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Agyemang K, Rose A, Sheikh ME, Asha M, Molinari E, Fullerton NE, Brennan D, Grivas A. Two cases of SMA syndrome after neurosurgical injury to the frontal aslant tract. Acta Neurochir (Wien) 2023; 165:2473-2478. [PMID: 36625909 PMCID: PMC10477090 DOI: 10.1007/s00701-022-05466-6] [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] [Received: 09/23/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
Supplementary motor area (SMA) syndrome is characterised by transient disturbance in volitional movement and speech production which classically occurs after injury to the medial premotor area. We present two cases of SMA syndrome following isolated surgical injury to the frontal aslant tract (FAT) with the SMA intact. The first case occurred after resection of a left frontal operculum tumour. The second case occurred after a transcortical approach to a ventricular neurocytoma. The clinical picture and fMRI activation patterns during recovery were typical for SMA syndrome and support the theory that the FAT is a critical bundle in the SMA complex function.
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Affiliation(s)
- Kevin Agyemang
- Institute of Neurological Sciences, Queen Elizabeth University Hospital (QEUH), 1345 Govan Road, Glasgow, G51 4TF, UK.
- School of Medicine, University of Glasgow, University Avenue, G12 8QQ, Glasgow, U.K..
| | - Anna Rose
- Institute of Neurological Sciences, Queen Elizabeth University Hospital (QEUH), 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Mustafa El Sheikh
- Institute of Neurological Sciences, Queen Elizabeth University Hospital (QEUH), 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Mutiu Asha
- Institute of Neurological Sciences, Queen Elizabeth University Hospital (QEUH), 1345 Govan Road, Glasgow, G51 4TF, UK
- School of Medicine, University of Glasgow, University Avenue, G12 8QQ, Glasgow, U.K
| | - Emanuela Molinari
- Institute of Neurological Sciences, Queen Elizabeth University Hospital (QEUH), 1345 Govan Road, Glasgow, G51 4TF, UK
- School of Medicine, University of Glasgow, University Avenue, G12 8QQ, Glasgow, U.K
| | - Natasha E Fullerton
- Institute of Neurological Sciences, Queen Elizabeth University Hospital (QEUH), 1345 Govan Road, Glasgow, G51 4TF, UK
- School of Medicine, University of Glasgow, University Avenue, G12 8QQ, Glasgow, U.K
| | - David Brennan
- Institute of Neurological Sciences, Queen Elizabeth University Hospital (QEUH), 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Athanasios Grivas
- Institute of Neurological Sciences, Queen Elizabeth University Hospital (QEUH), 1345 Govan Road, Glasgow, G51 4TF, UK
- School of Medicine, University of Glasgow, University Avenue, G12 8QQ, Glasgow, U.K
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Gallet C, Clavreul A, Bernard F, Menei P, Lemée JM. Frontal aslant tract in the non-dominant hemisphere: A systematic review of anatomy, functions, and surgical applications. Front Neuroanat 2022; 16:1025866. [DOI: 10.3389/fnana.2022.1025866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Knowledge of both the spatial organization and functions of white-matter fiber tracts is steadily increasing. We report here the anatomy and functions of the frontal aslant tract (FAT) in the non-dominant hemisphere (usually the right hemisphere). Despite the structural symmetry between the right and left FAT, these two tracts seem to display functional asymmetry, with several brain functions in common, but others, such as visuospatial and social cognition, music processing, shifting attention or working memory, more exclusively associated with the right FAT. Further studies are required to determine whether damage to the right FAT causes permanent cognitive impairment. Such studies will constitute the best means of testing whether this tract is a critical pathway that must be taken into account during neurosurgical procedures and the essential tasks to be incorporated into intraoperative monitoring during awake craniotomy.
