we identify the need for further research on deep white matter vascularization, especially regarding the arterial supply of white matter fiber tracts.
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Affiliation(s)
- Mykyta Smirnov
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
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Perin P, Rossetti R, Ricci C, Cossellu D, Lazzarini S, Bethge P, Voigt FF, Helmchen F, Batti L, Gantar I, Pizzala R. 3D Reconstruction of the Clarified Rat Hindbrain Choroid Plexus. Front Cell Dev Biol 2021; 9:692617. [PMID: 34395426 PMCID: PMC8359725 DOI: 10.3389/fcell.2021.692617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
The choroid plexus (CP) acts as a regulated gate between blood and cerebrospinal fluid (CSF). Despite its simple histology (a monostratified cuboidal epithelium overlying a vascularized stroma), this organ has remarkably complex functions several of which involve local interaction with cells located around ventricle walls. Our knowledge of CP structural organization is mainly derived from resin casts, which capture the overall features but only allow reconstruction of the vascular pattern surface, unrelated to the overlying epithelium and only loosely related to ventricular location. Recently, CP single cell atlases are starting to emerge, providing insight on local heterogeneities and interactions. So far, however, few studies have described CP spatial organization at the mesoscale level, because of its fragile nature and deep location within the brain. Here, using an iDISCO-based clearing approach and light-sheet microscopy, we have reconstructed the normal rat hindbrain CP (hCP) macro- and microstructure, using markers for epithelium, arteries, microvasculature, and macrophages, and noted its association with 4th ventricle-related neurovascular structures. The hCP is organized in domains associated to a main vessel (fronds) which carry a variable number of villi; the latter are enclosed by epithelium and may be flat (leaf-like) or rolled up to variable extent. Arteries feeding the hCP emerge from the cerebellar surface, and branch into straight arterioles terminating as small capillary anastomotic networks, which run within a single villus and terminate attaching multiple times to a large tortuous capillary (LTC) which ends into a vein. Venous outflow mostly follows arterial pathways, except for the lateral horizontal segment (LHS) and the caudal sagittal segment. The structure of fronds and villi is related to the microvascular pattern at the hCP surface: when LTCs predominate, leaflike villi are more evident and bulge from the surface; different, corkscrew-like villi are observed in association to arterioles reaching close to the CP surface with spiraling capillaries surrounding them. Both leaf-like and corkscrew-like villi may reach the 4th ventricle floor, making contact points at their tip, where no gap is seen between CP epithelium and ependyma. Contacts usually involve several adjacent villi and may harbor epiplexus macrophages. At the junction between medial (MHS) and lateral (LHS) horizontal segment, arterial supply is connected to the temporal bone subarcuate fossa, and venous outflow drains to a ventral vein which exits through the cochlear nuclei at the Luschka foramen. These vascular connections stabilize the hCP overall structure within the 4th ventricle but make MHS-LHS joint particularly fragile and very easily damaged when removing the brain from the skull. Even in damaged samples, however, CP fronds (or isolated villi) often remain strongly attached to the dorsal cochlear nucleus (DCN) surface; in these fronds, contacts are still present and connecting “bridges” may be seen, suggesting the presence of real molecular contacts rather than mere appositions.
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Affiliation(s)
- Paola Perin
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Carolina Ricci
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Daniele Cossellu
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Simone Lazzarini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Philipp Bethge
- Brain Research Institute, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, Zurich, Switzerland
| | - Fabian F Voigt
- Brain Research Institute, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, Zurich, Switzerland
| | - Fritjof Helmchen
- Brain Research Institute, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, Zurich, Switzerland
| | - Laura Batti
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Ivana Gantar
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Roberto Pizzala
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Tsutsumi S, Ono H, Ishii H. Subependymal hyperintense layer on CISS sequence: An MRI study. Childs Nerv Syst 2021; 37:147-152. [PMID: 32504169 DOI: 10.1007/s00381-020-04707-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study aimed to explore the subependymal layers overlying the cerebral ventricles using magnetic resonance imaging. METHODS A total of 69 outpatients underwent constructive interference in steady-state (CISS) sequence in thin-sliced, coronal, and sagittal sections. RESULTS The subependymal layers were delineated as linear hyperintensities, coursing along the outer margins of the ventricular walls. On coronal images, the hyperintensities surrounding the anterior horn of the lateral ventricle were identified in 97% of patients, while those of the third ventricle were identified in 96% of patients. In the trigone and posterior horn of the lateral ventricle, the hyperintensities were delineated in all patients. On sagittal images, subependymal hyperintensities were identified in all. At the level of the anterior horn and third ventricle, the subependymal hyperintensities were found to communicate with the Virchow-Robin spaces (VRSs) in 68% and 65% of patients, respectively. At the level of the trigone and posterior horn of the lateral ventricle, the VRSs communicated with the subependymal hyperintensities in 83% of patients. CONCLUSIONS Subependymal hyperintensity may represent an inflow passage of the VRSs that jointly contribute to efficient transependymal migration of the interstitial fluid into the ventricular cerebrospinal fluid.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hideo Ono
- Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Wang J, Yang Y, Li X, Zhou F, Wu Z, Liang Q, Liu Y, Wang Y, Na S, Chen X, Zhang X, Zhang B. Lateral Posterior Choroidal Collateral Anastomosis Predicts Recurrent Ipsilateral Hemorrhage in Adult Patients with Moyamoya Disease. AJNR Am J Neuroradiol 2019; 40:1665-1671. [PMID: 31537520 DOI: 10.3174/ajnr.a6208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/29/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Choroidal collateral anastomosis is associated with hemorrhage recurrence in patients with Moyamoya disease. However, the relationship between recurrent ipsilateral hemorrhage and choroidal collateral anastomosis subtypes (anterior choroidal artery anastomosis, lateral posterior choroidal artery anastomosis, and medial posterior choroidal artery anastomosis) is unclear. This study aimed to assess this potential association in adult patients with Moyamoya disease. MATERIALS AND METHODS Patients angiographically diagnosed with Moyamoya disease who underwent conservative treatment between January 2008 and December 2018 were included in this retrospective study. Two readers assessed the angiographic images to identify choroidal collateral anastomosis subtypes, and Cox proportional hazard regression models were used to estimate the risk of recurrent hemorrhage associated with each subtype. RESULTS Thirty-nine patients (mean age = 45.2 years) were included in this study. During 52.4 ± 37.0 months of follow-up, recurrent ipsilateral hemorrhage occurred in 48.7% (19/39) of patients. Patients with recurrent hemorrhage had a higher prevalence of choroidal collateral (94.8% versus 60.0%; P = .02) and lateral posterior choroidal artery (78.9% versus 25.0%; P < .01) anastomoses than those without recurrent hemorrhage. Lateral posterior choroidal artery anastomosis was associated with recurrent hemorrhage before (hazard ratio = 6.66; 95% CI, 2.18-20.39; P < .01) and after (hazard ratio = 5.78; 95% CI, 1.58-21.13; P < .01) adjustments were made for age, sex, and other confounding factors. CONCLUSIONS Choroidal collateral anastomosis is responsible for most cases of recurrent hemorrhage in adult patients with Moyamoya disease; lateral posterior choroidal artery anastomosis is a significant risk factor for these recurrent events.
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Affiliation(s)
- J Wang
- From the Department of Neurosurgery (J.W., Z.W.), The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.,Departments of Neurosurgery (J.W., Y.Y., Q.L., Y.W., S.N., X.C.)
| | - Y Yang
- Departments of Neurosurgery (J.W., Y.Y., Q.L., Y.W., S.N., X.C.)
| | - X Li
- Radiology (X.L., F.Z., X.Z., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - F Zhou
- Radiology (X.L., F.Z., X.Z., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Z Wu
- From the Department of Neurosurgery (J.W., Z.W.), The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Q Liang
- Departments of Neurosurgery (J.W., Y.Y., Q.L., Y.W., S.N., X.C.)
| | - Y Liu
- Department of Neurosurgery (Y.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Y Wang
- Departments of Neurosurgery (J.W., Y.Y., Q.L., Y.W., S.N., X.C.)
| | - S Na
- Departments of Neurosurgery (J.W., Y.Y., Q.L., Y.W., S.N., X.C.)
| | - X Chen
- Departments of Neurosurgery (J.W., Y.Y., Q.L., Y.W., S.N., X.C.)
| | - X Zhang
- Radiology (X.L., F.Z., X.Z., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - B Zhang
- Radiology (X.L., F.Z., X.Z., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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7
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Miyakoshi A, Funaki T, Fushimi Y, Kikuchi T, Kataoka H, Yoshida K, Mineharu Y, Takahashi JC, Miyamoto S. Identification of the Bleeding Point in Hemorrhagic Moyamoya Disease Using Fusion Images of Susceptibility-Weighted Imaging and Time-of-Flight MRA. AJNR Am J Neuroradiol 2019; 40:1674-1680. [PMID: 31515213 DOI: 10.3174/ajnr.a6207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/29/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The location of intracerebral hemorrhage in Moyamoya disease is a prognostic factor for rebleeding and the degree of preventive effects obtainable with bypass surgery. We evaluated whether the bleeding point and responsible vessel were detectable using fusion images of SWI and time-of-flight MRA performed during chronic-phase hemorrhage. MATERIALS AND METHODS We retrospectively enrolled 42 patients with hemorrhagic Moyamoya disease (48 hemorrhagic events). Fusion images of SWI and MRA were made using workstations, and we defined the bleeding point as the point at which the signal of an abnormally extended artery on MRA overlapped the hypointense area on SWI. Two independent raters identified the bleeding point, and classified the location and responsible vessels. RESULTS The bleeding point was detectable at a frequency of 79.2% by rater 1. Agreement for the presence of a bleeding point was high (interrater κ = 0.83; 95% CI, 0.65-1; intrarater κ = 0.86; 95% CI, 0.68-1). The frequency of a periventricular location of the bleeding point was 65.8% by rater 1, and agreement on the location was again high (interrater κ = 0.92; 95% CI, 0.82-1; intrarater κ = 0.85; 95% CI, 0.72-0.99). The choroidal artery was the most frequent responsible vessel (57.9% by rater 1), and agreement on the responsible vessel was high (interrater κ = 0.84; 95% CI, 0.69-1; intrarater κ = 0.90; 95% CI, 0.78-1). CONCLUSIONS Detection of the bleeding point in hemorrhagic Moyamoya disease using SWI and MRA fusion images offers highly reproducible results.
