1
|
Simsek O, Manteghinejad A, Kotha A, Whitehead MT. Third Ventricle Diameter Is Inversely Related to Thalamic Massa Intermedia Thickness in Hydrocephalus Caused by Congenital Aqueductal Stenosis. AJNR Am J Neuroradiol 2024; 45:1316-1321. [PMID: 38719610 DOI: 10.3174/ajnr.a8340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND AND PURPOSE In fetuses with lateral ventriculomegaly and normal posterior fossa cerebrospinal spaces, third ventricle distention is a compelling clue that supports a diagnosis of aqueductal stenosis. However, this association assumes normal ventricular anatomy. Structural constraints can impair pressure-induced compliance. We aimed to determine how thalamic massa intermedia size alterations may impact the size of the third ventricle in the setting of congenital aqueductal stenosis. MATERIALS AND METHODS This retrospective study was performed at a single academic pediatric hospital after institutional review board approval. We searched our brain MRI reports for all examinations describing aqueductal stenosis and included all the patients who had both fetal and postnatal examinations. Patients with interhypothalamic adhesions and hydrocephalus unrelated to congenital aqueductal stenosis were excluded from this study. We evaluated all the MRIs for the presence of thalamic massa intermedia and documented third ventricle diameters (supraoptic recess, central and suprapineal recesses) and the thalamic massa intermedia circumference. The Spearman correlation was used to identify the potential relationship between the thalamic massa intermedia circumference and third ventricle size in fetal and postnatal MRIs. Patients were also stratified into 2 groups based on the presence or absence of thalamic massa intermedia. Mann-Whitney U tests were used to compare third ventricle diameters between these groups. RESULTS The study included both fetal and postnatal studies from 59 patients. The overall third ventricle diameter was inversely proportional to the circumference of the thalamic massa intermedia in both groups (fetal: P = .001, ρ = -0.422; [95% CI, -0.628 to -0.181]; postnatal: P < .001, ρ = -0.653; [95% CI, -0.782 to -0.479]). Nonetheless, dilation of anterior and posterior recesses still occurred when the mid third ventricle was nondilated or less severely dilated in patients with an enlarged thalamic massa intermedia. Third ventricle dilation was most severe in patients lacking a thalamic massa intermedia compared with patients with a thalamic massa intermedia (P < .001). CONCLUSIONS In patients with suspected congenital aqueductal stenosis, lack of marked third ventriculomegaly as conventionally measured can sometimes be explained by thickening of the thalamic massa intermedia. In this circumstance, it is important to evaluate the extreme recesses of the third ventricle for evidence of dilation on fetal MRI.
Collapse
Affiliation(s)
- Onur Simsek
- From the Department of Radiology (O.S., A.M., A.K., M.T.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amirreza Manteghinejad
- From the Department of Radiology (O.S., A.M., A.K., M.T.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Apoorva Kotha
- From the Department of Radiology (O.S., A.M., A.K., M.T.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew T Whitehead
- From the Department of Radiology (O.S., A.M., A.K., M.T.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology (M.T.W.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Beger O, Alpergin BC, Zaimoglu M, Orhan O, Kılınç MC, Unal S, Eray HA, Eroglu U. Massa intermedia in adults: incidence, dimension, location and clinical importance. Surg Radiol Anat 2024; 46:137-152. [PMID: 38191743 DOI: 10.1007/s00276-023-03274-w] [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: 10/25/2023] [Accepted: 11/26/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE This retrospective magnetic resonance imaging investigation aimed to obtain information related to the anatomy of the massa intermedia (MI) in an adult population. METHODS The work conducted on MRI views of 1058 (539 males and 519 females) healthy adult samples aged with 48.93 ± 17.63 years. Initially, the presence or absence of MI was noted, and then if present, its numbers and location in the third ventricle were recorded. Its horizontal (HDMI) and vertical (VDMI) diameters were measured on MRI views, while the cross-sectional area (CSAMI) was calculated using its diameters. RESULTS MI was missing in 2.6% (27 cases) of 1058 adult samples. Six subjects (0.6%) had a double MI. HDMI, VDMI and CSAMI were measured as 4.83 ± 1.01 mm, 4.86 ± 0.98 mm, and 19.11 ± 7.23 mm2, respectively. MI size did not show a significant alteration from 19 up to 49 years, but then its size distinctly decreased between 50 and 60 years. After age 60, MI dimension did not display an important change. MI was settled in the antero-superior quadrant in 929 cases (90.63% of 1025 subjects), in the postero-superior quadrant in 22 cases (2.15%), in the antero-inferior quadrant in 32 cases (3.12%), in the postero-inferior quadrant in 8 cases (0.78%), and in the central part in 34 cases (3.32%). CONCLUSIONS The size, position and incidence of MI were not affected by sex, and its position and incidence were not affected by adult age periods. In adults, MI size demonstrated a significant decrease in the middle age.