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Superficial white matter bundle atlas based on hierarchical fiber clustering over probabilistic tractography data. Neuroimage 2022; 262:119550. [DOI: 10.1016/j.neuroimage.2022.119550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/20/2022] Open
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La Corte E, Eldahaby D, Greco E, Aquino D, Bertolini G, Levi V, Ottenhausen M, Demichelis G, Romito LM, Acerbi F, Broggi M, Schiariti MP, Ferroli P, Bruzzone MG, Serrao G. The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications. Front Neurol 2021; 12:641586. [PMID: 33732210 PMCID: PMC7959833 DOI: 10.3389/fneur.2021.641586] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior frontal gyrus. Advancements in neuroimaging and refinements to anatomical dissection techniques of the human brain white matter contributed to the recent description of the FAT anatomical and functional connectivity and its role in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders. Through the application of diffusion tractography and intraoperative electrical brain stimulation, the FAT was shown to have a role in speech and language functions (verbal fluency, initiation and inhibition of speech, sentence production, and lexical decision), working memory, visual–motor activities, orofacial movements, social community tasks, attention, and music processing. Microstructural alterations of the FAT have also been associated with neurological disorders, such as primary progressive aphasia, post-stroke aphasia, stuttering, Foix–Chavany–Marie syndrome, social communication deficit in autism spectrum disorders, and attention–deficit hyperactivity disorder. We provide a systematic review of the current literature about the FAT anatomical connectivity and functional roles. Specifically, the aim of the present study relies on providing an overview for practical neurosurgical applications for the pre-operative, intra-operative, and post-operative assessment of patients with brain tumors located around and within the FAT. Moreover, some useful tests are suggested for the neurosurgical evaluation of FAT integrity to plan a safer surgery and to reduce post-operative deficits.
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Affiliation(s)
- Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daniela Eldahaby
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elena Greco
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Domenico Aquino
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giacomo Bertolini
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Malte Ottenhausen
- Department of Neurological Surgery, University Medical Center Mainz, Mainz, Germany
| | - Greta Demichelis
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luigi Michele Romito
- Parkinson's Disease and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Paolo Schiariti
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Graziano Serrao
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Chakravarthi SS, Lyons L, Orozco AR, Verhey L, Mazaris P, Zacharia J, Singer JA. Combined Decompressive Hemicraniectomy and Port-Based Minimally Invasive Parafascicular Surgery for the Treatment of Subcortical Intracerebral Hemorrhage: Case Series, Technical Note, and Review of Literature. World Neurosurg 2020; 146:e1226-e1235. [PMID: 33271377 DOI: 10.1016/j.wneu.2020.11.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a neurosurgical emergency. Combined decompressive hemicraniectomy (DHC) and minimally invasive parafascicular surgery (MIPS) may provide a practical method of managing subcortical ICH. OBJECTIVE 1) To present a case series of combined DHC-MIPS for the treatment of subcortical-based ICH; 2) to describe technical nuances of DHC-MIPS; and 3) to provide a literature overview of MIPS for ICH. METHODS The following inclusion criteria were used: 1) Glasgow Coma Scale (GCS) score <3-4; 2) admission within 6 hours of onset; 3) increased intracranial pressure caused by hemorrhage; 4) patient unresponsive to medical management; 5) hemorrhage >30 cm3; 6) subcortical location; and 7) midline shift (mm). Before DHC, sulcal cannulation used the following coordinates: intersection of tragus-frontal bone and midpoint of midpupillary line and midline; coronal suture: 3-4 cm posterior to this point). RESULTS Three patients were selected: a 62-year old woman, a 45-year old woman, and a 36-year-old man. GCS and ICH scores on admission were 7 and 3, 3 and 4, and 3 and 4, respectively. ICH was located in left basal ganglia in patients 1 and 3 and right basal ganglia in patient 2, all with intraventricular extension. ICH volume was 81.7, 68.2, and 42.3 cm3, respectively. The postoperative GCS score was 11, 10, and 6, respectively. There were no intraoperative complications or mortalities. Evacuation was within 15 minutes in all patients. The modified Rankin Scale score was 3, 4, and 5, respectively, with semi-independence in case 1. CONCLUSIONS Combined DHC-MIPS, with the use of craniometric points, can provide a unique and simple surgical option for the management of subcortical ICH.