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Affiliation(s)
- A Miyakoshi
- From the Departments of Neurosurgery (A.M., T.F., T.K., H.K., K.Y., Y.M, S.M.)
| | - T Funaki
- From the Departments of Neurosurgery (A.M., T.F., T.K., H.K., K.Y., Y.M, S.M.)
| | - Y Fushimi
- Diagnostic Imaging and Nuclear Medicine (Y.F.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Kikuchi
- From the Departments of Neurosurgery (A.M., T.F., T.K., H.K., K.Y., Y.M, S.M.)
| | - H Kataoka
- From the Departments of Neurosurgery (A.M., T.F., T.K., H.K., K.Y., Y.M, S.M.)
| | - K Yoshida
- From the Departments of Neurosurgery (A.M., T.F., T.K., H.K., K.Y., Y.M, S.M.)
| | - Y Mineharu
- From the Departments of Neurosurgery (A.M., T.F., T.K., H.K., K.Y., Y.M, S.M.)
| | - J C Takahashi
- Department of Neurosurgery (J.C.T.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - S Miyamoto
- From the Departments of Neurosurgery (A.M., T.F., T.K., H.K., K.Y., Y.M, S.M.)
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Martín-Láez R, Valle-San Román N, Rodríguez-Rodríguez E, Marco-de Lucas E, Berciano Blanco J, Vázquez-Barquero A. Current concepts on the pathophysiology of idiopathic chronic adult hydrocephalus: Are we facing another neurodegenerative disease? NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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9
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Funaki T, Takahashi JC, Houkin K, Kuroda S, Takeuchi S, Fujimura M, Tomata Y, Miyamoto S. Angiographic features of hemorrhagic moyamoya disease with high recurrence risk: a supplementary analysis of the Japan Adult Moyamoya Trial. J Neurosurg 2018; 128:777-784. [DOI: 10.3171/2016.11.jns161650] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIn this paper, the authors set out to identify the angiographic features of moyamoya disease with posterior hemorrhage, which is a strong predictor of rebleeding.METHODSThis cross-sectional study used the data set of the Japan Adult Moyamoya Trial (clinical trial registration no.: C000000166 [www.umin.ac.jp/ctr/index.htm]). The panel designed the ancillary measurement of angiography at onset, classifying the collateral vessels into 3 subtypes: lenticulostriate anastomosis, thalamic anastomosis, and choroidal anastomosis. The association between each collateral and the hemorrhage site (anterior vs posterior) was assessed in the hemorrhagic hemisphere by using multivariate adjustment for potential confounders, including age, sex, and involvement of the posterior cerebral artery (PCA). The association was confirmed through topographical analysis of bleeding points.RESULTSAmong the 80 participants, 75 hemorrhagic hemispheres of 75 patients were analyzed. Lenticulostriate anastomosis was detected in 21 (28.0%) hemorrhagic hemispheres, thalamic anastomosis in 22 (29.3%), and choroidal anastomosis in 35 (46.7%). Choroidal anastomosis was a factor associated with posterior hemorrhage (OR 2.77 [95% CI 1.08–7.10], p = 0.034) and remained statistically significant after the multivariate adjustment (OR 2.66 [95% CI 1.00–7.07], p = 0.049). PCA involvement was also associated with posterior hemorrhage in both univariate and multivariate analyses. Topographical analysis revealed good correspondence between bleeding points associated with positive choroidal anastomosis and the anatomical distribution of the choroidal arteries, including the thalamus and the wall of the atrium.CONCLUSIONSChoroidal anastomosis and PCA involvement are characteristic of posterior hemorrhage in moyamoya disease. Choroidal anastomosis might be considered a potential source of posterior hemorrhage at high risk of rebleeding.
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Affiliation(s)
- Takeshi Funaki
- 1Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
| | - Jun C. Takahashi
- 2Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita
| | - Kiyohiro Houkin
- 3Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo
| | - Satoshi Kuroda
- 4Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | | | - Miki Fujimura
- 6Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai; and
| | - Yasutake Tomata
- 7Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Susumu Miyamoto
- 1Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
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10
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Longatti P, Boaro A, Canova G, Fiorindi A. The subependymal microvascular network revealed by endoscopic fluorescence angiography. J Neurosurg Sci 2017; 64:347-352. [PMID: 29115098 DOI: 10.23736/s0390-5616.17.04098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The subependymal vascularization of the cerebral ventricles has been described in anatomical studies on human specimens. Its identification in vivo during neuroendoscopic navigation could have anatomical interest and may lead to a safer ventricular navigation, also avoiding unexpected bleeding. The traditional endoscopic visualization allows the certain identification of only the main vessels. In this study we describe the features of the subependymal vascular network (SEVN) enhanced by sodium fluorescein (SF) angiography. We compare these findings with the vascular patterns visible under white light to evaluate the sensitivity of this technique in unveiling the most distant branches of the SEVN. METHODS We reviewed the video records of 39 fluorescein-assisted neuroendoscopic procedures. Steerable fiberscopes equipped with a dual observation mode for both white light and fluorescence were used. After preliminary inspection of the ventricular cavities, the camera was switched to the blue light fluorescent mode. Identical portion of ventricular walls observed in both modalities were compared and analyzed to enhance potential differences of the vascular features. RESULTS The main veins were positive (fluorescein enhanced) in 10 patients (25.6%), vessels of smaller diameter visible also under white light presented a detectable fluorescence in 27 patients (69.2%), the micro SEVN, not visible under with light, was revealed by SF in 21 patients (53.8%). CONCLUSIONS Fluorescein-guided neuroendoscopy deserves closer investigation since it allows detection of small vessels, not otherwise visible, in the ventricle walls. This method could be applied to ameliorate the knowledge of the environment the surgeon is working on, leading as a result to a safer navigation, also by avoiding minor bleedings.
