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de Matos K, Cury C, Chougar L, Strike LT, Rolland T, Riche M, Hemforth L, Martin A, Banaschewski T, Bokde ALW, Desrivières S, Flor H, Grigis A, Garavan H, Gowland P, Heinz A, Brühl R, Martinot JL, Paillère Martinot ML, Artiges E, Nees F, Papadopoulos Orfanos D, Lemaitre H, Paus T, Poustka L, Hohmann S, Millenet S, Fröhner JH, Smolka MN, Vaidya N, Walter H, Whelan R, Schumann G, Frouin V, Bach Cuadra M, Colliot O, Couvy-Duchesne B. Temporo-basal sulcal connections: a manual annotation protocol and an investigation of sexual dimorphism and heritability. Brain Struct Funct 2023; 228:1459-1478. [PMID: 37358662 DOI: 10.1007/s00429-023-02663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
The temporo-basal region of the human brain is composed of the collateral, the occipito-temporal, and the rhinal sulci. We manually rated (using a novel protocol) the connections between rhinal/collateral (RS-CS), collateral/occipito-temporal (CS-OTS) and rhinal/occipito-temporal (RS-OTS) sulci, using the MRI of nearly 3400 individuals including around 1000 twins. We reported both the associations between sulcal polymorphisms as well with a wide range of demographics (e.g. age, sex, handedness). Finally, we also estimated the heritability, and the genetic correlation between sulcal connections. We reported the frequency of the sulcal connections in the general population, which were hemisphere dependent. We found a sexual dimorphism of the connections, especially marked in the right hemisphere, with a CS-OTS connection more frequent in females (approximately 35-40% versus 20-25% in males) and an RS-CS connection more common in males (approximately 40-45% versus 25-30% in females). We confirmed associations between sulcal connections and characteristics of incomplete hippocampal inversion (IHI). We estimated the broad sense heritability to be 0.28-0.45 for RS-CS and CS-OTS connections, with hints of dominant contribution for the RS-CS connection. The connections appeared to share some of their genetic causing factors as indicated by strong genetic correlations. Heritability appeared much smaller for the (rarer) RS-OTS connection.
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Affiliation(s)
- Kevin de Matos
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
- CIBM Center for Biomedical Imaging, Vaud, Switzerland
- Radiology Department, Lausanne University and University Hospital, Lausanne, Switzerland
| | - Claire Cury
- CNRS, Inria, Inserm, IRISA UMR 6074, Empenn ERL U-1228, University of Rennes, 35000, Rennes, France
| | - Lydia Chougar
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
- Service de neuroradiologie, AP-HP, Pitié-Salpêtrière, Paris, France
| | - Lachlan T Strike
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, 4072, Australia
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Thibault Rolland
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
| | - Maximilien Riche
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, 75013, Paris, France
| | - Lisa Hemforth
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
| | - Alexandre Martin
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
- Inria Sophia Antipolis, Morpheme Project, Paris, France
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Arun L W Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Sylvane Desrivières
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute of Psychiatry, Psychology & Neuroscience, SGDP Centre, King's College London, London, UK
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Square J5, Mannheim, Germany
- Department of Psychology, School of Social Sciences, University of Mannheim, 68131, Mannheim, Germany
| | - Antoine Grigis
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT, 05405, USA
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, UK
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Rüdiger Brühl
- Physikalisch-Technische Bundesanstalt (PTB), Brunswick, Berlin, Germany
| | - Jean-Luc Martinot
- INSERM U 1299 "Trajectoires développementales & psychiatrie", CNRS, Institut National de la Santé et de la Recherche Médicale, Ecole Normale Supérieure Paris-Saclay, Centre Borelli, University Paris-Saclay, Gif-sur-Yvette, France
| | - Marie-Laure Paillère Martinot
- INSERM U 1299 "Trajectoires développementales & psychiatrie", CNRS, AP-HP, Institut National de la Santé et de la Recherche Médicale, Ecole Normale Supérieure Paris-Saclay, Centre Borelli, University Paris-Saclay, Gif-sur-Yvette, France
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Eric Artiges
- INSERM U 1299 "Trajectoires développementales & psychiatrie", CNRS, Institut National de la Santé et de la Recherche Médicale, Ecole Normale Supérieure Paris-Saclay, Centre Borelli, University Paris-Saclay, Gif-sur-Yvette, France
- Psychiatry Department, EPS Barthélémy Durand, Etampes, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Square J5, 68159, Mannheim, Germany
- Institute of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Square J5, Mannheim, Germany
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | | | - Herve Lemaitre
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
- UMR 5293, CNRS, CEA, Institut des Maladies Neurodégénératives, Université de Bordeaux, 33076, Bordeaux, France
| | - Tomáš Paus
- Departments of Psychiatry and Neuroscience, Université de Montréal and Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Departments of Psychiatry and Psychology, University of Toronto, Toronto, ON, Canada
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Juliane H Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Nilakshi Vaidya
- Department of Psychiatry and Neuroscience, Centre for Population Neuroscience and Stratified Medicine (PONS), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Gunter Schumann
- Department of Psychiatry and Neuroscience, Centre for Population Neuroscience and Stratified Medicine (PONS), Charité Universitätsmedizin Berlin, Berlin, Germany
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute for Science and Technology of Brain-Inspired Intelligence (ISTBI), Fudan University, Shanghai, China
| | - Vincent Frouin
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Meritxell Bach Cuadra
- CIBM Center for Biomedical Imaging, Vaud, Switzerland
- Radiology Department, Lausanne University and University Hospital, Lausanne, Switzerland
| | - Olivier Colliot
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
| | - Baptiste Couvy-Duchesne
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France.