Collapse
Affiliation(s)
- Orhan Beger
- Faculty of Medicine, Department of Anatomy, Gaziantep University, Gaziantep, 27310, Turkey.
| | - Baran Can Alpergin
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Murat Zaimoglu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Ozgur Orhan
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Mustafa Cemil Kılınç
- Çorum Erol Olçok Training and Research Hospital, Department of Neurosurgery, Hitit University, Çorum, Turkey
| | - Sena Unal
- Faculty of Medicine, Department of Radiology, Ankara University, Ankara, Turkey
| | - Halit Anil Eray
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| |
Collapse
|
3
|
Kılınç MC, Alpergin BC, Mete EB, Eroglu U, Beger O. Anatomic Features of the Interthalamic Adhesion in the Pediatric Population. World Neurosurg 2023; 180:e631-e643. [PMID: 37806519 DOI: 10.1016/j.wneu.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The main goal of this retrospective study was to examine the morphology of the interthalamic adhesion (ITA) in normal children aged between 1 and 18 years. METHODS The study universe consisted of magnetic resonance images of 180 healthy pediatric subjects (age, 9.50 ± 5.20 years, sex, 90 girls and 90 boys). The cross-sectional area (CSA), vertical diameter (VD), and horizontal diameter (HD) of the ITA were measured and in addition, its location was noted. RESULTS HD, VD, and CSA of the ITA were measured as 8.47 ± 1.64 mm, 7.59 ± 1.57 mm, and 52.06 ± 18.51 mm2, respectively. HD did not change from infancy until postpubescence, but then significantly decreased (P < 0.001). VD increased up to early childhood but then did not alter until the end of prepubescence. After that period, it decreased in postpubescence (P < 0.001). CSA tended to decrease in an irregular pattern according to pediatric age periods (P < 0.001). The ITA was located at the anterosuperior quadrant in 138 individuals (76.70%), at the anteroinferior quadrant in 7 individuals (3.90%), and the center of the lateral wall of the third ventricle in 35 individuals (19.40%). Linear functions were calculated as y = 9.490-0.107 × age (years) for HD, y = 8.453-0.091 × age (years) for VD, and y = 63.559-1.211 × age (years) for CSA. CONCLUSIONS ITA size irregularly decreases with advancing age from 1 to 18 years. Our calculated linear functions, showing the growth dynamics of the ITA by pediatric ages, may be helpful in estimating its dimension.
Collapse
Affiliation(s)
- Mustafa Cemil Kılınç
- Department of Neurosurgery, Çorum Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Baran Can Alpergin
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emre Bahir Mete
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| |
Collapse
|
4
|
Alpergin BC, Zaimoglu M, Beger O, Kılınç MC, Mete EB, Hasimoglu S, Eroglu U. Interthalamic Adhesion: Can it be used to Diagnose Idiopathic Intracranial Hypertension? World Neurosurg 2023; 180:e408-e414. [PMID: 37769844 DOI: 10.1016/j.wneu.2023.09.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE This retrospective study aimed at determining the dimension of the interthalamic adhesion (ITA) in patients with the idiopathic intracranial hypertension (IIH) for assisting in preoperative radiologic diagnosis. METHODS The study universe consisted of magnetic resonance images of 20 patients with IIH (age: 22.70 ± 4.04 years, sex: 14 females and 6 males) and 20 normal subjects (age 22.30± 2.94 years, sex: 14 females and 6 males). To determine the morphology of ITA, its height (vertical diameter) and width (horizontal diameter) were measured on the coronal and axial planes, respectively. RESULTS The height and width of ITA in IIH were measured as 2.58 ± 0.71 mm (range: 1.40-4.20 mm) and 2.73 ± 0.77 mm (range: 1.70-4.40 mm), respectively. Its height and width in controls were measured as 4.99 ± 1.04 mm (range: 2.70-6.30 mm) and 4.92 ± 1.11 mm (range: 2.60-6.50 mm), respectively. ITA height and width in IIH was significantly smaller compared with controls (P < 0.001). For an arbitrary cutoff of 3.85 mm, the sensitivity of the height of ITA was 85% with 95% specificity. For an arbitrary cutoff of 4.45 mm, the sensitivity of the width of ITA was 75% with 100% specificity. CONCLUSIONS The height and width of ITA are approximately 50% smaller in IIH than controls; therefore alterations in the dimension of ITA may be a valuable radiologic sign for the diagnosis of IIH.