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Affiliation(s)
- Pierluigi Longatti
- Department of Neurosurgery, Hospital of Treviso, University of Padua, Padua, Italy
| | - Alessandro Boaro
- Department of Neurosurgery, Hospital of Treviso, University of Padua, Padua, Italy
| | - Giuseppe Canova
- Department of Neurosurgery, Hospital of Treviso, University of Padua, Padua, Italy
| | - Alessandro Fiorindi
- Department of Neurosurgery, Hospital of Treviso, University of Padua, Padua, Italy -
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11
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Cerebral white matter hyperintensity is associated with intracranial atherosclerosis in a healthy population. Atherosclerosis 2017; 265:179-183. [PMID: 28915443 DOI: 10.1016/j.atherosclerosis.2017.09.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Cerebral white matter hyperintensity (WMH) is commonly found in ischemic stroke patients, especially when accompanied by intracranial atherosclerosis (ICAS). However, the relationship between WMH and ICAS in a healthy population has not been evaluated. METHODS A total of 3159 healthy subjects who underwent health checkups, including brain magnetic resonance imaging and angiography, were enrolled. ICAS was defined as an occlusion or more than 50% stenosis of intracranial vessels on magnetic resonance angiography. Volumes of WMH were quantitatively rated. RESULTS Eighty-two (2.6%) subjects had ICAS. The mean age of the cohort was 56 years, and the median volume of WMH was 1.02 [0.20-2.60] mL. In a multivariate analysis, ICAS [β = 0.331, 95% confidence interval (CI) = 0.086 to 0.576, p = 0.008] was significantly associated with WMH volumes after adjusting confounders. Age (β = 0.046, 95% CI = 0.042 to 0.050, p < 0.001), hypertension (β = 0.113, 95% CI = 0.017 to 0.210, p = 0.021), and diabetes (β = 0.154, 95% CI = 0.043 to 0.265, p = 0.006) were also significant, independently of ICAS. The ICAS (+) group had more frequent vascular risk factors including hypertension, diabetes, and statin use, than the ICAS (-) group, and these tendencies increased when WMH was accompanied by ICAS. CONCLUSIONS ICAS is associated with larger WMH volume in a healthy population. Close observation of this group and strict control of vascular risk factors are needed.
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12
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Hanihara M, Sato S, Shibahara I, Saito R, Kanamori M, Sonoda Y, Kinouchi H, Tominaga T, Kumabe T. Intraoperative Visualization of Subependymal Arteries at the Atrium Supplying the Descending Motor Pathway. World Neurosurg 2017; 101:296-303. [PMID: 28232151 DOI: 10.1016/j.wneu.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We previously disclosed that damage to the subependymal arteries (SEAs) caused by coagulation of the choroid plexus at the atrium can result in infarction within the lateral posterior choroidal artery territory, followed by hemiparesis. The present study describes the intraoperative anatomical findings of the SEAs and choroid plexus at the atrium, which were verified only by a few cadaveric studies. METHODS Locations of the SEA and descending motor pathway were determined with the neuronavigation system and subcortical electrical stimulation in 8 cases of periatrial brain tumor. Indocyanine green videoangiography was performed to verify the blood flow in the choroid plexus and SEAs. RESULTS Intraoperative visualization of the SEAs was performed successfully in all patients. The neuronavigation system and subcortical electrical stimulation mapping demonstrated that these SEAs penetrated into the descending motor pathway. Indocyanine green depicted the blood flow of the SEAs entering the wall of the lateral ventricle and adjacent brain parenchyma. The blood flow directions between the SEAs and choroid plexus were not uniform, because the SEAs were filled ahead of the choroid plexus in 3 cases, whereas the choroid plexus was filled first in the other 2 cases. CONCLUSIONS Manipulations to the inner side of the choroid plexus at the transition from the atrium to the body of lateral ventricle can damage the SEAs. Not only coagulation of the SEAs themselves, but also coagulation of choroid plexus itself may reduce the blood flow in the SEAs, resulting in ischemic complications at descending motor pathway.
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Affiliation(s)
- Mitsuto Hanihara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Department of Neurosurgery, University of Yamanashi Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Sumito Sato
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
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Fiorindi A, Boaro A, Del Moro G, Longatti P. Fluorescein-Guided Neuroendoscopy for Intraventricular Lesions: A Case Series. Oper Neurosurg (Hagerstown) 2017; 13:173-181. [DOI: 10.1093/ons/opw008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/23/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The benefits of neuroendoscopy in the pathological diagnosis of intra- and paraventricular tumors have already been shown in many neurosurgical studies. However, most authors agree that neuroendoscopic biopsies are not infrequently inconclusive due to small or inadequate samples, prompting the need for new diagnostic strategies.
OBJECTIVE: To describe a technique not previously reported in the literature, combining neuroendoscopy with angiofluorescein guidance for the pathological diagnosis of intra- and paraventricular tumors.
METHODS: The 4-mm steerable fiberscope used was equipped with dual observation modes for white light and fluorescein. Access was by the classical precoronal burr hole. After inspecting the ventricular system in white light, a 10-mg/kg dose of fluorescein sodium (FS) was administered intravenously to the patient. The endoscope was then switched to the blue light fluorescent mode to better localize the pathological tissue. The protocol had been submitted to the local ethics committee.