- Institute for Molecular Biosciences, The University of Queensland, St Lucia, QLD, 4062, Australia.
- ARAMIS Team, Pitié-Salpêtrière Hospital, Institut du Cerveau, 75013, Paris, France.
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Emerson SN, Kadri PADS, Toczylowski M, Al-Mefty O. Inferior is Superior—Transtentorial Transcollateral Sulcus Approach to the Ventricular Atrium: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e369-e370. [DOI: 10.1227/ons.0000000000000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
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Zachlod D, Kedo O, Amunts K. Anatomy of the temporal lobe: From macro to micro. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:17-51. [PMID: 35964970 DOI: 10.1016/b978-0-12-823493-8.00009-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The temporal cortex encompasses a large number of different areas ranging from the six-layered isocortex to the allocortex. The areas support auditory, visual, and language processing, as well as emotions and memory. The primary auditory cortex is found at the Heschl gyri, which develop early in ontogeny with the Sylvian fissure, a deep and characteristic fissure that separates the temporal lobe from the parietal and frontal lobes. Gyri and sulci as well as brain areas vary between brains and between hemispheres, partly linked to the functional organization of language and lateralization. Interindividual variability in anatomy makes a direct comparison between different brains in structure-functional analysis often challenging, but can be addressed by applying cytoarchitectonic probability maps of the Julich-Brain atlas. We review the macroanatomy of the temporal lobe, its variability and asymmetry at the macro- and the microlevel, discuss the relationship to brain areas and their microstructure, and emphasize the advantage of a multimodal approach to address temporal lobe organization. We review recent data on combined cytoarchitectonic and molecular architectonic studies of temporal areas, and provide links to their function.
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Affiliation(s)
- Daniel Zachlod
- Institute of Neuroscience and Medicine, INM-1, Research Centre Juelich, Juelich, Germany
| | - Olga Kedo
- Institute of Neuroscience and Medicine, INM-1, Research Centre Juelich, Juelich, Germany
| | - Katrin Amunts
- Institute of Neuroscience and Medicine, INM-1, Research Centre Juelich, Juelich, Germany; C&O Vogt Institute for Brain Research, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
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Legouhy A, Commowick O, Proisy M, Rousseau F, Barillot C. Regional brain development analysis through registration using anisotropic similarity, a constrained affine transformation. PLoS One 2020; 15:e0214174. [PMID: 32092061 PMCID: PMC7039415 DOI: 10.1371/journal.pone.0214174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 12/06/2019] [Indexed: 12/03/2022] Open
Abstract
We propose a novel method to quantify brain growth in 3 arbitrary orthogonal directions of the brain or its sub-regions through linear registration. This is achieved by introducing a 9 degrees of freedom (dof) transformation called anisotropic similarity which is an affine transformation with constrained scaling directions along arbitrarily chosen orthogonal vectors. This gives the opportunity to extract scaling factors describing brain growth along those directions by registering a database of subjects onto a common reference. This information about directional growth brings insights that are not usually available in longitudinal volumetric analysis. The interest of this method is illustrated by studying the anisotropic regional and global brain development of 308 healthy subjects betwen 0 and 19 years old. A gender comparison of those scaling factors is also performed for four age-intervals. We demonstrate through these applications the stability of the method to the chosen reference and its ability to highlight growth differences accros regions and gender.
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Affiliation(s)
- Antoine Legouhy
- CNRS, INRIA, INSERM, IRISA UMR 6074, Empenn ERL U-1228, Univ Rennes, Rennes, France
- * E-mail:
| | - Olivier Commowick
- CNRS, INRIA, INSERM, IRISA UMR 6074, Empenn ERL U-1228, Univ Rennes, Rennes, France
| | - Maïa Proisy
- CNRS, INRIA, INSERM, IRISA UMR 6074, Empenn ERL U-1228, Univ Rennes, Rennes, France
- Radiology Department, CHU Rennes, Rennes, France
| | | | - Christian Barillot
- CNRS, INRIA, INSERM, IRISA UMR 6074, Empenn ERL U-1228, Univ Rennes, Rennes, France
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Bouyeure A, Germanaud D, Bekha D, Delattre V, Lefèvre J, Pinabiaux C, Mangin JF, Rivière D, Fischer C, Chiron C, Hertz-Pannier L, Noulhiane M. Three-Dimensional Probabilistic Maps of Mesial Temporal Lobe Structures in Children and Adolescents' Brains. Front Neuroanat 2018; 12:98. [PMID: 30498435 PMCID: PMC6249374 DOI: 10.3389/fnana.2018.00098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/29/2018] [Indexed: 11/13/2022] Open
Abstract
The hippocampus and the adjacent perirhinal, entorhinal, temporopolar, and parahippocampal cortices are interconnected in a hierarchical MTL system crucial for memory processes. A probabilistic description of the anatomical location and spatial variability of MTL cortices in the child and adolescent brain would help to assess structure-function relationships. The rhinal sulcus (RS) and the collateral sulcus (CS) that border MTL cortices and influence their morphology have never been described in these populations. In this study, we identified the aforementioned structures on magnetic resonance images of 38 healthy subjects aged 7-17 years old. Relative to sulcal morphometry in the MTL, we showed RS-CS conformation is an additional factor of variability in the MTL that is not explained by other variables such as age, sex and brain volume; with an innovative method using permutation testing of the extrema of structures of interest, we showed that RS-SC conformation was not associated with differences of location of MTL sulci. Relative to probabilistic maps, we offered for the first time a systematic mapping of MTL structures in children and adolescent, mapping all the structures of the MTL system while taking sulcal morphology into account. Our results, with the probabilistic maps described here being freely available for download, will help to understand the anatomy of this region and help functional and clinical studies to accurately test structure-function hypotheses in the MTL during development. Free access to MTL pediatric atlas: http://neurovault.org/collections/2381/.
