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De Benedictis A, de Palma L, Rossi-Espagnet MC, Marras CE. Connectome-based approaches in pediatric epilepsy surgery: "State-of-the art" and future perspectives. Epilepsy Behav 2023; 149:109523. [PMID: 37944286 DOI: 10.1016/j.yebeh.2023.109523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Modern epilepsy science has overcome the traditional interpretation of a strict region-specific origin of epilepsy, highlighting the involvement of wider patterns of altered neuronal circuits. In selected cases, surgery may constitute a valuable option to achieve both seizure freedom and neurocognitive improvement. Although epilepsy is now considered as a brain network disease, the most relevant literature concerning the "connectome-based" epilepsy surgery mainly refers to adults, with a limited number of studies dedicated to the pediatric population. In this review, the Authors summarized the main current available knowledge on the relevance of WM surgical anatomy in epilepsy surgery, the post-surgical modifications of brain structural connectivity and the related clinical impact of such modifications within the pediatric context. In the last part, possible implications and future perspectives of this approach have been discussed, especially concerning the optimization of surgical strategies and the predictive value of the epilepsy network analysis for planning tailored approaches, with the final aim of improving case selection, presurgical planning, intraoperative management, and postoperative results.
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Affiliation(s)
| | - Luca de Palma
- Epilepsy and Movement Disorders Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Rizzi M, Nichelatti M, Ferri L, Consales A, De Benedictis A, Cossu M. Seizure outcomes and safety profiles of surgical options for epilepsy associated to hypothalamic hamartomas. A systematic review and meta-analysis. Epilepsy Res 2023; 198:107261. [PMID: 38006630 DOI: 10.1016/j.eplepsyres.2023.107261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE Several surgical options are available for treating hypothalamic hamartoma-related epilepsy but their respective efficacy and safety profiles are poorly defined. METHODS A literature search identified English-language articles reporting series of patients (minimum 3 patients with a follow-up ≥12 months) operated on by either microsurgery, endoscopic surgery, radiosurgery, radiofrequency thermocoagulation or laser interstitial thermal therapy for hypothalamic hamartoma-related epilepsy. The unit of analysis was each selected study. Pooled rates of seizure freedom and of neurological and endocrinological complications were analyzed using meta-analysis to calculate both fixed and random effects. The results of meta-analyses were compared. RESULTS Thirty-nine studies were included. There were 568 and 514 participants for seizure outcome and complication analyses, respectively. The pairwise comparison showed that: i) the proportion of seizure-free cases was significantly lower for radiosurgery as compared to microsurgery, radiofrequency thermocoagulation and laser ablation, and significantly lower for endoscopic surgery as compared to radiofrequency thermocoagulation; ii) the proportion of permanent hypothalamic dysfunction was significantly higher for microsurgery as compared to all other techniques, and significantly lower for endoscopic surgery as compared to radiofrequency thermocoagulation and laser ablation; iii) the incidence of permanent neurological disorders was significantly higher for microsurgery as compared to endoscopic surgery, radiosurgery and radiofrequency thermocoagulation, and significantly lower for radiosurgery as compared to laser ablation. CONCLUSIONS Minimally invasive surgical techniques, including endoscopic surgery, radiofrequency thermocoagulation and laser ablation, represent an acceptable compromise between efficacy and safety in the treatment of hypothalamic hamartoma-related epilepsy. Microsurgery and radiosurgery should be considered in carefully selected cases.
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Affiliation(s)
- Michele Rizzi
- Functional Neurosurgery Unit and Epilepsy Surgery Program, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy.
| | - Michele Nichelatti
- Service of Biostatistics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Massimo Cossu
- Neurosurgery Unit, Giannina Gaslini Pediatric Hospital IRCCS, Genoa, Italy
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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De Benedictis A, Sawant N, Marasi A, Rossi-Espagnet MC, Carai A, Luglietto D, Bua A, Randi F, Savioli A, Borro L, Zama M, Marras CE. Calcium phosphate and titanium cranioplasty after total angular craniopagus separation. Clin Neurol Neurosurg 2023; 232:107906. [PMID: 37482050 DOI: 10.1016/j.clineuro.2023.107906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
Craniopagus separation requires careful planning and a multi-staged surgical approach, managed by a multidisciplinary team. Despite growing experience on surgical management, the long-term restoration of the cranial defect has been rarely discussed so far. Several alloplastic materials have been proposed as effective and safe solutions for cranioplasty even for pediatric patients, allowing for bone generation, good aesthetic results, and low complication rates. We report, for the first time, on a separated craniopagus child who underwent successful implant of a tailor-made system based on the combination of calcium phosphate ceramic reinforced with a titanium mesh.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy.
| | - Ninad Sawant
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Alessandra Marasi
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | | | - Andrea Carai
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | - Davide Luglietto
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | - Antonella Bua
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | - Alessandra Savioli
- Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, 4, piazza S. Onofrio, 00165 Rome, Italy
| | - Luca Borro
- Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofrio, 00165 Rome, Italy
| | - Mario Zama
- Craniofacial Centre-Plastic and Maxillofacial Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofrio, 00165 Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
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Vavassori L, Venturini M, Zigiotto L, Annicchiarico L, Corsini F, Avesani P, Petit L, De Benedictis A, Sarubbo S. The arcuate fasciculus: Combining structure and function into surgical considerations. Brain Behav 2023; 13:e3107. [PMID: 37280786 PMCID: PMC10454270 DOI: 10.1002/brb3.3107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/19/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Two Centuries from today, Karl Friedrich Burdach attributed the nomenclature "arcuate fasciculus" to a white matter (WM) pathway connecting the frontal to the temporal cortices by arching around the Sylvian fissure. Although this label remained essentially unvaried, the concepts related to it and the characterization of the structural properties of this bundle evolved along with the methodological progress of the past years. Concurrently, the functional relevance of the arcuate fasciculus (AF) classically restricted to the linguistic domain has extended to further cognitive abilities. These features make it a relevant structure to consider in a large variety of neurosurgical procedures. OBJECTIVE Herein, we build on our previous review uncovering the connectivity provided by the Superior Longitudinal System, including the AF, and provide a handy representation of the structural organization of the AF by considering the frequency of defined reports in the literature. By adopting the same approach, we implement an account of which functions are mediated by this WM bundle. We highlight how this information can be transferred to the neurosurgical field by presenting four surgical cases of glioma resection requiring the evaluation of the relationship between the AF and the nearby structures, and the safest approaches to adopt. CONCLUSIONS Our cumulative overview reports the most common wiring patterns and functional implications to be expected when approaching the study of the AF, while still considering seldom descriptions as an account of interindividual variability. Given its extension and the variety of cortical territories it reaches, the AF is a pivotal structure for different cognitive functions, and thorough understanding of its structural wiring and the functions it mediates is necessary for preserving the patient's cognitive abilities during glioma resection.
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Affiliation(s)
- Laura Vavassori
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
- Center for Mind and Brain Sciences (CIMeC)University of TrentoTrento Provincia Autonoma di TrentoItaly
| | - Martina Venturini
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Luca Zigiotto
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Luciano Annicchiarico
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Francesco Corsini
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Paolo Avesani
- Center for Mind and Brain Sciences (CIMeC)University of TrentoTrento Provincia Autonoma di TrentoItaly
- Neuroinfrmatics Laboratory (NiLab)Bruno Kessler FoundationPovo Provincia Autonoma di TrentoItaly
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives (GIN‐IMN), UMR5293, CNRS, CEAUniversity of BordeauxBordeauxFrance
| | | | - Silvio Sarubbo
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
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Ricci L, Tamilia E, Mercier M, Pepi C, Carfì-Pavia G, De Benedictis A, Assenza G, Di Lazzaro V, Vigevano F, Specchio N, de Palma L. Phase-amplitude coupling between low- and high-frequency activities as preoperative biomarker of focal cortical dysplasia subtypes. Clin Neurophysiol 2023; 150:40-48. [PMID: 37002979 DOI: 10.1016/j.clinph.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To evaluate whether ictal phase-amplitude coupling (PAC) between high-frequency activity and low-frequency activity could be used as a preoperative biomarker of Focal Cortical Dysplasia (FCD) subtypes. We hypothesize that FCD seizures present unique PAC characteristics that may be linked to their specific histopathological features. METHODS We retrospectively examined 12 children with FCD and refractory epilepsy who underwent successful epilepsy surgery. We identified ictal onsets recorded with stereo-EEG. We estimated the strength of PAC between low-frequencies and high-frequencies for each seizure by means of modulation index. Generalized mixed effect models and receiver operating characteristic (ROC) curve analysis were used to test the association between ictal PAC and FCD subtypes. RESULTS Ictal PAC was significantly higher in patients with FCD type II compared to type I, only on SOZ-electrodes (p < 0.005). No differences in ictal PAC were found on non-SOZ electrodes. Pre-ictal PAC registered on SOZ electrodes predicted FCD histopathology with a classification accuracy > 0.9 (p < 0.05). CONCLUSIONS The correlations between histopathology and neurophysiology provide evidence for the contribution of ictal PAC as a preoperative biomarker of FCD subtypes. SIGNIFICANCE Developed into a proper clinical application, such a technique may help improve clinical management and facilitate the prediction of surgical outcome in patients with FCD undergoing stereo-EEG monitoring.