RESULTS: From September 2011 to March 2015, 9 consecutive patients (aged 1-56 yr) harboring intra- and paraventricular lesions prospectively underwent angiofluorescein-guided endoscopy. In all cases, a pathological diagnosis was obtained without complications. In 5 patients, an endoscopic third ventriculostomy, and, in 1 patient, a septostomy was performed during the same procedure. Fluorescein guidance definitely modified our site of biopsy in 4 cases.
CONCLUSION: In our experience, FS has proven to be a strong enhancer of all ventricular lesions presenting with a disrupted blood–brain barrier, including inflammatory processes. Fluorescein-guided neuroendoscopy appears to be a safe, economic method to improve diagnostic potential in ventricular lesions.
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Martín-Láez R, Valle-San Román N, Rodríguez-Rodríguez EM, Marco-de Lucas E, Berciano Blanco JA, Vázquez-Barquero A. Current concepts on the pathophysiology of idiopathic chronic adult hydrocephalus: Are we facing another neurodegenerative disease? Neurologia 2016; 33:449-458. [PMID: 27296497 DOI: 10.1016/j.nrl.2016.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/14/2016] [Accepted: 03/29/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Since its description five decades ago, the pathophysiology of idiopathic chronic adult hydrocephalus (iCAH) has been traditionally related to the effect that ventricular dilatation exerts on the structures surrounding the ventricular system. However, altered cerebral blood flow, especially a reduction in the CSF turnover rate, are starting to be considered the main pathophysiological elements of this disease. DEVELOPMENT Compression of the pyramidal tract, the frontostriatal and frontoreticular circuits, and the paraventricular fibres of the superior longitudinal fasciculus have all been reported in iCAH. At the level of the corpus callosum, gliosis replaces a number of commissural tracts. Cerebral blood flow is also altered, showing a periventricular watershed region limited by the subependymal arteries and the perforating branches of the major arteries of the anterior cerebral circulation. The CSF turnover rate is decreased by 75%, leading to the reduced clearance of neurotoxins and the interruption of neuroendocrine and paracrine signalling in the CSF. CONCLUSIONS iCAH presents as a complex nosological entity, in which the effects of subcortical microangiopathy and reduced CSF turnover play a key role. According to its pathophysiology, it is simpler to think of iCAH more as a neurodegenerative disease, such as Alzheimer disease or Binswanger disease than as the classical concept of hydrocephalus.
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Affiliation(s)
- R Martín-Láez
- Servicio de Neurocirugía, Hospital Universitario «Marqués de Valdecilla», Santander, Cantabria, España.
| | - N Valle-San Román
- Servicio de Radiología, Hospital Universitario «Marqués de Valdecilla», Santander, Cantabria, España
| | - E M Rodríguez-Rodríguez
- Servicio de Neurología, Hospital Universitario «Marqués de Valdecilla», Instituto de Investigación Sanitaria IDIVAL, Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Universidad de Cantabria, Santander, Cantabria, España
| | - E Marco-de Lucas
- Servicio de Radiología, Hospital Universitario «Marqués de Valdecilla», Santander, Cantabria, España
| | - J A Berciano Blanco
- Servicio de Neurología, Hospital Universitario «Marqués de Valdecilla», Instituto de Investigación Sanitaria IDIVAL, Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Universidad de Cantabria, Santander, Cantabria, España
| | - A Vázquez-Barquero
- Servicio de Neurocirugía, Hospital Universitario «Marqués de Valdecilla», Santander, Cantabria, España
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Djulejić V, Marinković S, Georgievski B, Stijak L, Aksić M, Puškaš L, Milić I. Clinical significance of blood supply to the internal capsule and basal ganglia. J Clin Neurosci 2016; 25:19-26. [DOI: 10.1016/j.jocn.2015.04.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/18/2015] [Indexed: 11/29/2022]
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16
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Martín-Láez R, Caballero-Arzapalo H, Valle-San Román N, López-Menéndez LÁ, Arango-Lasprilla JC, Vázquez-Barquero A. Incidence of Idiopathic Normal-Pressure Hydrocephalus in Northern Spain. World Neurosurg 2015; 87:298-310. [PMID: 26548835 DOI: 10.1016/j.wneu.2015.10.069] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the incidence of idiopathic normal-pressure hydrocephalus (iNPH) can be 1.20 cases/1000 inhabitants/year in individuals ≥ 70 years old, in most series, the incidence of shunt-responsive iNPH appears to be <1/100,000 inhabitants/year. We report the results of a prospective 10-year longitudinal study of the incidence of iNPH in a northern Spanish population. METHODS In a stable population of 590,000 inhabitants served by a single neurosurgical department, we periodically asked all primary care practitioners, neurologists, and geriatricians to refer for iNPH screening any patient with ventricular dilation who was complaining of motor disturbances, cognitive impairment, or sphincter dysfunction. RESULTS From January 2003 to December 2012, 293 patients were referred with suspected normal-pressure hydrocephalus. In 187 patients, iNPH was diagnosed; 89 of these patients were classified as probable iNPH, and 98 were classified as possible iNPH. Cerebrospinal fluid diversion was performed in 152 patients, and 119 showed a good outcome. The incidence of iNPH was significantly greater in male patients and patients >60 years old and increased exponentially with age. After age 60, the standardized age- and sex-adjusted incidence rates for iNPH, shunt surgery for iNPH, and shunt-responsive iNPH were 13.36 cases/100,000 inhabitants/year, 10.85 cases/100,000 inhabitants/year, and 8.55 cases/100,000 inhabitants/year. No differences were detected in the response rate between probable and possible iNPH (80.52% vs. 76.00%; P = 0.497). CONCLUSIONS Even with a protocol for patient referral in place, reported iNPH incidence was lower than predicted, reflecting a persistent problem of underdiagnosis in our population.