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Affiliation(s)
- Antoine Bouyeure
- INSERM, CEA, Université Paris Descartes, Sorbonne Paris Cité, Neurospin, UNIACT, UMR1129, Gif-sur-Yvette, France
| | - David Germanaud
- INSERM, CEA, Université Paris Descartes, Sorbonne Paris Cité, Neurospin, UNIACT, UMR1129, Gif-sur-Yvette, France
- Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Robert-Debré, DHU Protect, Service de Neurologie Pédiatrique et des Maladies Métaboliques, Paris, France
| | - Dhaif Bekha
- INSERM, CEA, Université Paris Descartes, Sorbonne Paris Cité, Neurospin, UNIACT, UMR1129, Gif-sur-Yvette, France
| | - Victor Delattre
- INSERM, CEA, Université Paris Descartes, Sorbonne Paris Cité, Neurospin, UNIACT, UMR1129, Gif-sur-Yvette, France
| | - Julien Lefèvre
- CNRS, ENSAM, LSIS UMR 7296, Aix Marseille University, Toulon University, Toulon, France
| | - Charlotte Pinabiaux
- Université Paris Ouest Nanterre La Défense, Laboratoire CHArt (EA 4004), Nanterre, France
| | | | - Denis Rivière
- CEA, University Paris Saclay, NeuroSpin, UNATI, Gif-sur-Yvette, France
| | - Clara Fischer
- CEA, University Paris Saclay, NeuroSpin, UNATI, Gif-sur-Yvette, France
| | - Catherine Chiron
- INSERM, CEA, Université Paris Descartes, Sorbonne Paris Cité, Neurospin, UNIACT, UMR1129, Gif-sur-Yvette, France
| | - Lucie Hertz-Pannier
- INSERM, CEA, Université Paris Descartes, Sorbonne Paris Cité, Neurospin, UNIACT, UMR1129, Gif-sur-Yvette, France
| | - Marion Noulhiane
- INSERM, CEA, Université Paris Descartes, Sorbonne Paris Cité, Neurospin, UNIACT, UMR1129, Gif-sur-Yvette, France
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Dorfer C, Czech T, Aull-Watschinger S, Baumgartner C, Jung R, Kasprian G, Novak K, Pirker S, Seidl B, Stefanits H, Trimmel K, Pataraia E. Mesial temporal lobe epilepsy: long-term seizure outcome of patients primarily treated with transsylvian selective amygdalohippocampectomy. J Neurosurg 2017; 129:174-181. [PMID: 29027855 DOI: 10.3171/2017.4.jns162699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to present long-term seizure outcome data in a consecutive series of patients with refractory mesial temporal lobe epilepsy primarily treated with transsylvian selective amygdalohippocampectomy (SAHE). METHODS The authors retrospectively analyzed prospectively collected data for all patients who had undergone resective surgery for medically refractory epilepsy at their institution between July 1994 and December 2014. Seizure outcome was assessed according to the International League Against Epilepsy (ILAE) and the Engel classifications. RESULTS The authors performed an SAHE in 158 patients (78 males, 80 females; 73 right side, 85 left side) with a mean age of 37.1 ± 10.0 years at surgery. Four patients lost to follow-up and 1 patient who committed suicide were excluded from analysis. The mean follow-up period was 9.7 years. At the last available follow-up (or before reoperation), 68 patients (44.4%) had achieved an outcome classified as ILAE Class 1a, 46 patients (30.1%) Class 1, 6 patients (3.9%) Class 2, 16 patients (10.4%) Class 3, 15 patients (9.8%) Class 4, and 2 patients (1.3%) Class 5. These outcomes correspond to Engel Class I in 78.4% of the patients, Engel Class II in 10.5%, Engel Class III in 8.5%, and Engel Class IV in 2.0%. Eleven patients underwent a second surgery (anterior temporal lobectomy) after a mean of 4.4 years from the SAHE (left side in 6 patients, right side in 5). Eight (72.7%) of these 11 patients achieved seizure freedom. The overall ILEA seizure outcome since (re)operation after a mean follow-up of 10.0 years was Class 1a in 72 patients (47.0%), Class 1 in 50 patients (32.6%), Class 2 in 7 patients (4.6%), Class 3 in 15 patients (9.8%), Class 4 in 8 patients (5.2%), and Class 5 in 1 patient (0.6%). These outcomes correspond to an Engel Class I outcome in 84.3% of the patients. CONCLUSIONS A satisfactory long-term seizure outcome following transsylvian SAHE was demonstrated in a selected group of patients with refractory temporal lobe epilepsy.
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Affiliation(s)
| | | | | | - Christoph Baumgartner
- 3Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | | | - Gregor Kasprian
- 4Radiology and Nuclear Medicine, Medical University of Vienna; and
| | | | - Susanne Pirker
- 3Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
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Jeelani Y, Gokoglu A, Anor T, Al-Mefty O, Cohen AR. Transtentorial transcollateral sulcus approach to the ventricular atrium: an endoscope-assisted anatomical study. J Neurosurg 2017; 126:1246-1252. [DOI: 10.3171/2016.3.jns151289] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Conventional approaches to the atrium of the lateral ventricle may be associated with complications related to direct cortical injury or brain retraction. The authors describe a novel approach to the atrium through a retrosigmoid transtentorial transcollateral sulcus corridor.