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Affiliation(s)
- Srikant S Chakravarthi
- Department of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA
| | - Leah Lyons
- Department of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA
| | - Andres Restrepo Orozco
- Department of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA
| | - Leonard Verhey
- Department of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA
| | - Paul Mazaris
- Department of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA
| | - Joseph Zacharia
- Department of Neurocritical Care, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA
| | - Justin A Singer
- Department of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA.
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Monroy-Sosa A, Navarro-Fernández JO, Chakravarthi SS, Rodríguez-Orozco J, Rovin R, de la Garza J, Kassam A. Minimally invasive trans-sulcal parafascicular surgical resection of cerebral tumors: translating anatomy to early clinical experience. Neurosurg Rev 2020; 44:1611-1624. [PMID: 32683512 DOI: 10.1007/s10143-020-01349-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/16/2020] [Accepted: 07/06/2020] [Indexed: 12/19/2022]
Abstract
The minimally invasive port-based trans-sulcal parafascicular surgical corridor (TPSC) has incrementally evolved to provide a safe, feasible, and effective alternative to access subcortical and intraventricular pathologies. A detailed anatomical foundation is important in mitigating cortical and white matter tract injury with this corridor. Thus, the aims of this study are (1) to provide a detailed anatomical construct and overview of TPSCs and (2) to translate an anatomical framework to early clinical experience. Based on regional anatomical constraints, suitable parafascicular entry points were identified and described. Fiber tracts at both minimal and increased risks for each corridor were analyzed. TPSC-managed cases for metastatic or primary brain tumors were retrospectively reviewed. Adult patients 18 years or older with Karnofsky Performance Status (KPS) ≥ 70 were included. Subcortical brain metastases between 2 and 6 cm or primary brain tumors between 2 and 5 cm were included. Patient-specific corridors and trajectories were determined using MRI-tractography. Anatomy: The following TPSCs were described and translated to clinical practice: superior frontal, inferior frontal, inferior temporal, intraparietal, and postcentral sulci. Clinical: Eleven patients (5 males, 6 females) were included (mean age = 52 years). Seven tumors were metastatic, and 4 were primary. Gross total, near total, and subtotal resection was achieved in 7, 3, and 1 patient(s), respectively. Three patients developed intraoperative complications; all recovered from their intraoperative deficits and returned to baseline in 30 days. A detailed TPSC anatomical framework is critical in conducting safe and effective port-based surgical access. This review may represent one of the few early translational TPSC studies bridging anatomical data to clinical subcortical and intraventricular surgical practice.
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Affiliation(s)
- Alejandro Monroy-Sosa
- Department of Neurosurgery, Aurora St. Luke's Medical Center, Aurora Neuroscience Innovation Institute, 2801 W Kinnickinnic River Pkwy #680, Milwaukee, WI, 53215, USA. .,Neuroanatomy Lab. Advocate - Aurora Research Institute, Milwaukee, WI, USA. .,Unit of Neuroscience, National Cancer Institute, Mexico City, Mexico.
| | | | - Srikant S Chakravarthi
- Department of Neurosurgery, Aurora St. Luke's Medical Center, Aurora Neuroscience Innovation Institute, 2801 W Kinnickinnic River Pkwy #680, Milwaukee, WI, 53215, USA.,Neuroanatomy Lab. Advocate - Aurora Research Institute, Milwaukee, WI, USA
| | | | - Richard Rovin
- Department of Neurosurgery, Aurora St. Luke's Medical Center, Aurora Neuroscience Innovation Institute, 2801 W Kinnickinnic River Pkwy #680, Milwaukee, WI, 53215, USA
| | - Jaime de la Garza
- Unit of Neuroscience, National Cancer Institute, Mexico City, Mexico
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