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Affiliation(s)
- Rubén Martín-Láez
- Department of Neurosurgery-Spine Unit, University Hospital "Marqués de Valdecilla", Santander, Spain.
| | - Hugo Caballero-Arzapalo
- Department of Neurosurgery-Spine Unit, University Hospital "Marqués de Valdecilla", Santander, Spain
| | | | - Luis Ángel López-Menéndez
- Department of Neurosurgery-Spine Unit, University Hospital "Marqués de Valdecilla", Santander, Spain
| | | | - Alfonso Vázquez-Barquero
- Department of Neurosurgery-Spine Unit, University Hospital "Marqués de Valdecilla", Santander, Spain
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The collateral circulation in pediatric moyamoya disease. Childs Nerv Syst 2015; 31:389-98. [PMID: 25378261 DOI: 10.1007/s00381-014-2582-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The descriptions of collateral circulation in moyamoya have so far been a mixture of topography-based and vessels' source-based analyses. We aimed to investigate the anatomy and systematize the vascular anastomotic networks in pediatric moyamoya disease. METHODS From a series of 25 consecutive complete angiographic studies of newly diagnosed children with moyamoya, 14 children had moyamoya disease and 11 were diagnosed with moyamoya syndrome, i.e., moyamoya angiopathy with some additional concomitant systemic disease. We retrospectively analyzed the arterial branches supplying the moyamoya anastomotic networks, their origin, course, location, and connections with the recipient vessels. RESULTS We describe four types of anastomotic networks in children with moyamoya disease, two superficial-meningeal and two deep-parenchymal. As superficial-meningeal, we defined the leptomeningeal and the durocortical networks. Apart from the previously described leptomeningeal network observed in the convexial watershed zones, we report on the basal temporo-orbitofrontal leptomeningeal network. The second superficial-meningeal network is the durocortical network, which can be basal or calvarian in location. We define as deep-parenchymal networks the nonpreviously described subependymal network and the inner striatal and inner thalamic networks. The subependymal network is fed by the intraventricular branches of the choroidal system and diencephalic perforators, which at the level of the periventricular subependymal zone, anastomose with medullary-cortical arteries as well as with striatal arteries. The inner striatal and thalamic networks are constituted by intrastriatal connections among striatal arteries and intrathalamic connections among thalamic arteries when the disease compromises the origin of one or more sources of their supply. CONCLUSION The previously inexplicitly described "moyamoya abnormal network" in pediatric moyamoya disease can be described as a composition of four anastomotic networks with distinct angioarchitecture. A better understanding of the collateralization in moyamoya may help in defining a new staging system of the disease with clinical relevance.
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Funaki T, Fushimi Y, Takahashi JC, Takagi Y, Araki Y, Yoshida K, Kikuchi T, Miyamoto S. Visualization of periventricular collaterals in moyamoya disease with flow-sensitive black-blood magnetic resonance angiography: preliminary experience. Neurol Med Chir (Tokyo) 2015; 55:204-9. [PMID: 25739429 PMCID: PMC4533333 DOI: 10.2176/nmc.oa.2014-0360] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fragile abnormal collaterals in moyamoya disease, known as "moyamoya vessels," have rarely been defined. While flow-sensitive black-blood magnetic resonance angiography (FSBB-MRA) is a promising technique for visualizing perforating arteries, as of this writing no other reports exist regarding its application to moyamoya disease. Six adults with moyamoya disease underwent FSBB-MRA. It depicted abnormal collaterals as extended lenticulostriate, thalamic perforating, or choroidal arteries, which were all connected to the medullary or insular artery in the periventricular area and supplied the cortex. This preliminary case series illustrates the potential for FSBB-MRA to reveal abnormal moyamoya vessels, which could be reasonably defined as periventricular collaterals.
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Affiliation(s)
- Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
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Kazumata K, Shinbo D, Ito M, Shichinohe H, Kuroda S, Nakayama N, Houkin K. Spatial Relationship between Cerebral Microbleeds, Moyamoya Vessels, and Hematoma in Moyamoya Disease. J Stroke Cerebrovasc Dis 2014; 23:1421-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/10/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022] Open
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20
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Innervation of the brain, intracerebral Schwann cells and intracerebral and intraventricular schwannomas. Childs Nerv Syst 2014; 30:815-24. [PMID: 24643709 DOI: 10.1007/s00381-014-2394-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023]
Abstract
The cerebral vasculature and the choroid plexus are innervated by peripheral nerves. The anatomy of the vascular supply to the brain and its related perivascular nerves is reviewed. Intracerebral and intraventricular schwannomas most likely come from neoplastic transformation of Schwann cells investing the perivascular nerves and nerves within the choroid plexus.