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De Benedictis A, Marasi A, Rossi-Espagnet MC, Napolitano A, Parrillo C, Fracassi D, Baldassari G, Borro L, Bua A, de Palma L, Luisi C, Pepi C, Savioli A, Luglietto D, Marras CE. Vertical Hemispherotomy: Contribution of Advanced Three-Dimensional Modeling for Presurgical Planning and Training. J Clin Med 2023; 12:jcm12113779. [PMID: 37297974 DOI: 10.3390/jcm12113779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/22/2023] [Accepted: 04/22/2023] [Indexed: 06/12/2023] Open
Abstract
Vertical hemispherotomy is an effective treatment for many drug-resistant encephalopathies with unilateral involvement. One of the main factors influencing positive surgical results and long-term seizure freedom is the quality of disconnection. For this reason, perfect anatomical awareness is mandatory during each step of the procedure. Although previous groups attempted to reproduce the surgical anatomy through schematic representations, cadaveric dissections, and intraoperative photographs and videos, a comprehensive understanding of the approach may still be difficult, especially for less experienced neurosurgeons. In this work, we reported the application of advanced technology for three-dimensional (3D) modeling and visualization of the main neurova-scular structures during vertical hemispherotomy procedures. In the first part of the study, we built a detailed 3D model of the main structures and landmarks involved during each disconnection phase. In the second part, we discussed the adjunctive value of augmented reality systems for the management of the most challenging etiologies, such as hemimegalencephaly and post-ischemic encephalopathy. We demonstrated the contribution of advanced 3D modeling and visualization to enhance the quality of anatomical representation and interaction between the operator and model according to a surgical perspective, optimizing the quality of presurgical planning, intraoperative orientation, and educational training.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Alessandra Marasi
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | | | - Antonio Napolitano
- Medical Physics Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Chiara Parrillo
- Medical Physics Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Donatella Fracassi
- Medical Physics Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Giulia Baldassari
- Medical Physics Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Luca Borro
- Multimodal Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Antonella Bua
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Concetta Luisi
- Clinical and Experimental Neurology, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Chiara Pepi
- Clinical and Experimental Neurology, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Alessandra Savioli
- Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Davide Luglietto
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
| | - Carlo E Marras
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, Piazza S. Onofrio, 00165 Rome, Italy
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Antonelli M, Lucignani M, Parrillo C, Grassi F, Figà Talamanca L, Rossi Espagnet MC, Gandolfo C, Secinaro A, Pasquini L, De Benedictis A, Placidi E, De Palma L, Marras CE, Marasi A, Napolitano A. Magnetic resonance imaging based neurosurgical planning on hololens 2: A feasibility study in a paediatric hospital. Digit Health 2023; 9:20552076231214066. [PMID: 38025111 PMCID: PMC10656794 DOI: 10.1177/20552076231214066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/31/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The goal of this work is to show how to implement a mixed reality application (app) for neurosurgery planning based on neuroimaging data, highlighting the strengths and weaknesses of its design. Methods Our workflow explains how to handle neuroimaging data, including how to load morphological, functional and diffusion tensor imaging data into a mixed reality environment, thus creating a first guide of this kind. Brain magnetic resonance imaging data from a paediatric patient were acquired using a 3 T Siemens Magnetom Skyra scanner. Initially, this raw data underwent specific software pre-processing and were subsequently transformed to ensure seamless integration with the mixed reality app. After that, we created three-dimensional models of brain structures and the mixed reality environment using Unity™ engine together with Microsoft® HoloLens 2™ device. To get an evaluation of the app we submitted a questionnaire to four neurosurgeons. To collect data concerning the performance of a user session we used Unity Performance Profiler. Results The use of the interactive features, such as rotating, scaling and moving models and browsing through menus, provided by the app had high scores in the questionnaire, and their use can still be improved as suggested by the performance data collected. The questionnaire's average scores were high, so the overall experiences of using our mixed reality app were positive. Conclusion We have successfully created a valuable and easy-to-use neuroimaging data mixed reality app, laying the foundation for more future clinical uses, as more models and data derived from various biomedical images can be imported.
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Affiliation(s)
- Martina Antonelli
- Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Martina Lucignani
- Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Chiara Parrillo
- Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Francesco Grassi
- Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Lorenzo Figà Talamanca
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Maria C Rossi Espagnet
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University, Roma, Italy
| | - Carlo Gandolfo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Luca Pasquini
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University, Roma, Italy
| | - Alessandro De Benedictis
- Pediatric Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Elisa Placidi
- Medical Physics UOC, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Luca De Palma
- Rare and Complex Epilepsies, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Carlo E Marras
- Pediatric Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Alessandra Marasi
- Pediatric Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
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Pepi C, De Benedictis A, Rossi-Espagnet MC, Cappelletti S, Da Rold M, Falcicchio G, Vigevano F, Marras CE, Specchio N, De Palma L. Hemispherotomy in Infants with Hemimegalencephaly: Long-Term Seizure and Developmental Outcome in Early Treated Patients. Brain Sci 2022; 13:brainsci13010073. [PMID: 36672056 PMCID: PMC9856354 DOI: 10.3390/brainsci13010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
Hemimegalencephaly (HME) is a rare brain congenital malformation, consisting in altered neuronal migration and proliferation within one hemisphere, which is responsible for early onset drug-resistant epilepsy. Hemispherotomy is an effective treatment option for patients with HME and drug-resistant epilepsy. Surgical outcome may be variable among different surgical series, and the long-term neuropsychological trajectory has been rarely defined using a standardized neurocognitive test. We report the epileptological and neuropsychological long-term outcomes of four consecutive HME patients, operated on before the age of three years. All patients were seizure-free and drug-free, and the minimum follow-up duration was of five years. Despite the excellent post-surgical seizure outcome, the long-term developmental outcome is quite variable between patients, ranging from mild to severe intellectual disabilities. Patients showed improvement mainly in communication skills, while visuo-perceptive and coordination abilities were more impaired. Epileptological outcome seems to be improved in early treated patients; however, neuropsychological outcome in HME patients may be highly variable despite early surgery.
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Affiliation(s)
- Chiara Pepi
- Rare and Complex Epilepsies Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy
| | | | | | - Simona Cappelletti
- Unit of Clinical Psychology, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Martina Da Rold
- Scientific Institute, IRCCS “E. Medea”, Association “La Nostra Famiglia”, 31015 Conegliano, Italy
| | - Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs—University of Bari Aldo Moro, 70121 Bari, Italy
| | - Federico Vigevano
- Rare and Complex Epilepsies Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Nicola Specchio
- Rare and Complex Epilepsies Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy
- Correspondence: ; Tel.: +39-06-68592645; Fax: +39-06-68592463
| | - Luca De Palma
- Rare and Complex Epilepsies Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy
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Spitzer H, Ripart M, Whitaker K, D’Arco F, Mankad K, Chen AA, Napolitano A, De Palma L, De Benedictis A, Foldes S, Humphreys Z, Zhang K, Hu W, Mo J, Likeman M, Davies S, Güttler C, Lenge M, Cohen NT, Tang Y, Wang S, Chari A, Tisdall M, Bargallo N, Conde-Blanco E, Pariente JC, Pascual-Diaz S, Delgado-Martínez I, Pérez-Enríquez C, Lagorio I, Abela E, Mullatti N, O’Muircheartaigh J, Vecchiato K, Liu Y, Caligiuri ME, Sinclair B, Vivash L, Willard A, Kandasamy J, McLellan A, Sokol D, Semmelroch M, Kloster AG, Opheim G, Ribeiro L, Yasuda C, Rossi-Espagnet C, Hamandi K, Tietze A, Barba C, Guerrini R, Gaillard WD, You X, Wang I, González-Ortiz S, Severino M, Striano P, Tortora D, Kälviäinen R, Gambardella A, Labate A, Desmond P, Lui E, O’Brien T, Shetty J, Jackson G, Duncan JS, Winston GP, Pinborg LH, Cendes F, Theis FJ, Shinohara RT, Cross JH, Baldeweg T, Adler S, Wagstyl K. Interpretable surface-based detection of focal cortical dysplasias: a Multi-centre Epilepsy Lesion Detection study. Brain 2022; 145:3859-3871. [PMID: 35953082 PMCID: PMC9679165 DOI: 10.1093/brain/awac224] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/22/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
One outstanding challenge for machine learning in diagnostic biomedical imaging is algorithm interpretability. A key application is the identification of subtle epileptogenic focal cortical dysplasias (FCDs) from structural MRI. FCDs are difficult to visualize on structural MRI but are often amenable to surgical resection. We aimed to develop an open-source, interpretable, surface-based machine-learning algorithm to automatically identify FCDs on heterogeneous structural MRI data from epilepsy surgery centres worldwide. The Multi-centre Epilepsy Lesion Detection (MELD) Project collated and harmonized a retrospective MRI cohort of 1015 participants, 618 patients with focal FCD-related epilepsy and 397 controls, from 22 epilepsy centres worldwide. We created a neural network for FCD detection based on 33 surface-based features. The network was trained and cross-validated on 50% of the total cohort and tested on the remaining 50% as well as on 2 independent test sites. Multidimensional feature analysis and integrated gradient saliencies were used to interrogate network performance. Our pipeline outputs individual patient reports, which identify the location of predicted lesions, alongside their imaging features and relative saliency to the classifier. On a restricted 'gold-standard' subcohort of seizure-free patients with FCD type IIB who had T1 and fluid-attenuated inversion recovery MRI data, the MELD FCD surface-based algorithm had a sensitivity of 85%. Across the entire withheld test cohort the sensitivity was 59% and specificity was 54%. After including a border zone around lesions, to account for uncertainty around the borders of manually delineated lesion masks, the sensitivity was 67%. This multicentre, multinational study with open access protocols and code has developed a robust and interpretable machine-learning algorithm for automated detection of focal cortical dysplasias, giving physicians greater confidence in the identification of subtle MRI lesions in individuals with epilepsy.