METHODS
Bilateral retrosigmoid craniotomies were performed on 4 formalin-fixed, colored latex–injected human cadaver heads (a total of 8 approaches). Microsurgical dissections were performed under 3× to 24× magnification, and endoscopic visualization was provided by 0° and 30° rigid endoscope lens systems. Image guidance was provided by coupling an electromagnetic tracking system with an open source software platform. Objective measurements on cortical thickness traversed and total depth of exposure were recorded. Additionally, the basal occipitotemporal surfaces of 10 separate cerebral hemisphere specimens were examined to define the surface topography of sulci and gyri, with attention to the appearance and anatomical patterns and variations of the collateral sulcus and the surrounding gyri.
RESULTS
The retrosigmoid approach allowed for clear visualization of the basal occipitotemporal surface. The collateral sulcus was identified and permitted easy endoscopic access to the ventricular atrium. The conical corridor thus obtained provided an average base working area of 3.9 cm2 at an average depth of 4.5 cm. The mean cortical thickness traversed to enter the ventricle was 1.4 cm. The intraventricular anatomy of the ipsilateral ventricle was defined clearly in all 8 exposures in this manner. The anatomy of the basal occipitotemporal surface, observed in a total of 18 hemispheres, showed a consistent pattern, with the collateral sulcus abutted by the parahippocampal gyrus medially, and the fusiform and lingual gyrus laterally. The collateral sulcus was found to be caudally bifurcated in 14 of the 18 specimens.
CONCLUSIONS
The retrosigmoid supracerebellar transtentorial transcollateral sulcus approach is technically feasible. This approach has the potential advantage of providing a short and direct path to the atrium, hence avoiding violation of deep neurovascular structures and preserving eloquent areas. Although this approach appears unconventional, it may provide a minimally invasive option for the surgical management of selected lesions within the atrium of the lateral ventricle.
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Affiliation(s)
- Yasser Jeelani
- 1Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School; and
| | - Abdulkerim Gokoglu
- 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tomer Anor
- 1Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School; and
| | - Ossama Al-Mefty
- 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alan R. Cohen
- 1Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School; and
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8
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Cikla U, Menekse G, Quraishi A, Neves G, Keles A, Liu C, Salamat SM, Baskaya MK. The sulci of the inferior surface of the temporal lobe: An anatomical study. Clin Anat 2016; 29:932-42. [PMID: 27521775 DOI: 10.1002/ca.22767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/29/2016] [Accepted: 08/07/2016] [Indexed: 11/10/2022]
Abstract
Understanding the anatomy of temporal lobe sulci and their variations can allow for safer neurosurgical approaches. Although the inferior temporal sulci and their relations to each other has been described by several authors, the nomenclature used has not been universal. The aim of this study was to investigate the anatomic features of the three main sulci of the inferior temporal lobe and provide a simple description of complex patterns among these sulci. Sulcal variations and their relations were examined in seventy formalin-fixed, adult cadaveric cerebral hemispheres. We recommend a simple but modified classification specifically for anatomic variations of the rhinal and collateral sulci. Furthermore, we describe the frequency of occipitotemporal sulci that contain 5 and 6 segments, not previously mentioned. The length and depth of all sulci were measured in all samples. Additionally, more detailed results regarding the patterns, courses, connections, relationships and measurements were given. Understanding of the complex anatomy of this clinically important region is of benefit to neurosurgeons, providing necessary guidance for neurosurgical approaches to the inferior surface of the temporal lobe. Clin. Anat. 29:932-942, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ulas Cikla
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Guner Menekse
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Arman Quraishi
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Gabriel Neves
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Abdullah Keles
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Collin Liu
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Shahriar M Salamat
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mustafa K Baskaya
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
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9
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Three-dimensional probability maps of the rhinal and the collateral sulci in the human brain. Brain Struct Funct 2016; 221:4235-4255. [DOI: 10.1007/s00429-016-1189-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/12/2016] [Indexed: 10/21/2022]
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10
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Sulcal and gyral anatomy of the basal occipital-temporal lobe. Surg Radiol Anat 2014; 36:959-65. [PMID: 24744138 DOI: 10.1007/s00276-014-1294-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The sulcal and gyral anatomy of the basal occipital-temporal lobe is highly variable and detailed descriptions of this region are limited and often inconsistent. The aim of this study was to describe the salient features of the sulcal and gyral anatomy of the basal occipital-temporal lobe. METHODS We studied the sulcal and gyral patterns of 30 formalin-fixed cerebral hemispheres. RESULTS The major landmarks are the collateral sulcus (separated into the rhinal, proper, and caudal segments) and occipitotemporal sulcus (often interrupted), which were always present in this study. The bifurcation of the caudal collateral sulcus is a useful landmark. In relation to these sulci, we have described the surface anatomy and nominated landmarks of the medial (parahippocampal and lingual) and lateral (fusiform) occipitotemporal gyri. CONCLUSIONS Understanding of the sulcal and gyral patterns of the basal occipital-temporal lobe may provide valuable information in its radiological and intraoperative interpretation.
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Huntgeburth SC, Petrides M. Morphological patterns of the collateral sulcus in the human brain. Eur J Neurosci 2012; 35:1295-311. [PMID: 22512258 DOI: 10.1111/j.1460-9568.2012.08031.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The collateral sulcal complex is an important landmark on the medial surface of the temporal lobe. Anteriorly, it delineates the limbic regions of the parahippocampal gyrus from the visual-processing areas of the fusiform gyrus. Posteriorly, it continues into the occipital lobe, bearing no relationship to the memory-related limbic regions. Given the considerable extent of the sulcus and functional heterogeneity of the surrounding cortex, an investigation of the morphology of this sulcus was carried out to examine whether it is continuous or a series of sulcal parts, i.e. independent sulci classified together under the name collateral sulcus. We investigated the collateral sulcal complex using magnetic resonance images taking into account the three-dimensional nature of the brain. Our examination demonstrated three separate sulcal segments: (i) an anterior segment, the rhinal sulcus, delineating the uncus from the adjacent temporal neocortex, (ii) a middle segment, the collateral sulcus proper, forming the lateral border of the posterior parahippocampal cortex, and (iii) a caudal segment, the occipital extent of the collateral sulcus, within the occipital lobe. Three relationships exist between the rhinal sulcus and collateral sulcus proper, only one being clearly identifiable from the surface. Posteriorly, the collateral sulcus proper and the occipital collateral sulcus, although appearing continuous on the brain surface, can be separated in the depth of the sulcus in all cases. These results provide quantification of the location and variability within standard stereotaxic space for the three collateral sulcus segments that could be used to aid accurate identification of functional activation peaks derived from neuroimaging studies.