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Park JH, Kwon HM, Lee J, Kim DS, Ovbiagele B. Association of intracranial atherosclerotic stenosis with severity of white matter hyperintensities. Eur J Neurol 2014; 22:44-52, e2-3. [PMID: 24712717 DOI: 10.1111/ene.12431] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) have been linked to small-vessel disease, but the precise pathogenesis underlying WMHs remains unclear. Studies about an association of WMHs with extracranial atherosclerotic stenosis (ECAS) showed conflicting results and the relationship of WMHs with intracranial atherosclerotic stenosis (ICAS) is uncertain. METHODS A cross-sectional study of 679 consecutive Korean patients with acute ischaemic stroke (mean age 67.8 ± 12.6; 395 males) who underwent brain MRI/MR angiography was conducted. Severity of deep WMHs (d-WMHs, n = 560) and periventricular WMHs (p-WMHs, n = 590) was rated separately and compared across three groups: ICAS (n = 318), ECAS (n = 71) and no cerebral atherosclerotic stenosis (NCAS) (n = 290). RESULTS The ICAS group showed a higher d-WMH/p-WMH score (1.62 ± 0.85/1.65 ± 0.79) than both the ECAS (1.25 ± 0.87/1.23 ± 0.78) and NCAS (1.19 ± 0.92/1.24 ± 0.81) groups (P < 0.001 for all). Patients with a greater number of ICAS were more likely to have higher scores of d-WMH/p-WMH (P < 0.001 for all). Patients with higher scores of d-WMH/p-WMH had a higher incidence of ICAS (P < 0.001 for all), but not of ECAS or NCAS. In multivariable analysis, a dose-response relationship was observed between the extent of ICAS versus WMHs. Compared with one ICAS lesion, for d-WMHs the odds ratio (OR) = 2.61 [95% confidence interval (CI) 0.95-7.20] for two ICAS lesions and OR = 3.37 (1.10-10.32) for ≥3 ICAS lesions; whilst for p-WMHs (score ≥2) OR = 1.70 (95% CI 0.96-2.98) for two ICAS lesions and OR = 2.02 (1.15-3.55) for ≥3 ICAS lesions. CONCLUSION ICAS is independently associated with progressively greater WMH burden. The association of ICAS with WMH severity appears to be stronger than that of ECAS/NCAS in the Korean (Asian) stroke population.
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Affiliation(s)
- J-H Park
- Department of Neurology, Myongji Hospital, Goyang, Korea
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Saito R, Kumabe T, Sonoda Y, Kanamori M, Mugikura S, Takahashi S, Tominaga T. Infarction of the lateral posterior choroidal artery territory after manipulation of the choroid plexus at the atrium: causal association with subependymal artery injury. J Neurosurg 2013; 119:158-63. [PMID: 23540272 DOI: 10.3171/2013.2.jns121221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The atrium of the lateral ventricle is often affected by tumors, and some patients with these tumors suffer neurological deficits, including hemiparesis after surgery. The authors of this study investigated the possible mechanisms causing the relatively high incidences of ischemic complications associated with surgery approaching the atrium of the lateral ventricle. METHODS Clinical records and radiological images of 28 patients were retrospectively studied. These patients had their lateral ventricles opened at the atrium during the resection of gliomas as well as other nonbenign brain tumors, and were treated for gliomas at our tertiary referral center in the Tohoku district, Japan, between January 2008 and December 2010. RESULTS Routine postoperative diffusion-weighted MR images obtained within 72 hours after surgery detected infarction in the periatrial/periventricular regions in 7 patients, presumably corresponding to the lateral posterior choroidal artery (LPChA) territory. Five of these 7 patients suffered neurological sequelae with varying severities. The choroid plexus at the atrium was coagulated to achieve hemostasis during the surgery in all of these patients. Detailed analysis of microangiograms revealed ventriculofugal arteries arising from the lateral ventricle. Damage of the subependymal artery that supplies the ventriculofugal arteries caused by coagulation of the choroid plexus at the atrium probably resulted in the infarction in these patients. CONCLUSIONS Neurosurgeons must be aware of the possibility of LPChA territory infarction during surgery in the atrial or periatrial regions caused by subependymal artery obstruction after manipulating or coagulating the choroid plexus near the atrium.
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Affiliation(s)
- Ryuta Saito
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Madhugiri VS, Gundamaneni SK, Yadav AK, Sasidharan GM, Roopesh KVR. Idiopathic intraventricular aneurysm presenting with intraventricular hemorrhage: case report and review of the literature. Pediatr Neurosurg 2012; 48:174-80. [PMID: 23406825 DOI: 10.1159/000346264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/28/2012] [Indexed: 11/19/2022]
Abstract
Intraventricular hemorrhage (IVH) is a relatively commonly encountered problem in neurosurgical practice. The underlying causes could include hypertension, arteriovenous malformations (AVM), angiomas, trauma, tumors, aneurysms and moyamoya disease. Truly idiopathic intraventricular aneurysms (IVA) are rare. A high index of suspicion needs to be maintained since, with the appropriate treatment, the outcome is generally good. We report the case of a 14-year-old boy who presented with sudden onset headache and vomiting. CT angiogram pointed to the possibility of an IVA. This was confirmed by MRI with three-dimensional constructive interference in steady state (CISS-3D) sequences and digital subtraction angiography. The patient underwent microsurgical excision of the aneurysm and is doing well on follow-up. Idiopathic IVA can present with IVH at any age. MRI with CISS-3D and MR angiography would be the imaging modality of choice since it can also rule out other causes of intraventricular bleeding such as tumors and AVM. These lesions could be managed effectively by microsurgical excision/clipping. The necessity of investigating every patient who presents with IVH is debatable.