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Affiliation(s)
- Hannah Spitzer
- Institute of Computational Biology, Helmholtz Center Munich, Munich 85764, Germany
| | - Mathilde Ripart
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
| | | | - Felice D’Arco
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Kshitij Mankad
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Andrew A Chen
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome 00165, Italy
| | - Luca De Palma
- Rare and Complex Epilepsies, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome 00165, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome 00165, Italy
| | - Stephen Foldes
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Zachary Humphreys
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Marcus Likeman
- Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Shirin Davies
- School of Psychology, Cardiff University Brain Research Imaging Centre, Cardiff CF24 4HQ, UK
- The Welsh Epilepsy Unit, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, UK
| | | | - Matteo Lenge
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | - Nathan T Cohen
- Center for Neuroscience, Children’s National Hospital, Washington, DC 20012, USA
| | - Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610093, China
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Shan Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Aswin Chari
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Martin Tisdall
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Nuria Bargallo
- Department of Neuroradiology, Hospital Clinic Barcelona and Magnetic Resonance Imaging, Core Facility, IDIBAPS, Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid 28029, Spain
| | | | | | - Saül Pascual-Diaz
- Magnetic Resonance Imaging, Core Facility, IDIBAPS, Barcelona 08036, Spain
| | | | | | | | - Eugenio Abela
- Center for Neuropsychiatry and Intellectual Disability, Psychiatrische Dienste Aargau AG, Windisch 5120, Switzerland
| | - Nandini Mullatti
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Jonathan O’Muircheartaigh
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
- Department of Perinatal Imaging and Health, St. Thomas’ Hospital, King’s College London, London SE1 7EH, UK
| | - Katy Vecchiato
- Department of Perinatal Imaging and Health, St. Thomas’ Hospital, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Yawu Liu
- Department of Neurology, University of Eastern Finland, Kuopio 70210, Finland
| | - Maria Eugenia Caligiuri
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro 88100, Italy
| | - Ben Sinclair
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Neurology, Monash University, Melbourne, VIC 3004, Australia
| | - Anna Willard
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Jothy Kandasamy
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Ailsa McLellan
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Drahoslav Sokol
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Mira Semmelroch
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Ane G Kloster
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
| | - Giske Opheim
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
- Department of Neuroradiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
| | - Letícia Ribeiro
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | - Clarissa Yasuda
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | | | - Khalid Hamandi
- School of Psychology, Cardiff University Brain Research Imaging Centre, Cardiff CF24 4HQ, UK
- The Welsh Epilepsy Unit, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - Anna Tietze
- Charité University Hospital, Berlin 10117, Germany
| | - Carmen Barba
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | - Renzo Guerrini
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | | | - Xiaozhen You
- Center for Neuroscience, Children’s National Hospital, Washington, DC 20012, USA
| | - Irene Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Sofía González-Ortiz
- Department of Neuroradiology, Hospital del Mar, Barcelona 08003, Spain
- Magnetic Resonance Imaging Core Facility, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
| | | | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | - Reetta Kälviäinen
- Department of Neurology, University of Eastern Finland, Kuopio 70210, Finland
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Kuopio 70210, Finland
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Angelo Labate
- Neurology Unit, Department of BIOMORF, University of Messina, Messina 98168, Italy
| | - Patricia Desmond
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia
| | - Elaine Lui
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia
| | - Terence O’Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Medicine, The Royal Melbourne Hospital, Parkville, VIC, 3052, Australia
| | - Jay Shetty
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, VIC 3071, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC 3084, Australia
| | - John S Duncan
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Gavin P Winston
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, ON, Canada K7L 3N6
| | - Lars H Pinborg
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
- Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital—Rigshopsitalet, Copenhagen 2100, Denmark
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | - Fabian J Theis
- Institute of Computational Biology, Helmholtz Center Munich, Munich 85764, Germany
- Department of Mathematics, Technical University of Munich, Garching 85748, Germany
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Helen Cross
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Torsten Baldeweg
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Sophie Adler
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
| | - Konrad Wagstyl
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK
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Rizzi M, Sartori I, Del Vecchio M, Berta L, Lizio D, Zauli FM, De Benedictis A, Sarubbo S, Al-Orabi K, Mariani V, Avanzini P. Correction to: Tracing in vivo the dorsal loop of the optic radiation: convergent perspectives from tractography and electrophysiology compared to a neuroanatomical ground truth. Brain Struct Funct 2022; 227:2229. [PMID: 35511297 DOI: 10.1007/s00429-022-02501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michele Rizzi
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
| | - Ivana Sartori
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy.
| | - Maria Del Vecchio
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
| | - Luca Berta
- Department of Medical Physics, ASST GOM Niguarda, Milan, Italy
| | - Domenico Lizio
- Department of Medical Physics, ASST GOM Niguarda, Milan, Italy
| | - Flavia Maria Zauli
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Alessandro De Benedictis
- Department of Neurosciences, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Ospedale Santa Chiara, Trento, Italy
| | - Khalid Al-Orabi
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
| | - Valeria Mariani
- Neurology and Stroke Unit, ASST Sette Laghi-Ospedale di Circolo, Varese, Italy
| | - Pietro Avanzini
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
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12
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Ferro V, Boccuzzi E, Colafati GS, De Benedictis A, Supino MC, Faa MF, Musolino AM, Reale A, Raucci U. Children With a Soft Scalp Hematoma Presenting to the Emergency Department More Than 24 Hours After a Head Injury. Pediatr Emerg Care 2022; 38:e1217-e1223. [PMID: 35358149 DOI: 10.1097/pec.0000000000002682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The soft scalp hematoma is one of the clinical markers used as a predictor for the presence of intracranial injury in children with a head trauma. We evaluated the significance of time presentation in the management of these patients. METHODS We conducted a retrospective study of children and adolescents aged 0 to <18 years by comparing the clinical, radiological, and epidemiological features in those presenting within 24 hours with those presenting greater than 24 hours after a head injury. RESULTS We identified 188 and 98 patients with early presentation and late presentation, respectively. The percentage of children aged 0 to <6 months was lower in those with late presentation (6.12%) than those with early presentation (20.21%) with a significant difference (P < .001). Likewise, the percentage of children aged ≥24 months was lower in children with late presentation (7.14%) than those with early presentation (34.04%) with a significant difference (P < .001). The severe mechanism rate was more elevated in early presentation (38.83%) with a significant difference (-14.34%; 95% confidence interval [CI], -25.34% to -3.34%; P = .015). The symptom rate resulted higher in early presentation (14.36%) with a significant difference (-11.30%; 95% CI, -17.36% to 5.22%; P = .003). The parietal scalp hematoma occurred mostly in children with late presentation (85.71%) with a significant difference (19.76%; 95% CI, 10.07% to 29.45%; P < .001). The occipital scalp hematoma rate was higher in early presentation with a significant difference (-17.50%; 95% CI, -22.99% to -12.12%; P < .001). There was no significant difference in the prevalence of different types of intracranial injury, and the only 5 patients needing a neurosurgical intervention were exclusively children with an early presentation. CONCLUSION Although children with soft scalp hematoma presenting to the emergency department greater than 24 hours after a head injury may have pathological findings on computed tomography, all of them had a good short- and long-term outcomes, and no neurological deterioration aroused the medical attention on follow-up. For this subset of patients that does not experience red flags (neurological symptoms, focal signs on examination, or severe injury mechanism), a wait-and-see approach might be more appropriate rather than neuroimaging.
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Affiliation(s)
| | | | | | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neuro-Rehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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De Benedictis A, Pietrobattista A, Talamanca LF, Monti L, Paolantonio G, Natali GL, Bua A, Savioli A, Alessandra Marasi E, Randi F, Carai A, Spada M, Marras CE. “De novo” brain arteriovenous malformation in a child with congenital porto-systemic shunt and multisystemic angiomas. Clin Neurol Neurosurg 2022; 217:107236. [DOI: 10.1016/j.clineuro.2022.107236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
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Specchio N, Pavia GC, Palma L, De Benedictis A, Pepi C, Conti M, Marras CE, Vigevano F, Curatolo P. Current role of surgery for tuberous sclerosis complex‐associated epilepsy. Pediatr Investig 2022; 6:16-22. [PMID: 35382422 PMCID: PMC8960933 DOI: 10.1002/ped4.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare multisystem, autosomal dominant neurocutaneous syndrome in which epilepsy is the most common of several neurological and psychiatric manifestations. Around two thirds of patients develop drug‐resistant epilepsy for whom surgical resection of epileptogenic foci is indicated when seizures remain inadequately controlled following trial of two antiseizure medications. The challenge with presurgical and surgical approaches with patients with TSC is overcoming the complexity from the number of tubers and the multiplex epileptogenic network forming the epileptogenic zone. Data suggest that seizure freedom is achieved by 55%–60% of patients, but predictive factors for success have remained elusive, which makes for unconfident selection of surgical candidates. This article presents three different cases as illustrations of the potential challenges faced when assessing the suitability of TSC patients for epilepsy surgery.