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Affiliation(s)
- Sonja C Huntgeburth
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, Canada H3A 2B4.
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Reckess GZ, Dunn CB, Bauer RM, Leonard CM. Anterior temporobasal sulcal morphology: development of a reliable rating protocol and normative data. Brain Struct Funct 2012; 218:889-901. [PMID: 22744398 DOI: 10.1007/s00429-012-0436-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 06/05/2012] [Indexed: 11/28/2022]
Abstract
The three anterior temporobasal (aTB) sulci, which are the collateral, rhinal, and occipitotemporal sulci, contribute to the morphology of memory-related structures and are important landmarks for neuroimaging. Prevalence of inter-connections among these sulci may distinguish healthy adults and individuals with memory-related disorders (Kim et al. Neurology 70:2159-2165, 2008; Zhan et al. Hum Brain Mapp 30:874-882, 2009). However, methods for quantifying the existence and nature of such connections are vague and varied, and normative frequencies are inconsistent across studies. Therefore, the goals of the current study are twofold: (1) to develop a reliable method of identifying aTB sulci and their interconnections based on surface renderings generated from serial magnetic resonance images (MRIs). This protocol includes training materials and a rating log (see supplementary materials) that can be disseminated and applied by other researchers. (2) To determine the prevalence of interconnections among the three aTB sulci in a large sample of healthy adults (200 undergraduate students), which can be used as normative data for future comparison with clinical samples. Notably, the resulting protocol, called the Sulcal Classification Rating Protocol for anterior Temporobasal sulci, distinguishes "clear" from "ambiguous" connections. When only clear connections are included, our prevalence rates are consistent with post-mortem findings of Ono et al. (Atlas of the Cerebral Sulci. Thieme Medical Publishers, Inc., New York, 1990); when both clear and ambiguous connections are counted as a connection, our results largely replicate MRI-based findings (e.g., Kim et al. Neurology 70:2159-2165, 2008). We propose that systematic variations in rater classification of ambiguous connections could explain discrepancies in the literature.
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Affiliation(s)
- Gila Z Reckess
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
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Wang F, Sun T, Li X, Xia H, Li Z. Microsurgical and tractographic anatomical study of insular and transsylvian transinsular approach. Neurol Sci 2011; 32:865-74. [PMID: 21863272 PMCID: PMC3171658 DOI: 10.1007/s10072-011-0721-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 07/16/2011] [Indexed: 11/28/2022]
Abstract
This study is to define the operative anatomy of the insula with emphasis on the transsylvian transinsular approach. The anatomy was studied in 15 brain specimens, among five were dissected by use of fiber dissection technique; diffusion tensor imaging of 10 healthy volunteers was obtained with a 1.5-T MR system. The temporal stem consists mainly of the uncinate fasciculus, inferior occipitofrontal fasciculus, Meyer’s loop of the optic radiation and anterior commissure. The transinsular approach requires an incision of the inferior limiting sulcus. In this procedure, the fibers of the temporal stem can be interrupted to various degrees. The fiber dissection technique is a very relevant and reliable method for neurosurgeons to study the details of brain anatomic features. The DTI fiber tracking technique can identify the fiber tracts of the temporal stem. Moreover, it will also help further functional study of human insula.
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Affiliation(s)
- Feng Wang
- Department of Neurosurgery, Affiliated Hospital of Ningxia Medical University, Yinchuan, China
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Malikova H, Liscak R, Vojtech Z, Prochazka T, Vymazal J, Vladyka V, Druga R. Stereotactic radiofrequency amygdalohippocampectomy: Does reduction of entorhinal and perirhinal cortices influence good clinical seizure outcome? Epilepsia 2011; 52:932-40. [DOI: 10.1111/j.1528-1167.2011.03048.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reoperation after selective amygdalohippocampectomy: an MRI analysis of the extent of temporomesial resection in ten cases. Acta Neurochir (Wien) 2011; 153:239-48. [PMID: 20853122 DOI: 10.1007/s00701-010-0802-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Selective amygdalohippocampectomy (SAHE) yields 60-80% of patients with medically refractory mesial temporal lobe epilepsy seizure-free and seems to be equally effective compared to the more extended temporal lobe resections. The resection of the entire entorhinal cortex (EC) is of crucial importance to warrant complete seizure control for those patients. Thus, evidence of residual EC could be a predictor of a potentially successful reoperation in patients with recurrent seizures after SAHE. We performed an analysis of preoperative and postoperative magnetic resonance imaging (MRI) in patients who underwent a reoperation after an unsuccessful transsylvian SAHE to assess the presence of residual EC before reoperation and to determine whether certain anatomical variants may dispose patients to incomplete resection of EC. MATERIALS AND METHODS Ten patients who underwent reoperation after SAHE for the recurrence of medically refractory seizures were studied. MRI after SAHE was assessed for the presence of residual EC using T2-weighted and inversion recovery sequences perpendicularly to the main axis of the hippocampus. The results were compared with a control group of ten patients who became seizure-free after SAHE. In the nine patients of the study group, the sulcal anatomy of the basal temporal lobe was graphically outlined and analysed on MRI scans performed before SAHE to characterise the sulcal boundaries of the EC. FINDINGS Residual EC was found in nine of ten patients and was absent in the control group. After reoperation (median follow-up of 36.5 months), eight out of ten patients were completely seizure-free. In seven out of nine patients, a discontinuous course of the lateral sulcal boundaries of the EC was determined. CONCLUSIONS Careful analysis of MRI verified residual mesiotemporal structures in the majority of patients who became seizure-free after reoperation. Certain temporobasal sulcal patterns might dispose for a higher risk of incomplete resection of the EC. The study confirms that reoperation is an effective treatment modality for patients with recurrent seizures after transsylvian SAHE.