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Affiliation(s)
- Venkatesh S Madhugiri
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
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Tsutsumi S, Ito M, Yasumoto Y, Tabuchi T, Ogino I. The Virchow-Robin spaces: delineation by magnetic resonance imaging with considerations on anatomofunctional implications. Childs Nerv Syst 2011; 27:2057-66. [PMID: 21909964 DOI: 10.1007/s00381-011-1574-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/31/2011] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The Virchow-Robin spaces (V-R spaces) are well-known, but not systematically understood fluid-filled perivascular spaces that allow the convexity and basal perforating vessels to penetrate deep into the cerebral parenchyma. OBJECTIVE This study aims to delineate anatomical characteristics of the normal V-R spaces by MR imaging with considerations on clinical and anatomofunctional implications of the V-R spaces. METHODS In this prospective study with 3T magnetic resonance (MR) imaging, the whole extent of the intracranial V-R spaces was classified into basal, cortical, subcortical, paraventricular, and brainstem segments, on the basis of the topological difference in 105 control subjects. Morphological characteristics in each segment of the V-R spaces are described. For comparison with the neuroimaging appearance, V-R spaces were histologically examined in cadaveric human brains. The physiological functions of the V-R spaces and pathognomonic implications of unusually dilated, but asymptomatic, V-R spaces encountered in five subjects are discussed. RESULTS The V-R spaces were found to form a complicated, while anatomically highly consistent, intraparenchymal canal network distributed over the whole cerebral hemispheres and connect the cerebral convexity, basal cistern, and ventricular system. CONCLUSION The V-R spaces may be essential for drainage routes of cerebral metabolites, additional buoyancy for the brain, and maintenance of homogenous intracranial pressure. MR imaging may be more advantageous in depicting the V-R spaces than histological examination.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan.
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Lévêque M, McLaughlin N, Laroche M, Bojanowski MW. Endoscopic treatment of distal choroidal artery aneurysm. J Neurosurg 2009; 114:116-9. [PMID: 20540628 DOI: 10.3171/2009.9.jns081659] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Distal choroidal artery aneurysms stemming from the lateral wall of the ventricles are rare and are mostly associated with moyamoya disease. The treatment of these aneurysms is difficult because of their deep location. The authors report the case of a 50-year-old woman followed for moyamoya disease presenting with 2 intraventricular hemorrhages. Cerebral angiography showed an aneurysm located on the left distal choroidal artery. Magnetic resonance imaging also demonstrated that the lesion protruded from the lateral wall of the trigone of the left lateral ventricle. Using MR imaging-guided stereotactic localization, the aneurysm was accurately reached endoscopically and successfully resected from the parent artery. The patient was discharged neurologically intact. To the best of the authors' knowledge, this is the first report of a successfully endoscopically treated distal anterior choroidal artery aneurysm. Endoscopic surgery may be added to the armamentarium of procedures used to treat intraventricular aneurysms.
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Affiliation(s)
- Marc Lévêque
- Department of Neurosurgery, Hôpital Notre-Dame, Montreal, Quebec, Canada
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Govaert P, Ramenghi L, Taal R, de Vries L, Deveber G. Diagnosis of perinatal stroke I: definitions, differential diagnosis and registration. Acta Paediatr 2009; 98:1556-67. [PMID: 19663912 DOI: 10.1111/j.1651-2227.2009.01461.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Perinatal stroke can be divided into three subtypes: ischaemic stroke, either arterial or sinovenous and haemorrhagic stroke. For the sake of universal registration and to perform intervention studies, we propose a detailed diagnostic registration system for perinatal stroke taking 10 variables into account. These variables are discussed here and in the accompanying article. MATERIAL AND RESULTS Differentiation is needed from focal brain changes as a result of disorders other than stroke, whereby accurate timing is possible only when early neonatal imaging is available. Detailed templates are presented for arterial and venous vascular classification. AIS is further subdivided into single territory and complex infarction and some stratification is proposed in the complicated stroke group. This registration system has been applied to a retrospective cohort of 134 newborns with stroke (single-centre observation from 1999 to 2007) and the results are compared with published data. By applying this registration system, intervention studies for one homogeneous stroke type (e.g. complete middle cerebral artery stroke) may be facilitated. CONCLUSION Ten variables may be sufficient to register a perinatal stroke. These include gestational age, birthweight, gender, delivery mode, time of detection, presentation, type of stroke, vessel affected or type of cavity, imaging method at detection and clinical context.
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Affiliation(s)
- P Govaert
- Department of Neonatology, Sophia Children's Hospital Erasmus MC Rotterdam, Rotterdam, The Netherlands.
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Abstract
This chapter provides arterial and venous stroke templates, designed with neonatal brain ultrasound as the viewpoint and adult stroke templates as the basis. Images change with maturation of the stages of infarction: swelling, necrosis, organisation and tissue loss. Adult templates permit recognition of well-delineated stroke types observed in the newborn brain. All circle of Willis arteries can be involved, as can their perforator branches. Middle cerebral artery (MCA) truncal stroke (anterior or posterior) is an important entity, with different prognosis than complete MCA stroke. Knowledge of these templates also aids in the definition of combinations of infarction (e.g. internal carotid artery stroke or pial plus perforator stroke) and of interarterial watershed injury. Venous templates, even if still under development around the time of birth, permit us to understand brain injury associated with sinus or deep vein thrombosis, especially several types of intracranial haemorrhage. Hindbrain stroke templates are scarcely applied to perinatal lesions.
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Affiliation(s)
- Paul Govaert
- Sophia Children's Hospital Erasmus MC Rotterdam, dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
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