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Affiliation(s)
- Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neurosciences Bambino Gesù Children's Hospital, IRCCS Rome Italy
| | - Giusy Carfi Pavia
- Rare and Complex Epilepsy Unit, Department of Neurosciences Bambino Gesù Children's Hospital, IRCCS Rome Italy
| | - Luca Palma
- Rare and Complex Epilepsy Unit, Department of Neurosciences Bambino Gesù Children's Hospital, IRCCS Rome Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences Bambino Gesù Children's Hospital, IRCCS Rome Italy
| | - Chiara Pepi
- Rare and Complex Epilepsy Unit, Department of Neurosciences Bambino Gesù Children's Hospital, IRCCS Rome Italy
| | - Marta Conti
- Rare and Complex Epilepsy Unit, Department of Neurosciences Bambino Gesù Children's Hospital, IRCCS Rome Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neurosciences Bambino Gesù Children's Hospital, IRCCS Rome Italy
| | - Federico Vigevano
- Department of Neurosciences Bambino Gesù Children's Hospital, IRCCS Rome Italy
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department Tor Vergata University Rome Italy
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Carai A, Marras CE. Networking of the Human Cerebellum: From Anatomo-Functional Development to Neurosurgical Implications. Front Neurol 2022; 13:806298. [PMID: 35185765 PMCID: PMC8854219 DOI: 10.3389/fneur.2022.806298] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
In the past, the cerebellum was considered to be substantially involved in sensory-motor coordination. However, a growing number of neuroanatomical, neuroimaging, clinical and lesion studies have now provided converging evidence on the implication of the cerebellum in a variety of cognitive, affective, social, and behavioral processes as well. These findings suggest a complex anatomo-functional organization of the cerebellum, involving a dense network of cortical territories and reciprocal connections with many supra-tentorial association areas. The final architecture of cerebellar networks results from a complex, highly protracted, and continuous development from childhood to adulthood, leading to integration between short-distance connections and long-range extra-cerebellar circuits. In this review, we summarize the current evidence on the anatomo-functional organization of the cerebellar connectome. We will focus on the maturation process of afferent and efferent neuronal circuitry, and the involvement of these networks in different aspects of neurocognitive processing. The final section will be devoted to identifying possible implications of this knowledge in neurosurgical practice, especially in the case of posterior fossa tumor resection, and to discuss reliable strategies to improve the quality of approaches while reducing postsurgical morbidity.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- *Correspondence: Alessandro De Benedictis
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Luca de Palma
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Cossu M, d’Orio P, Barba C, Asioli S, Cardinale F, Casciato S, Caulo M, Colicchio G, Consales A, D’Aniello A, De Benedictis A, De Palma L, Didato G, Di Gennaro G, Di Giacomo R, Esposito V, Guerrini R, Nichelatti M, Revay M, Rizzi M, Vatti G, Villani F, Zamponi N, Tassi L, Marras CE. Focal Cortical Dysplasia IIIa in Hippocampal Sclerosis-Associated Epilepsy: Anatomo-Electro-Clinical Profile and Surgical Results From a Multicentric Retrospective Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa369_s093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cossu M, Nichelatti M, De Benedictis A, Rizzi M. Lateral versus vertical hemispheric disconnection for epilepsy: a systematic review and meta-analysis. J Neurosurg 2021:1-11. [PMID: 34653979 DOI: 10.3171/2021.5.jns21949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lateral periinsular hemispherotomy (LPH) and vertical parasagittal hemispherotomy (VPH) are the most popular disconnective techniques for intractable epilepsies associated with unilateral hemispheric pathologies. The authors aimed to investigate possible differences in seizure outcome and complication rates between patients who underwent LPH and VPH. METHODS A comprehensive literature search of PubMed and Embase identified English-language articles published from database inception to December 2019 that reported series (minimum 12 patients with follow-up ≥ 12 months) on either LPH or VPH. Pooled rates of seizure freedom and complications (with a particular focus on hydrocephalus) were analyzed using meta-analysis to calculate both fixed and random effects. Heterogeneity (Cochran's Q test) and inconsistency (fraction of Q due to actual heterogeneity) were also calculated. RESULTS Twenty-five studies were included. Data from 825 patients were available for seizure outcome analysis (583 underwent LPH and 242 underwent VPH), and data from 692 patients were available for complication analysis (453 underwent LPH and 239 underwent VPH). No differences were found in the pooled rates of Engel class I seizure outcome between patients who underwent LPH (80.02% and 79.44% with fixed and random effects, respectively) and VPH (79.89% and 80.69% with fixed and random effects, respectively) (p = 0.953). No differences were observed in the pooled rates of shunted hydrocephalus between patients who underwent LPH (11.34% and 10.63% with fixed and random effects, respectively) and VPH (11.07% and 9.98% with fixed and random effects, respectively) (p = 0.898). Significant heterogeneity and moderate inconsistency were determined for hydrocephalus occurrence in patients who underwent both LPH and VPH. CONCLUSIONS LPH and VPH techniques present similar excellent seizure outcomes, with comparable and acceptable safety profiles.
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Affiliation(s)
- Massimo Cossu
- 1"Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Nichelatti
- 2Service of Biostatistics, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano, Niguarda, Milan, Italy; and
| | - Alessandro De Benedictis
- 3Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Michele Rizzi
- 1"Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
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De Benedictis A, de Palma L, Herur-Raman A, Pepi C, Colafati GS, Carboni A, Randi F, Savioli A, Ricci G, Mastronuzzi A, Carai A, Specchio N, Marras CE. Infra-Occipital Supra-Tentorial Approach for Resection of Low-Grade Tumor of the Left Lingual Gyrus: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E257-E258. [PMID: 34022047 DOI: 10.1093/ons/opab172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Surgical treatment of lesions involving the postero-medial occipito-temporal region is challenging because of high risk of morbidity due to damage or excessive retraction of critical neuro-vascular structures, especially within the dominant hemisphere.1-3 Here, we describe the case of a 17-yr-old patient who underwent resection of an epileptogenic low-grade tumor located within the left-dominant lingual gyrus. Seizures were characterized, as a first symptom, by right-sided simple visual hallucination that pointed to the left pericalcarine region, corresponding to the lesion location. No signs of primary involvement of anterior temporo-mesial structures (hippocampus/amygdala) were found. As the anatomo-electroclinical correlation was concordant, direct tumor removal was indicated through an infra-occipital supratentorial approach. This route allowed direct access to the target through a safe extra-axial corridor, which limits intraparenchymal dissection until the tumor margin is identified and avoids critical vascular structures, such as the vein of Labbé.4,5 An external cerebrospinal fluid (CSF) drainage was used to facilitate brain relaxation, minimizing brain and venous retraction and, consequently, reducing the risk of postoperative neurological complications, especially for vision. Postoperative magnetic resonance imaging (MRI) demonstrated no surgical complications. Pathological examination revealed a ganglioglioma. At 9-mo follow-up, the neurological examination was normal, antiepileptic therapy was stopped, and the patient was seizure-free. The video describes the main surgical steps, using both intraoperative videos and advanced 3-dimensional modeling of neuroimaging pictures. Informed consent was obtained for surgery and video recording.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luca de Palma
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Aalap Herur-Raman
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Chiara Pepi
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Alessia Carboni
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Savioli
- Intensive Care Unit, Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppe Ricci
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Specchio
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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19
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Carai A, De Benedictis A, Calloni T, Onorini N, Paternò G, Randi F, Colafati GS, Mastronuzzi A, Marras CE. Intraoperative Ultrasound-Assisted Extent of Resection Assessment in Pediatric Neurosurgical Oncology. Front Oncol 2021; 11:660805. [PMID: 33968768 PMCID: PMC8097032 DOI: 10.3389/fonc.2021.660805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022] Open
Abstract
Central nervous system tumors represent the most frequent solid malignancy in the pediatric population. Maximal safe surgical resection is a mainstay of treatment, with significant prognostic impact for the majority of histotypes. Intraoperative ultrasound (ioUS) is a widely available tool in neurosurgery to assist in intracerebral disease resection. Despite technical caveats, preliminary experiences suggest a satisfactory predictive ability, when compared to magnetic resonance imaging (MRI) studies. Most of the available evidence on ioUS applications in brain tumors derive from adult series, a scenario that might not be representative of the pediatric population. We present our preliminary experience comparing ioUS-assisted resection assessment to early post-operative MRI findings in 154 consecutive brain tumor resections at our pediatric neurosurgical unit. A high concordance was observed between ioUS and post-operative MRI. Overall ioUS demonstrated a positive predictive value of 98%, a negative predictive value of 92% in assessing the presence of tumor residue compared to postoperative MRI. Overall, sensibility and specificity were 86% and 99%, respectively. On a multivariate analysis, the only variable significantly associated to unexpected tumor residue on postoperative MRI was histology. Tumor location, patient positioning during surgery, age and initial tumor volume were not significantly associated with ioUS predictive ability. Our data suggest a very good predictive value of ioUS in brain tumor resective procedures in children. Low-grade glioma, high-grade glioma and craniopharyngioma might represent a setting deserving specific endeavours in order to improve intraoperative extent of resection assessment ability.
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Affiliation(s)
- Andrea Carai
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Tommaso Calloni
- School of Neurosurgery, University of Milan-Bicocca, Milan, Italy
| | - Nicola Onorini
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Paternò
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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20
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Cossu M, d'Orio P, Barba C, Asioli S, Cardinale F, Casciato S, Caulo M, Colicchio G, Consales A, D'Aniello A, De Benedictis A, De Palma L, Didato G, Di Gennaro G, Di Giacomo R, Esposito V, Guerrini R, Nichelatti M, Revay M, Rizzi M, Vatti G, Villani F, Zamponi N, Tassi L, Marras CE. Focal Cortical Dysplasia IIIa in Hippocampal Sclerosis-Associated Epilepsy: Anatomo-Electro-Clinical Profile and Surgical Results From a Multicentric Retrospective Study. Neurosurgery 2021; 88:384-393. [PMID: 32860416 DOI: 10.1093/neuros/nyaa369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hippocampal sclerosis (HS) may be associated with focal cortical dysplasia IIIa (FCD IIIa) in patients undergoing surgery for temporal lobe epilepsy (TLE). OBJECTIVE To investigate whether the anatomo-electro-clinical profile and surgical outcome in patients with HS-related TLE are affected by coexisting FCD IIIa. METHODS A total of 220 patients, operated in 5 centers, with at least 24 mo follow-up (FU), were retrospectively studied. Preliminary univariate and subsequent multivariate analyses were performed to investigate possible associations between several potential presurgical, surgical, and postsurgical predictors and different variables (Engel's class I and Engel's class Ia, co-occurrence of FCD IIIa). RESULTS At last available postoperative control (FU: range 24-95 mo, median 47 mo), 182 (82.7%) patients were classified as Engel's class I and 142 (64.5%) as Engel's class Ia. At multivariate analysis, extension of neocortical resection and postoperative electroencephalogram were significantly associated with Engel's class I, whereas length of FU had a significant impact on class Ia in the whole cohort and in isolated HS (iHS) patients, but not in the FCD IIIa group. No differences emerged in the anatomo-electro-clinical profile and surgical results between patients with FCD IIIa and with iHS. CONCLUSION Coexistence of FCD IIIa did not confer a distinct anatomo-electro-clinical profile to patients with HS-related epilepsy. Postoperative seizure outcome was similar in FCD IIIa and iHS cases. These findings indicate limited clinical relevance of FCD IIIa in HS-related epilepsy and might be useful for refining future FCD classifications. Further studies are needed to clarify the correlation of class Ia outcome with the duration of FU.