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Schramm J, Lehmann TN, Zentner J, Mueller CA, Scorzin J, Fimmers R, Meencke HJ, Schulze-Bonhage A, Elger CE. Randomized controlled trial of 2.5-cm versus 3.5-cm mesial temporal resection--Part 2: volumetric resection extent and subgroup analyses. Acta Neurochir (Wien) 2011; 153:221-8. [PMID: 21170557 DOI: 10.1007/s00701-010-0901-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/25/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND This paper is addressing outcome differences in interesting subgroups from a previous randomized controlled trial of the extent of mesial temporal lobe resection (TLR) for drug-resistant epilepsy, by looking at effects of randomization, intended resection group, center, and true resection extent on seizure outcome. METHODS One hundred and seventy-nine cases with volumetrically assessed resection extent were used. Analyses of the extent of resection and subgroups and within subgroups for the two treatment arms will be performed, looking for confounding factors and using statistical methods (chi-square test, logistic regression analysis, and two-factorial ANOVA). RESULTS True resection extent varied considerably. Outcome comparison for right versus left resections, subgroups with mesial temporal sclerosis (MTS), or largest and smallest resections revealed no remarkable difference, compared to overall class I outcome. The intent-to-treat analyses within these subgroups revealed differences for class I outcome, albeit lacking in significance, except for better TLR outcome. Small true resection volume differences or randomization into the two resection groups could not explain the outcome differences between the selective amygdalohippocampectomy (SAH) and TLR subgroups. Logistic regression analysis showed an interaction between intended resection length and surgery type, confirming the impression of different impacts of the intended resection length under the two surgery types. The outcome difference between SAH and TLR was more likely explained by a center effect. In a two-factorial ANOVA for resected hippocampal volume, Engel outcome class I, and resection type, the outcome was not found to be correlated with true resection volume. A multifactorial logistic regression showed a mild interaction between the resection type with center on the Engel outcome class, extent of resection, and surgery type interacted, as did the extent of resection and center. CONCLUSION Patients with quite similar extent of resection can be seizure free or non-seizure free. In this cohort, seizure freedom rates fell again when the extent of mesial resection was maximized. Differences in class I outcome for SAH and TLR were not due to erroneous randomization, true resection extent, or presence of MTS, but were influenced by a center effect. Subgroup analyses did not help to provide arguments to favor one surgery type over the other.
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Schramm J, Lehmann TN, Zentner J, Mueller CA, Scorzin J, Fimmers R, Meencke HJ, Schulze-Bonhage A, Elger CE. Randomized controlled trial of 2.5-cm versus 3.5-cm mesial temporal resection in temporal lobe epilepsy--Part 1: intent-to-treat analysis. Acta Neurochir (Wien) 2011; 153:209-19. [PMID: 21170558 DOI: 10.1007/s00701-010-0900-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/25/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Only one prospective randomized study on the extent of mesial resection in surgery for temporal lobe epilepsy (TLE) exists. This randomized controlled trial (RCT) examines whether 3.5-cm mesial resection is leading to a better seizure outcome than a 2.5-cm resection. METHODS Three epilepsy surgery centers using similar MRI protocols, neuropsychological tests, and resection types for TLE surgery included 207 patients in a RCT with pre- and postoperative volumetrics. One hundred and four patients were randomized into a 2.5-cm resection group and 103 patients into a 3.5-cm resection group, i.e., an intended minimum resection length of 25 versus 35 mm for the hippocampus and parahippocampus. Primary outcome measure was seizure freedom Engel class I throughout the first year. The study was powered to detect a 20% difference in class I outcome. Seizure outcome was available for 207 patients, complete volumetric results for 179 patients. Outcome analysis was restricted to control of successful randomization and an intent-to-treat analysis of seizure outcome. RESULTS The mean true resection volumes were significantly different for the 2.5-cm and 3.5-cm resection groups; thus, the randomization was successful. Median resection volume in the 2.5-cm group was 72.86% of initial volume and 83.44% in the 3.5-cm group. At 1 year, seizure outcome Engel class I was 74% in the 2.5-cm and 72.8% in the 3.5-cm resection group. CONCLUSIONS The primary intent-to-treat analysis did not show a different seizure freedom rate for the more posteriorly reaching 3.5-cm resection group. It appears possible that not maximal volume resection but adequate volume resection leads to good seizure freedom.