Collapse
Affiliation(s)
- Baran Can Alpergin
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Murat Zaimoglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Mustafa Cemil Kılınç
- Department of Neurosurgery, Çorum Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Emre Bahir Mete
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Siavash Hasimoglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
5
|
Asghar A, Narayan RK, Kumar P, Ravi KS, Tubbs RS, Patra A, Naaz S. Absence of the interthalamic adhesion (ITA) as a neuroanatomical association or risk factor for neuropsychiatric disorders: A systemic review and meta-analysis. Indian J Psychiatry 2023; 65:985-994. [PMID: 38108053 PMCID: PMC10725209 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_744_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 12/19/2023] Open
Abstract
Background This study aimed to provide an up-to-date account of the frequency of "the absence of interthalamic adhesion (AITA) as a risk factor or association" in healthy subjects and neuropsychiatric patients. Owing to the increased interest in the contribution of ITA to neurological function in previous literature, a meta-analysis of its frequency and sex dependency is required. Aim This study aimed to study whether the AITA is associated with neuropsychiatric disorders. Settings and Design This study is a meta-analysis and systemic review. Methods and Material Literature searches were conducted in PubMed, Web of Science, and Google Scholar using the keywords "interthalamic adhesion," "massa intermedia," "adhesio interthalamica," and "adhesion" along with the Boolean operators (OR, AND, and NOT). Three reviewers independently assessed the abstracts and full texts for validation based on the inclusion criteria. The meta-analysis was performed using Microsoft Excel 2019 for descriptive studies and RevMan 5.2 for comparative studies. Results The incidence of absent ITA was 15.3% in healthy subjects and 28.76% in neuropsychiatric subjects. The relative probability of AITA was 2.30 [95% confidence interval (CI), 1.96-2.70] in neuropsychiatric illness. Healthy men were 1.91 times more likely, and men with neuropsychiatric disorders were 1.82 times more likely to have absent ITA than women. Conclusions and Relevance In this study, a consistent association of AITA with psychiatric disorders was observed, rendering the condition to be treated as an associated risk factor affecting the function of the habenula nuclear complex via the stria medullaris thalami. A cohort or longitudinal study is needed to compare the incidence of psychiatric disorders in individuals with or without ITA and to calculate the attributed risk.
Collapse
Affiliation(s)
- Adil Asghar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ravi K. Narayan
- Department of Anatomy, ESIC Medical College and Hospital, Bihta, Patna, Bihar, India
| | - Pankaj Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kumar S. Ravi
- Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
| | - Apurba Patra
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Shagufta Naaz
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
6
|
Prevalence of the interthalamic adhesion in the human brain: a review of literature. Brain Struct Funct 2021; 226:2481-2487. [PMID: 34254165 DOI: 10.1007/s00429-021-02287-8] [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: 01/18/2021] [Accepted: 04/25/2021] [Indexed: 10/20/2022]
Abstract
The interthalamic adhesion (IA) is a midline structure connecting the two thalami. Though it has been studied for centuries its exact function remains elusive. Early studies had noted its peculiar absence even among some healthy individuals. Population studies have investigated the differences in prevalence of IA in pathologic conditions and healthy controls. However, there is a general lack of consensus on IA prevalence in the healthy population. Understanding the true prevalence is critical in providing context for future studies, as well as uncovering further clues regarding IA's function. We systematically reviewed the existing literature to evaluate the prevalence of IA. The average prevalence among reviewed studies was higher than previously reported, at 87.3%. Studies utilizing magnetic resonance imaging rather than cadaveric specimens reported higher rates of IA prevalence. A higher prevalence among females was noted throughout the literature that persisted regardless of acquisition modality utilized.
Collapse
|
7
|
Prevalence and anatomical characteristics of the human massa intermedia. Brain Struct Funct 2021; 226:471-480. [DOI: 10.1007/s00429-020-02193-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
|
8
|
Whitehead MT, Najim N. Thalamic Massa Intermedia in Children with and without Midline Brain Malformations. AJNR Am J Neuroradiol 2020; 41:729-735. [PMID: 32115420 DOI: 10.3174/ajnr.a6446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/22/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The massa intermedia is a normal midline transventricular thalamic connection. Massa intermedia aberrations are common in schizophrenia, Chiari II malformation, X-linked hydrocephalus, Cornelia de Lange syndrome, and diencephalic-mesencephalic junction dysplasia, among others. We have noticed that massa intermedia abnormalities often accompany other midline malformations. The massa intermedia has never been formally evaluated in a group of exclusively pediatric patients, to our knowledge. We sought to compare and contrast the prevalence, size, and location of the massa intermedia in pediatric patients with and without congenital midline brain abnormalities. MATERIALS AND METHODS Successive 3T brain MR imaging examinations from pediatric patients with and without midline malformations were procured from the imaging data base at a pediatric hospital. Massa intermedia presence, size, morphology, and position were determined using 3D-TIWI with 1-mm isotropic resolution. The brain commissures, septum pellucidum, hypothalamus, hippocampus, vermis, and brain stem were evaluated to determine whether alterations were related to or predictive of massa intermedia abnormalities. RESULTS The massa intermedia was more frequently absent, dysmorphic, and/or displaced in patients with additional midline abnormalities than in those without. The massa intermedia was absent in 40% of patients with midline malformations versus 12% of patients with normal findings (P < .001). Massa intermedia absence, surface area, and morphology were predictable by various attributes and alterations of the commissures, hippocampus, hypothalamus, vermis, brain stem, and third ventricle. CONCLUSIONS Most pediatric patients have a thalamic massa intermedia centered in the anterior/superior third ventricle. Massa intermedia abnormalities are commonly associated with other midline malformations. Normal-variant massa intermedia absence is a diagnosis of exclusion.
Collapse
Affiliation(s)
- M T Whitehead
- From the Department of Radiology (M.T.W., N.N.), Children's National Hospital, Washington, DC .,The George Washington University Hospital (M.T.W.), Washington, DC
| | - N Najim
- From the Department of Radiology (M.T.W., N.N.), Children's National Hospital, Washington, DC
| |
Collapse
|