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Affiliation(s)
- Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Piergiorgio d'Orio
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.,Institute of Neuroscience, National Research Council, Parma, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | | | | | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | | | | | - Luca De Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Giuseppe Didato
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | | | - Roberta Di Giacomo
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Martina Revay
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Michele Rizzi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy.,Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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21
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Sarubbo S, Annicchiarico L, Corsini F, Zigiotto L, Herbet G, Moritz-Gasser S, Dalpiaz C, Vitali L, Tate M, De Benedictis A, Amorosino G, Olivetti E, Rozzanigo U, Petralia B, Duffau H, Avesani P. Planning Brain Tumor Resection Using a Probabilistic Atlas of Cortical and Subcortical Structures Critical for Functional Processing: A Proof of Concept. Oper Neurosurg (Hagerstown) 2021; 20:E175-E183. [PMID: 33372966 DOI: 10.1093/ons/opaa396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Functional preoperative planning for resection of intrinsic brain tumors in eloquent areas is still a challenge. Predicting subcortical functional framework is especially difficult. Direct electrical stimulation (DES) is the recommended technique for resection of these lesions. A reliable probabilistic atlas of the critical cortical epicenters and subcortical framework based on DES data was recently published. OBJECTIVE To propose a pipeline for the automated alignment of the corticosubcortical maps of this atlas with T1-weighted MRI. METHODS To test the alignment, we selected 10 patients who underwent resection of brain lesions by using DES. We aligned different cortical and subcortical functional maps to preoperative volumetric T1 MRIs (with/without gadolinium). For each patient we quantified the quality of the alignment, and we calculated the match between the location of the functional sites found at DES and the functional maps of the atlas. RESULTS We found an accurate brain extraction and alignment of the functional maps with both the T1 MRIs of each patient. The matching analysis between functional maps and functional responses collected during surgeries was 88% at cortical and, importantly, 100% at subcortical level, providing a further proof of the correct alignment. CONCLUSION We demonstrated quantitatively and qualitatively the reliability of this tool that may be used for presurgical planning, providing further functional information at the cortical level and a unique probabilistic prevision of distribution of the critical subcortical structures. Finally, this tool offers the chance for multimodal planning through integrating this functional information with other neuroradiological and neurophysiological techniques.
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Affiliation(s)
- Silvio Sarubbo
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.,Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Luciano Annicchiarico
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.,Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Francesco Corsini
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.,Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Luca Zigiotto
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.,Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), NSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), NSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Chiara Dalpiaz
- Department of Anesthesiology and Intensive Care, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Luca Vitali
- Department of Anesthesiology and Intensive Care, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Matthew Tate
- Departments of Neurosurgery and Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Gabriele Amorosino
- Neuroinformatics Laboratory (NiLab), Bruno Kessler Foundation (FBK), Trento, Italy.,Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Emanuele Olivetti
- Neuroinformatics Laboratory (NiLab), Bruno Kessler Foundation (FBK), Trento, Italy.,Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Umberto Rozzanigo
- Department of Radiology, Division of Neuroradiology, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Benedetto Petralia
- Department of Radiology, Division of Neuroradiology, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), NSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Paolo Avesani
- Neuroinformatics Laboratory (NiLab), Bruno Kessler Foundation (FBK), Trento, Italy.,Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
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22
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Carai A, Mastronuzzi A, Colafati GS, Voicu P, Onorini N, Carboni A, Del Baldo G, Herur-Raman AJ, De Benedictis A, Marras CE. SURG-03. IMMERSIVE VIRTUAL REALITY APPLICATIONS IN NEUROSURGICAL ONCOLOGY. Neuro Oncol 2020. [PMCID: PMC7715307 DOI: 10.1093/neuonc/noaa222.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Tridimensional (3D) rendering of volumetric neuroimaging is increasingly been used to assist surgical management of brain tumors. New technologies allowing immersive virtual reality (VR) visualization of obtained models offer the opportunity to appreciate neuroanatomical details and spatial relationship between the tumor and normal neuroanatomical structures to a level never seen before. We present our preliminary experience with the Surgical Theatre, a commercially available 3D VR system, in 60 consecutive neurosurgical oncology cases. 3D models were developed from volumetric CT scans and MR standard and advanced sequences. The system allows the loading of 6 different layers at the same time, with the possibility to modulate opacity and threshold in real time. Use of the 3D VR was used during preoperative planning allowing a better definition of surgical strategy. A tailored craniotomy and brain dissection can be simulated in advanced and precisely performed in the OR, connecting the system to intraoperative neuronavigation. Smaller blood vessels are generally not included in the 3D rendering, however, real-time intraoperative threshold modulation of the 3D model assisted in their identification improving surgical confidence and safety during the procedure. VR was also used offline, both before and after surgery, in the setting of case discussion within the neurosurgical team and during MDT discussion. Finally, 3D VR was used during informed consent, improving communication with families and young patients. 3D VR allows to tailor surgical strategies to the single patient, contributing to procedural safety and efficacy and to the global improvement of neurosurgical oncology care.
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Affiliation(s)
| | | | | | - Paul Voicu
- Bambino Gesù Children’s Hospital, Rome, Italy
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23
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De Benedictis A, Colafati GS, Carboni A, Carai A, Marras CE. Asymptomatic intrapetrous carotid artery stenosis after a gunshot to the head. Neurology 2020; 95:1057-1058. [PMID: 33055267 DOI: 10.1212/wnl.0000000000011055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alessandro De Benedictis
- From the Neurosurgery Unit (A.D.B., A. Carai, C.E.M.), Department of Neurological and Psychiatric Sciences (A.D.B., A. Carai, C.E.M.), and Neuroradiology Unit (G.S.C., A. Carboni), Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Giovanna Stefania Colafati
- From the Neurosurgery Unit (A.D.B., A. Carai, C.E.M.), Department of Neurological and Psychiatric Sciences (A.D.B., A. Carai, C.E.M.), and Neuroradiology Unit (G.S.C., A. Carboni), Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessia Carboni
- From the Neurosurgery Unit (A.D.B., A. Carai, C.E.M.), Department of Neurological and Psychiatric Sciences (A.D.B., A. Carai, C.E.M.), and Neuroradiology Unit (G.S.C., A. Carboni), Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Carai
- From the Neurosurgery Unit (A.D.B., A. Carai, C.E.M.), Department of Neurological and Psychiatric Sciences (A.D.B., A. Carai, C.E.M.), and Neuroradiology Unit (G.S.C., A. Carboni), Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Efisio Marras
- From the Neurosurgery Unit (A.D.B., A. Carai, C.E.M.), Department of Neurological and Psychiatric Sciences (A.D.B., A. Carai, C.E.M.), and Neuroradiology Unit (G.S.C., A. Carboni), Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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24
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Bertò G, Bullock D, Astolfi P, Hayashi S, Zigiotto L, Annicchiarico L, Corsini F, De Benedictis A, Sarubbo S, Pestilli F, Avesani P, Olivetti E. Classifyber, a robust streamline-based linear classifier for white matter bundle segmentation. Neuroimage 2020; 224:117402. [PMID: 32979520 DOI: 10.1016/j.neuroimage.2020.117402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/12/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022] Open
Abstract
Virtual delineation of white matter bundles in the human brain is of paramount importance for multiple applications, such as pre-surgical planning and connectomics. A substantial body of literature is related to methods that automatically segment bundles from diffusion Magnetic Resonance Imaging (dMRI) data indirectly, by exploiting either the idea of connectivity between regions or the geometry of fiber paths obtained with tractography techniques, or, directly, through the information in volumetric data. Despite the remarkable improvement in automatic segmentation methods over the years, their segmentation quality is not yet satisfactory, especially when dealing with datasets with very diverse characteristics, such as different tracking methods, bundle sizes or data quality. In this work, we propose a novel, supervised streamline-based segmentation method, called Classifyber, which combines information from atlases, connectivity patterns, and the geometry of fiber paths into a simple linear model. With a wide range of experiments on multiple datasets that span from research to clinical domains, we show that Classifyber substantially improves the quality of segmentation as compared to other state-of-the-art methods and, more importantly, that it is robust across very diverse settings. We provide an implementation of the proposed method as open source code, as well as web service.