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Liscak R, Malikova H, Kalina M, Vojtech Z, Prochazka T, Marusic P, Vladyka V. Stereotactic radiofrequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy. Acta Neurochir (Wien) 2010; 152:1291-8. [PMID: 20361215 DOI: 10.1007/s00701-010-0637-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 03/12/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Minimally invasive percutaneous single trajectory stereotactic radiofrequency amygdalohippocampectomy was used to treat mesial temporal lobe epilepsy (MTLE). The aim of the study was to evaluate complications and effectiveness of this procedure. MATERIALS AND METHODS A group of 51 patients with MTLE was treated using stereotactic thermo-lesion of amygdalohippocampal complex under local anaesthesia. The target was reached through the occipital approach with a single trajectory using MRI stereotactic localisation. Thermocoagulation of the amygdalohippocampal complex was planned according to the individual anatomy of each patient. Amygdalohippocampectomy was performed using a string electrode with a 10-mm active tip, and 16-38 lesions (median = 25) were performed in all patients along the 30- to 45-mm trajectory (median = 35) in the amygdalohippocampal complex. RESULTS The procedure was well tolerated by all patients with no severe permanent morbidity; meningitis was recorded in two patients (4%), hematoma was detected in four patients, clinically insignificant in three of them, and one patient required temporary ventricular drainage (2%). Thirty-two patients were followed up over at least 2 years, and the clinical outcomes were evaluated by Engel's classification; 25 of them (78%) were Engel I, five (16%) were Engel II, and two (6%) were Engel IV. CONCLUSIONS Stereotactic amygdalohippocampectomy is a minimally invasive procedure with low morbidity and good results that can be the method of choice in selected patients with MTLE.
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Affiliation(s)
- Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Hospital Na Homolce, Roentgenova 2, Prague, Czech Republic.
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Yaşargil MG, Krayenbühl N, Roth P, Hsu SPC, Yaşargil DCH. The selective amygdalohippocampectomy for intractable temporal limbic seizures. J Neurosurg 2010; 112:168-85. [PMID: 19575575 DOI: 10.3171/2008.12.jns081112] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The proximal (anterior) transsylvian approach through a pterional craniotomy was developed by the senior author (M.G.Y.) in 1967 for the microsurgical treatment of saccular aneurysms of the circle of Willis, frontoorbital and temporobasal arteriovenous malformations, cavernomas, and extrinsic and intrinsic tumors. The acquired positive surgical experiences on this large series enabled the senior author, in 1973, to apply this approach for the selective amygdalohippocampectomy in patients with intractable mesial temporal lobe epilepsy. METHODS The proximal (anterior) transsylvian-transamygdala approach to the mesial temporal structures permits the selective two-thirds resection of the amygdala and hippocampus-parahippocampus in an anteroinferior to posteroinferior exploration axis along the base of the semicircular temporal horn. This strategy ensures preservation of the overlying neopallial temporal convolutions such as the T1, T2, T3, and T4 gyri as well as the related subcortical connective fiber systems and other essential components of the temporal white matter. The application of rigid brain self-retaining retractor systems was strictly avoided during the entire procedure. Computer-assisted navigation was never used. On routine postoperative CT scanning and MR imaging studies, infarction was not observed in any patient. The availability of tractography technology has proven that the connective fiber system around the resected mesial temporal area remains intact. RESULTS The surgical outcome and results on neoplastic and vascular lesions of the mesiobasal temporal region have been presented in Volumes II, IIIB, and IVB of Microneurosurgery. The surgical outcomes and results in 102 patients with mesial temporal seizures who underwent surgery performed by the senior author in Zürich have been previously published. In this paper, 73 patients who underwent surgery between 1994 and September 2006 in Little Rock, Arkansas, are presented, and 13 other patients are excluded who underwent surgery after September 2006. Altogether, among 188 patients who underwent surgery, there was no surgical mortality or morbidity, and no neurological deficits, new neurocognitive dysfunction, or impairments of the preoperative incapacities. CONCLUSIONS The surgical outcome in terms of seizures was rewarding in the majority of patients, particularly in those who exhibited the following irregularities on preoperative investigations: regular local dysfunctions on electroencephalography, dysmorphic changes in the mesiobasal temporal parenchyma on MR imaging studies, and hypometabolism in the anterior third of the temporal lobe on PET studies.
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Affiliation(s)
- M Gazi Yaşargil
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Fischl B, Stevens AA, Rajendran N, Yeo BTT, Greve DN, Van Leemput K, Polimeni JR, Kakunoori S, Buckner RL, Pacheco J, Salat DH, Melcher J, Frosch MP, Hyman BT, Grant PE, Rosen BR, van der Kouwe AJW, Wiggins GC, Wald LL, Augustinack JC. Predicting the location of entorhinal cortex from MRI. Neuroimage 2009; 47:8-17. [PMID: 19376238 DOI: 10.1016/j.neuroimage.2009.04.033] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/23/2009] [Accepted: 04/07/2009] [Indexed: 11/18/2022] Open
Abstract
Entorhinal cortex (EC) is a medial temporal lobe area critical to memory formation and spatial navigation that is among the earliest parts of the brain affected by Alzheimer's disease (AD). Accurate localization of EC would thus greatly facilitate early detection and diagnosis of AD. In this study, we used ultra-high resolution ex vivo MRI to directly visualize the architectonic features that define EC rostrocaudally and mediolaterally, then applied surface-based registration techniques to quantify the variability of EC with respect to cortical geometry, and made predictions of its location on in vivo scans. The results indicate that EC can be localized quite accurately based on cortical folding patterns, within 3 mm in vivo, a significant step forward in our ability to detect the earliest effects of AD when clinical intervention is most likely to be effective.
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Affiliation(s)
- Bruce Fischl
- Athinoula A Martinos Center, Department of Radiology, MGH, Harvard Medical School, Charlestown, MA 02129, USA.