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Affiliation(s)
- Giulia Bertò
- NeuroInformatics Laboratory (NILab), Bruno Kessler Foundation (FBK), Trento, Italy; Center for Mind and Brain Sciences (CIMeC), University of Trento, Italy
| | - Daniel Bullock
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA
| | - Pietro Astolfi
- NeuroInformatics Laboratory (NILab), Bruno Kessler Foundation (FBK), Trento, Italy; Center for Mind and Brain Sciences (CIMeC), University of Trento, Italy; PAVIS, Italian Institute of Technology (IIT), Genova, Italy
| | - Soichi Hayashi
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA
| | - Luca Zigiotto
- Division of Neurosurgery, Structural and Functional Connectivity Lab, S. Chiara Hospital, Trento, Italy
| | - Luciano Annicchiarico
- Division of Neurosurgery, Structural and Functional Connectivity Lab, S. Chiara Hospital, Trento, Italy
| | - Francesco Corsini
- Division of Neurosurgery, Structural and Functional Connectivity Lab, S. Chiara Hospital, Trento, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab, S. Chiara Hospital, Trento, Italy
| | - Franco Pestilli
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA
| | - Paolo Avesani
- NeuroInformatics Laboratory (NILab), Bruno Kessler Foundation (FBK), Trento, Italy; Center for Mind and Brain Sciences (CIMeC), University of Trento, Italy
| | - Emanuele Olivetti
- NeuroInformatics Laboratory (NILab), Bruno Kessler Foundation (FBK), Trento, Italy; Center for Mind and Brain Sciences (CIMeC), University of Trento, Italy.
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25
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Lodi M, Boccuto L, Carai A, Cacchione A, Miele E, Colafati GS, Diomedi Camassei F, De Palma L, De Benedictis A, Ferretti E, Catanzaro G, Pò A, De Luca A, Rinelli M, Lepri FR, Agolini E, Tartaglia M, Locatelli F, Mastronuzzi A. Low-Grade Gliomas in Patients with Noonan Syndrome: Case-Based Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10080582. [PMID: 32806529 PMCID: PMC7460327 DOI: 10.3390/diagnostics10080582] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022] Open
Abstract
Noonan syndrome (NS) is a congenital autosomic dominant condition characterized by a variable spectrum from a clinical and genetical point of view. Germline mutations in more than ten genes involved in RAS-MAPK signal pathway have been demonstrated to cause the disease. An higher risk for leukemia and solid malignancies, including brain tumors, is related to NS. A review of the published literature concerning low grade gliomas (LGGs) in NS is presented. We described also a 13-year-old girl with NS associated with a recurrent mutation in PTPN11, who developed three different types of brain tumors, i.e., an optic pathway glioma, a glioneuronal neoplasm of the left temporal lobe and a cerebellar pilocytic astrocytoma. Molecular characterization of the glioneuronal tumor allowed to detect high levels of phosphorylated MTOR (pMTOR); therefore, a therapeutic approach based on an mTOR inhibitor (everolimus) was elected. The treatment was well tolerated and proved to be effective, leading to a stabilization of the tumor, which was surgical removed. The positive outcome of the present case suggests considering this approach for patients with RASopathies and brain tumors with hyperactivated MTOR signaling.
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Affiliation(s)
- Mariachiara Lodi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
| | - Luigi Boccuto
- School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29634, USA;
- JC Self Research Institute of the Greenwood Genetic Center, Greenwood, SC 29646, USA
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (A.D.B.)
| | - Antonella Cacchione
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
| | | | | | - Luca De Palma
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.D.P.); (E.F.)
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (A.D.B.)
| | - Elisabetta Ferretti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.D.P.); (E.F.)
| | | | - Agnese Pò
- Department of Molecular Medicine, Sapienza University, 00161 Rome, Italy;
| | - Alessandro De Luca
- Medical Genetics Division, Fondazione IRCCS-Casa Sollievo della Sofferenza, 71043 San Giovanni Rotondo, Italy;
| | - Martina Rinelli
- Laboratory of Medical Genetics, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (F.R.L.); (E.A.)
| | - Francesca Romana Lepri
- Laboratory of Medical Genetics, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (F.R.L.); (E.A.)
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (F.R.L.); (E.A.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Franco Locatelli
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
- Department of Pediatric Hematology and Oncology Cell and Gene Therapy, Bambino Gesù Hospital, IRCCS, University La Sapienza, 00165 Rome, Italy
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
- Correspondence: ; Tel.: +39-0668594664; Fax: +39-0668592292
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Specchio N, Ferretti A, Pietrafusa N, Trivisano M, Calabrese C, Carfì Pavia G, De Benedictis A, Marras CE, de Palma L, Vigevano F. Refractory Status Epilepticus in Genetic Epilepsy-Is Vagus Nerve Stimulation an Option? Front Neurol 2020; 11:443. [PMID: 32595584 PMCID: PMC7303322 DOI: 10.3389/fneur.2020.00443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
Refractory and super-refractory status epilepticus (RSE, SRSE) are severe conditions that can have long-term neurological consequences with high morbidity and mortality rates. The usefulness of vagus nerve-stimulation (VNS) implantation during RSE has been documented by anecdotal cases and in systematic reviews; however, the use of VNS in RSE has not been widely adopted. We successfully implanted VNS in two patients with genetic epilepsy admitted to hospital for SRSE; detailed descriptions of the clinical findings and VNS parameters are provided. Our patients were implanted 25 and 58 days after status epilepticus (SE) onset, and a stable remission of SE was observed from the seventh and tenth day after VNS implantation, respectively, without change in anti-seizure medication. We used a fast ramp-up of stimulation without evident side effects. Our results support the consideration of VNS implantation as a safe and effective adjunctive treatment for SRSE.
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Affiliation(s)
- Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Alessandro Ferretti
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Nicola Pietrafusa
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Marina Trivisano
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Costanza Calabrese
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Giusy Carfì Pavia
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luca de Palma
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
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Rheault F, De Benedictis A, Daducci A, Maffei C, Tax CMW, Romascano D, Caverzasi E, Morency FC, Corrivetti F, Pestilli F, Girard G, Theaud G, Zemmoura I, Hau J, Glavin K, Jordan KM, Pomiecko K, Chamberland M, Barakovic M, Goyette N, Poulin P, Chenot Q, Panesar SS, Sarubbo S, Petit L, Descoteaux M. Tractostorm: The what, why, and how of tractography dissection reproducibility. Hum Brain Mapp 2020; 41:1859-1874. [PMID: 31925871 PMCID: PMC7267902 DOI: 10.1002/hbm.24917] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/23/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
Investigative studies of white matter (WM) brain structures using diffusion MRI (dMRI) tractography frequently require manual WM bundle segmentation, often called "virtual dissection." Human errors and personal decisions make these manual segmentations hard to reproduce, which have not yet been quantified by the dMRI community. It is our opinion that if the field of dMRI tractography wants to be taken seriously as a widespread clinical tool, it is imperative to harmonize WM bundle segmentations and develop protocols aimed to be used in clinical settings. The EADC-ADNI Harmonized Hippocampal Protocol achieved such standardization through a series of steps that must be reproduced for every WM bundle. This article is an observation of the problematic. A specific bundle segmentation protocol was used in order to provide a real-life example, but the contribution of this article is to discuss the need for reproducibility and standardized protocol, as for any measurement tool. This study required the participation of 11 experts and 13 nonexperts in neuroanatomy and "virtual dissection" across various laboratories and hospitals. Intra-rater agreement (Dice score) was approximately 0.77, while inter-rater was approximately 0.65. The protocol provided to participants was not necessarily optimal, but its design mimics, in essence, what will be required in future protocols. Reporting tractometry results such as average fractional anisotropy, volume or streamline count of a particular bundle without a sufficient reproducibility score could make the analysis and interpretations more difficult. Coordinated efforts by the diffusion MRI tractography community are needed to quantify and account for reproducibility of WM bundle extraction protocols in this era of open and collaborative science.
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Affiliation(s)
- Francois Rheault
- Sherbrooke Connectivity Imaging Laboratory (SCIL)Université de SherbrookeSherbrookeCanada
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and NeurorehabilitationBambino Gesù Children's Hospital, IRCCSRomeItaly
| | | | - Chiara Maffei
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General Hospital and Harvard Medical SchoolBostonMA
| | - Chantal M. W. Tax
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of PsychologyCardiff UniversityCardiffUK
| | - David Romascano
- Signal Processing Lab (LTS5)École Polytechnique Fédérale de LausanneLausanneSwitzerland
| | | | | | | | - Franco Pestilli
- Department of Psychological and Brain SciencesIndiana UniversityBloomingtonIN
| | - Gabriel Girard
- Signal Processing Lab (LTS5)École Polytechnique Fédérale de LausanneLausanneSwitzerland
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Laboratory (SCIL)Université de SherbrookeSherbrookeCanada
| | | | - Janice Hau
- Brain Development Imaging Laboratories, Department of PsychologySan Diego State UniversitySan DiegoCAUSA
| | - Kelly Glavin
- Learning Research & Development Center (LRDC)University of PittsburghPittsburghPAUSA
| | | | - Kristofer Pomiecko
- Learning Research & Development Center (LRDC)University of PittsburghPittsburghPAUSA
| | - Maxime Chamberland
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of PsychologyCardiff UniversityCardiffUK
| | - Muhamed Barakovic
- Signal Processing Lab (LTS5)École Polytechnique Fédérale de LausanneLausanneSwitzerland
| | | | - Philippe Poulin
- Sherbrooke Connectivity Imaging Laboratory (SCIL)Université de SherbrookeSherbrookeCanada
| | | | | | - Silvio Sarubbo
- Division of Neurosurgery, Emergency Department, "S. Chiara" HospitalAzienda Provinciale per i Servizi Sanitari (APSS)TrentoItaly
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives ‐ UMR 5293, CNRSCEA University of BordeauxBordeauxFrance
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Laboratory (SCIL)Université de SherbrookeSherbrookeCanada
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De Benedictis A, Rossi-Espagnet MC, Diomedi-Camassei F, Rossi S, Fontana E, Randi F, Ponzo V, Nucci C, Esposito G, Paternò G, Brunetti C, Savioli A, Carai A, Marras CE. Intraventricular Ectopic Cerebellum. World Neurosurg 2020; 137:158-163. [PMID: 31996339 DOI: 10.1016/j.wneu.2020.01.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cerebellar ectopy is a rare finding, with few cases previously reported. Intraventricular localized cerebellar ectopy was described in only 1 case within the fourth ventricle. CASE DESCRIPTION A 9-year-old girl suffered for 2 years from bilateral frontoparietal headaches, sometimes accompanied by vomiting and photophobia. Magnetic resonance imaging demonstrated an oval-shaped lesion within the left lateral ventricle, characterized by well-defined margins without a clear cleavage plane from the adjacent choroid plexus. The mass presented an intermediate signal on T1- and T2-weighted sequences, similar to gray matter, and reduced ADC values on ADC maps compared with white matter, with no enhancement after gadolinium-based contrast injection. After resection, macroscopic examination revealed an organoid structure with leptomeningeal lining and a clear-cut cortex and white matter components. Histology demonstrated normal cerebellum with a double-layered cortex and normal underlying white matter. The cerebellar ectopy was focally covered by bundles of capillary vascular structures covered by a monostratified ependymal cell lining, consistent with choroid plexus. CONCLUSIONS We describe, for the first time to our knowledge, the case of a child with ectopic cerebellar tissue harboring the supratentorial ventricular system. Plausible etiologic mechanism consists in the herniation of the cerebellar germinal tissue into the ventricular system through the ependyma, allowing cell migration to the supratentorial compartment, followed by maturation into the normal cerebellum.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | | | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Fontana
- Neuroradiology Unit, Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Viviana Ponzo
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlotta Nucci
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giacomo Esposito
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Paternò
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carolina Brunetti
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Savioli
- Intensive Care Unit, Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Sarubbo S, Tate M, De Benedictis A, Merler S, Moritz-Gasser S, Herbet G, Duffau H. A normalized dataset of 1821 cortical and subcortical functional responses collected during direct electrical stimulation in patients undergoing awake brain surgery. Data Brief 2019; 28:104892. [PMID: 31886348 PMCID: PMC6921148 DOI: 10.1016/j.dib.2019.104892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
In this data article, we provide the dataset which served as the basis for our related research article “Mapping critical cortical hubs and white matter pathways by direct electrical stimulation: an original functional atlas of the human brain” [1], which represents the first probabilistic cortical and subcortical atlas of critical structures mediating human brain functions based on direct electrical stimulation (DES) in patients undergoing awake brain surgery. 1162 cortical and 659 subcortical DES-derived responses were recorded during testing of 16 functional domains in 256 patients undergoing awake surgery. Normalized [Montreal Neurological Institute (MNI) 152] spatial coordinates for cortical and subcortical responses, and probabilistic heat maps for each functional domain, were computed using methods previously developed by our group [2,3]. Source data, including the MNI-normalized coordinates of all 1821 DES-derived cortical and subcortical data points, and multi-planar (MNI-152, T1 1mm) videos showing the probabilistic distribution of each functional domain are provided. This novel dataset can improve and refine our understanding about the functional anatomy of critical brain networks, and these data are made available for medical and neuroscience applications.
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Affiliation(s)
- Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, Azienda Provinciale per i Servizi Sanitari (APSS), 9 Largo Medaglie d'Oro, 38122, Trento, Italy
| | - Matthew Tate
- Departments of Neurosurgery and Neurology, Northwestern University, Feinberg School of Medicine, 420 E Superior St, 60611, Chicago, IL, USA
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, 4 Piazza Sant'Onofrio, 00165, Rome, Italy
| | | | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
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Sarubbo S, Tate M, De Benedictis A, Merler S, Moritz-Gasser S, Herbet G, Duffau H. Mapping critical cortical hubs and white matter pathways by direct electrical stimulation: an original functional atlas of the human brain. Neuroimage 2019; 205:116237. [PMID: 31626897 DOI: 10.1016/j.neuroimage.2019.116237] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The structural and functional organization of brain networks subserving basic daily activities (i.e. language, visuo-spatial cognition, movement, semantics, etc.) are not completely understood to date. Here, we report the first probabilistic cortical and subcortical atlas of critical structures mediating human brain functions based on direct electrical stimulation (DES), a well-validated tool for the exploration of cerebral processing and for performing safe surgical interventions in eloquent areas. METHODS We collected 1162 cortical and 659 subcortical DES responses during testing of 16 functional domains in 256 patients undergoing awake surgery. Spatial coordinates for each functional response were calculated, and probability distributions for the entire patient cohort were mapped onto a standardized three-dimensional brain template using a multinomial statistical analysis. In addition, matching analyses were performed against prior established anatomy-based cortical and white matter (WM) atlases. RESULTS The probabilistic maps for each functional domain were provided. The topographical analysis demonstrated a wide spatial distribution of cortical functional responses, while subcortical responses were more restricted, localizing to known WM pathways. These DES-derived data showed reliable matching with existing cortical and WM atlases as well as recent neuroimaging and neurophysiological data. CONCLUSIONS We present the first integrated and comprehensive cortical-subcortical atlas of structures essential for humans' neural functions based on highly-specific DES mapping during real-time neuropsychological testing. This novel atlas can serve as a complementary tool for neuroscientists, along with data obtained from other modalities, to improve and refine our understanding of the functional anatomy of critical brain networks.
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Affiliation(s)
- Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, Azienda Provinciale per i Servizi Sanitari (APSS), 9 Largo Medaglie d'Oro, 38122, Trento, Italy.
| | - Matthew Tate
- Departments of Neurosurgery and Neurology, Northwestern University, Feinberg School of Medicine, 420 E Superior St, 60611, Chicago, IL, USA
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, 4 Piazza Sant'Onofrio, 00165, Rome, Italy
| | | | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France; National Institute for Health and Medical Research (INSERM), U1051, Team ''Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors'', Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France; National Institute for Health and Medical Research (INSERM), U1051, Team ''Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors'', Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France; National Institute for Health and Medical Research (INSERM), U1051, Team ''Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors'', Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
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Sarubbo S, Petit L, De Benedictis A, Chioffi F, Ptito M, Dyrby TB. Uncovering the inferior fronto-occipital fascicle and its topological organization in non-human primates: the missing connection for language evolution. Brain Struct Funct 2019; 224:1553-1567. [PMID: 30847641 DOI: 10.1007/s00429-019-01856-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 02/27/2019] [Indexed: 01/19/2023]
Abstract
Whether brain networks underlying the multimodal processing of language in humans are present in non-human primates is an unresolved question in primate evolution. Conceptual awareness in humans, which is the backbone of verbal and non-verbal semantic elaboration, involves intracerebral connectivity via the inferior fronto-occipital fascicle (IFOF). While non-human primates can communicate through visual information channels, there has been no formal demonstration that they possess a functional homologue of the human IFOF. Therefore, we undertook a post-mortem diffusion MRI tractography study in conjunction with Klingler micro-dissection to search for IFOF fiber tracts in brain of Old-World (vervet) monkeys. We found clear and concordant evidence from both techniques for the existence of bilateral fiber tracts connecting the frontal and occipital lobes. These tracts closely resembled the human IFOF with respect to trajectory, topological organization, and cortical terminal fields. Moreover, these fibers are clearly distinct from other bundles previously described in this region of monkey brain, i.e., the inferior longitudinal and uncinate fascicles, and the external and extreme capsules. This demonstration of an IFOF in brain of a species that diverged from the human lineage some 22 millions years ago enhances our comprehension about the evolution of language and social behavior.
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Affiliation(s)
- Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), 38122, Trento, Italy.
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Franco Chioffi
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), 38122, Trento, Italy
| | - Maurice Ptito
- École d'optométrie, Université de Montréal, Montreal, QC, Canada
| | - Tim B Dyrby
- Danish Research Centre for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
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David S, Heemskerk AM, Corrivetti F, Thiebaut de Schotten M, Sarubbo S, Corsini F, De Benedictis A, Petit L, Viergever MA, Jones DK, Mandonnet E, Axer H, Evans J, Paus T, Leemans A. The Superoanterior Fasciculus (SAF): A Novel White Matter Pathway in the Human Brain? Front Neuroanat 2019; 13:24. [PMID: 30890921 PMCID: PMC6412356 DOI: 10.3389/fnana.2019.00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/07/2019] [Indexed: 01/01/2023] Open
Abstract
Fiber tractography (FT) using diffusion magnetic resonance imaging (dMRI) is widely used for investigating microstructural properties of white matter (WM) fiber-bundles and for mapping structural connections of the human brain. While studying the architectural configuration of the brain's circuitry with FT is not without controversy, recent progress in acquisition, processing, modeling, analysis, and visualization of dMRI data pushes forward the reliability in reconstructing WM pathways. Despite being aware of the well-known pitfalls in analyzing dMRI data and several other limitations of FT discussed in recent literature, we present the superoanterior fasciculus (SAF), a novel bilateral fiber tract in the frontal region of the human brain that-to the best of our knowledge-has not been documented. The SAF has a similar shape to the anterior part of the cingulum bundle, but it is located more frontally. To minimize the possibility that these FT findings are based on acquisition or processing artifacts, different dMRI data sets and processing pipelines have been used to describe the SAF. Furthermore, we evaluated the configuration of the SAF with complementary methods, such as polarized light imaging (PLI) and human brain dissections. The FT results of the SAF demonstrate a long pathway, consistent across individuals, while the human dissections indicate fiber pathways connecting the postero-dorsal with the antero-dorsal cortices of the frontal lobe.