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Schramm J. Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia 2008; 49:1296-307. [PMID: 18410360 DOI: 10.1111/j.1528-1167.2008.01604.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The efficacy of surgery to treat drug-resistant temporal lobe epilepsy (TLE) has been demonstrated in a prospective randomized trial. It remains controversial which resection method gives best results for seizure freedom and neuropsychological function. This review of 53 studies addressing extent of resection in surgery for TLE identified seven prospective studies of which four were randomized. There is considerable variability between the intended resection and the volumetrically assessed end result. Even leaving hippocampus or amygdalum behind can result in seizure freedom rates around 50%. Most authors found seizure outcome in selective amygdalohippocampectomy (SAH) to be similar to that of lobectomy and there is considerable evidence for better neuropsychological outcome in SAH. Studies varied in the relationship between extent of mesial resection and seizure freedom, most authors finding no positive correlation to larger mesial resection. Electrophysiological tailoring saw no benefit from larger resection in 6 of 10 studies. It must be concluded that class I evidence concerning seizure outcome related to type and extent of resection of mesial temporal lobe structures is rare. Many studies are only retrospective and do not use MRI volumetry. SAH appears to have similar seizure outcome and a better cognitive outcome than TLR. It remains unclear whether a larger mesial resection extent leads to better seizure outcome.
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Affiliation(s)
- Johannes Schramm
- Department of Neurosurgery, Bonn University Medical Center, University of Bonn, Bonn, Germany.
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Schramm J, Aliashkevich AF. Surgery for temporal mediobasal tumors: experience based on a series of 235 patients. Neurosurgery 2007; 60:285-94; discussion 294-5. [PMID: 17290179 DOI: 10.1227/01.neu.0000249281.69384.d7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the clinical characteristics, diagnosis, various approaches, and outcomes in a retrospective review of a large series of temporomediobasal (TMB) tumors. METHODS Charts from 235 patients with TMB tumors were identified from the glioma and epilepsy surgery database and from the electronic operations log. Preoperative magnetic resonance imaging scans were available for all patients and postoperative follow-up was available for 155 of these patients (mean follow-up period, 59 mo; range, 2-172 mo). Preoperative symptoms, approaches, technical problems, and surgical complications are described. RESULTS Two hundred and thirty-five patients with intra-axial TMB tumors (mean age, 35 yr) were collected during an 11-year period. The largest tumor groups were astrocytomas (38.0%), gangliogliomas (29.8%), dysembryoplastic neuroepithelial tumor (11.1%), and glioblastomas (11.1%). The most frequent tumor location was the mesial Type A tumor (45.1%), with this type also showing the highest proportion of benign (World Health Organization Grades I and II) histological features (91.3%). Of all tumors, 76.2% were benign. Larger tumor size was associated with higher frequency of malignant histopathological findings. The leading symptom was epilepsy in 91% of patients, followed by drug-resistant epilepsy in 71.5%. Significant preoperative neurological deficits, such as hemiparesis or aphasia, were seen in 3.8% of the patients; another 12% had visual field deficits. Thirty-eight patients with low-grade tumors had undergone surgery previously. Several surgical approaches were chosen: transsylvian in 28%, anterior two-thirds temporal lobe resection in 23%, temporal pole resection in 15.3%, subtemporal in 19%, and transcortical in 6%. The most frequent neurological complications were transient: dysphasia (4.2%), hemiparesis (5%), and oculomotor disturbance (2.5%). Permanent nonvisual neurological complications occurred in fewer than 2% of the patients and significant new hemianopic defects were found in another 5.4% of the patients. The most severe complication was one intraoperative internal carotid artery lesion. One patient died. CONCLUSION Small tumor size, magnetic resonance imaging, and microsurgery have made resection of mostly benign TMB tumors possible in a large number of patients. This series supports the conclusion that these tumors can be operated on with a relative degree of safety for the patient, provided that the anatomy of the mesial temporal lobe and the variety of approaches are well known to the surgeon. However, because of the complex anatomic structures in the vicinity, transient neurological deterioration is not infrequent and certain neurological disturbances (e.g., quadrantanopia) even seem to be unavoidable, whereas permanent significant deficits are rare.
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Affiliation(s)
- Johannes Schramm
- Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany.
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Pereira PMG, Oliveira E, Secca MF. Assessment of the preferred scout sagittal orientation for temporal lobe imaging with magnetic resonance. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2004; 18:19-25. [PMID: 15583976 DOI: 10.1007/s10334-004-0074-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Revised: 07/12/2004] [Accepted: 09/07/2004] [Indexed: 11/30/2022]
Abstract
Oblique magnetic resonance imaging of the temporal lobe (tilted orientation) requires a stable reference line with minimum variability. In the clinical setting, where several observers carry out examination of the patients, there is a need to assure minimum inter-observer variability, in order to obtain comparable tilted anatomical planes. This is particularly relevant when performing quantitative imaging (qMRI) of the hippocampus, amygdala and para-hippocampal cortices. In this study, eight experienced observers tested the stability of four sagittal reference lines by manually tracing the posterior commissure-obex (PC-OB) line, the line tangential to the anterior surface of the pons at its most convex point and the lines orthogonal to the main axis of both hippocampi, in ten exams of healthy subjects. The stability of the tracing was assessed by comparing the inter-observer variability expressed by the variances of the measurements. The observers' performance was assessed by comparing the precision of the tracing for each line. We tested the results statistically using Bartlett's test (analysis of the variances of the four lines) followed by Fischer-Snedecor (in order to compare the two lines that had the smallest variance). The PC-OB line and the line tangential to the anterior surface of the pons had smaller inter-observer variances than the orthogonal lines (p < 0.01). In addition, the variance of the PC-OB line was smaller than that of the line tangential to the pons (p < 0.01). There were no significant intra-observer differences in the precision of tracing of any of the lines. We show quantitatively that the PC-OB line is the scout reference that yields the smallest inter-observer variance. Thus, this line should be preferred to improve the reproducibility of temporal lobe imaging while performing tilted coronal and axial sequences, to make quantitative assessments of the hippocampus, amygdala and para-hippocampal cortices.
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