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Affiliation(s)
- Szabolcs David
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Anneriet M. Heemskerk
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | | | | | - Silvio Sarubbo
- Structural and Functional Connectivity Lab Project, Department of Emergency, Division of Neurosurgery, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Francesco Corsini
- Structural and Functional Connectivity Lab Project, Department of Emergency, Division of Neurosurgery, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Alessandro De Benedictis
- Department of Neurosciences, Division of Neurosurgery, “Bambino Gesù” Children Hospital, IRCCS, Rome, Italy
| | - Laurent Petit
- Groupe d’Imagerie Neurofonctionnelle (GIN), Institut des Maladies Neurodégératives (IMN)-UMR5293-CNRS, CEA, Université de Bordeaux, Bordeaux, France
| | - Max A. Viergever
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Derek K. Jones
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, United Kingdom
| | | | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
| | - John Evans
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, United Kingdom
| | - Tomáš Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Carai A, Marongiu A, Trezza A, De Benedictis A, Cossu S, Randi F, Miele E, Cacchione A, Colafati GS, Camassei FD, Mastronuzzi A, Marras CE. NSRG-18. IMPACT OF MOLECULAR SUBGROUP ON SURGICAL MANAGEMENT OF MEDULLOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea Carai
- Neurosurgery Unit, Neurosciences and Neurorehabilitation Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandra Marongiu
- Neurosurgery Unit, NESMOS Department, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Trezza
- Neurosurgery Unit, Neurosciences and Neurorehabilitation Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Neurosciences and Neurorehabilitation Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvia Cossu
- Neurosurgery Unit, Neurosciences and Neurorehabilitation Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Neurosciences and Neurorehabilitation Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Evelina Miele
- Neuro-oncology Unit, Onco-Hemathology and Cell Therapy Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Antonella Cacchione
- Neuro-oncology Unit, Onco-Hemathology and Cell Therapy Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | | | - Angela Mastronuzzi
- Neuro-oncology Unit, Onco-Hemathology and Cell Therapy Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Neurosciences and Neurorehabilitation Department, Bambino Gesù Children’s Hospital, Rome, Italy
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De Benedictis A, Nocerino E, Menna F, Remondino F, Barbareschi M, Rozzanigo U, Corsini F, Olivetti E, Marras CE, Chioffi F, Avesani P, Sarubbo S. Photogrammetry of the Human Brain: A Novel Method for Three-Dimensional Quantitative Exploration of the Structural Connectivity in Neurosurgery and Neurosciences. World Neurosurg 2018; 115:e279-e291. [PMID: 29660551 DOI: 10.1016/j.wneu.2018.04.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Anatomic awareness of the structural connectivity of the brain is mandatory for neurosurgeons, to select the most effective approaches for brain resections. Although standard microdissection is a validated technique to investigate the different white matter (WM) pathways and to verify the results of tractography, the possibility of interactive exploration of the specimens and reliable acquisition of quantitative information has not been described. Photogrammetry is a well-established technique allowing an accurate metrology on highly defined three-dimensional (3D) models. The aim of this work is to propose the application of the photogrammetric technique for supporting the 3D exploration and the quantitative analysis on the cerebral WM connectivity. METHODS The main perisylvian pathways, including the superior longitudinal fascicle and the arcuate fascicle were exposed using the Klingler technique. The photogrammetric acquisition followed each dissection step. The point clouds were registered to a reference magnetic resonance image of the specimen. All the acquisitions were coregistered into an open-source model. RESULTS We analyzed 5 steps, including the cortical surface, the short intergyral fibers, the indirect posterior and anterior superior longitudinal fascicle, and the arcuate fascicle. The coregistration between the magnetic resonance imaging mesh and the point clouds models was highly accurate. Multiple measures of distances between specific cortical landmarks and WM tracts were collected on the photogrammetric model. CONCLUSIONS Photogrammetry allows an accurate 3D reproduction of WM anatomy and the acquisition of unlimited quantitative data directly on the real specimen during the postdissection analysis. These results open many new promising neuroscientific and educational perspectives and also optimize the quality of neurosurgical treatments.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.
| | - Erica Nocerino
- Theoretical Physics ETH Zürich, Zurich, Switzerland; LSIS Laboratory-Laboratoire des Sciences de l'Information et des Systèmes, I&M Team, Images & Models AMU, Aix-Marseille Université POLYTECH, Marseille, France
| | - Fabio Menna
- 3D Optical Metrology (3DOM) Unit, Bruno Kessler Foundation (FBK), Trento, Italy
| | - Fabio Remondino
- 3D Optical Metrology (3DOM) Unit, Bruno Kessler Foundation (FBK), Trento, Italy
| | | | - Umberto Rozzanigo
- Department of Radiology, Neuroradiology Unit, "S. Chiara" Hospital, Trento APSS, Italy
| | - Francesco Corsini
- Division of Neurosurgery, Structural and Functional Connectivity (SFC) Lab Project, "S. Chiara" Hospital, Trento APSS, Italy
| | - Emanuele Olivetti
- Neuroinformatics Laboratory (NILab), Bruno Kessler Foundation, Trento, Italy; Center for Mind/Brain Science (CIMeC), University of Trento, Mattarello (TN), Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Franco Chioffi
- Division of Neurosurgery, Structural and Functional Connectivity (SFC) Lab Project, "S. Chiara" Hospital, Trento APSS, Italy
| | - Paolo Avesani
- Neuroinformatics Laboratory (NILab), Bruno Kessler Foundation, Trento, Italy; Center for Mind/Brain Science (CIMeC), University of Trento, Mattarello (TN), Italy
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity (SFC) Lab Project, "S. Chiara" Hospital, Trento APSS, Italy
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Sangiorgi S, Benedictis AD, Reguzzoni M, Trezza A, Cossu S, Marras CE, Bellocchi S, Manelli A, Protasoni M. Arterial and microvascular supply of cerebral hemispheres in the nude mouse revealed using corrosion casting and scanning electron microscopy. J Anat 2018; 232:739-746. [PMID: 29441571 DOI: 10.1111/joa.12791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2018] [Indexed: 11/29/2022] Open
Abstract
Morphological analyses of cerebral vascularization are not only important for the characterization of the anatomical and physiological relationships between vascular and nervous tissue, but also required to understand structural modifications that occur in many pathological conditions affecting the brain. The aim of this study was to generate a three-dimensional vascular map of the cerebral hemispheres in the nude mouse brain, a widely used animal model for studying tumour biology. We used the corrosion casting (CC) technique to isolate blood vessels from 30 nude mouse brains. All casts were analysed using scanning electron microscopy (SEM), which generated quantitative data regarding vessel length and diameter as well as inter-vascular and inter-branching distances. We identified three different topographical regions: (i) the cortical region, characterized by a superficial wide sheet of vessels giving rise to terminal perforant vessels that penetrate the grey matter; (ii) the inner part of the grey matter, in which dense capillary nets form many flake-like structures extending towards the grey-white matter boundary, where perforant vessels finally change direction and form a well-defined vascular sheet; and (iii) the white matter layer, characterized by a more disorganized vascular architecture. In this study, we demonstrate the accuracy of the CC-SEM method in revealing the 3D-topographical organization of the vascular network of the normal nude mouse brain. These baseline data will serve as a reference for future anatomical investigations of pathological alterations, such as tumour infiltrations, using the nude mouse model.
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Affiliation(s)
- Simone Sangiorgi
- Neurosurgery Unit, Department of Surgery, ASST lariana - S. Anna Hospital, Como, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Marcella Reguzzoni
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Trezza
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Silvia Cossu
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Silvio Bellocchi
- Neurosurgery Unit, Department of Surgery, ASST lariana - S. Anna Hospital, Como, Italy
| | | | - Marina Protasoni
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Sarubbo S, De Benedictis A, Merler S, Mandonnet E, Barbareschi M, Dallabona M, Chioffi F, Duffau H. Structural and functional integration between dorsal and ventral language streams as revealed by blunt dissection and direct electrical stimulation. Hum Brain Mapp 2018; 37:3858-3872. [PMID: 27258125 DOI: 10.1002/hbm.23281] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/07/2016] [Accepted: 05/24/2016] [Indexed: 01/24/2023] Open
Abstract
The most accepted framework of language processing includes a dorsal phonological and a ventral semantic pathway, connecting a wide network of distributed cortical hubs. However, the cortico-subcortical connectivity and the reciprocal anatomical relationships of this dual-stream system are not completely clarified. We performed an original blunt microdissection of 10 hemispheres with the exposition of locoregional short fibers and six long-range fascicles involved in language elaboration. Special attention was addressed to the analysis of termination sites and anatomical relationships between long- and short-range fascicles. We correlated these anatomical findings with a topographical analysis of 93 functional responses located at the terminal sites of the language bundles, collected by direct electrical stimulation in 108 right-handers. The locations of phonological and semantic paraphasias, verbal apraxia, speech arrest, pure anomia, and alexia were statistically analyzed, and the respective barycenters were computed in the MNI space. We found that terminations of main language bundles and functional responses have a wider distribution in respect to the classical definition of language territories. Our analysis showed that dorsal and ventral streams have a similar anatomical layer organization. These pathways are parallel and relatively segregated over their subcortical course while their terminal fibers are strictly overlapped at the cortical level. Finally, the anatomical features of the U-fibers suggested a role of locoregional integration between the phonological, semantic, and executive subnetworks of language, in particular within the inferoventral frontal lobe and the temporoparietal junction, which revealed to be the main criss-cross regions between the dorsal and ventral pathways. Hum Brain Mapp 37:3858-3872, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Silvio Sarubbo
- Division of Neurosurgery, Department of Neurosciences, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy. .,Structural and Functional Connectivity Lab, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy.
| | - Alessandro De Benedictis
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital - IRCCS, 4 Piazza Sant'Onofrio, Roma, 00165, Italy
| | - Stefano Merler
- Bruno Kessler Foundation (FBK), 18 via Sommarive, Trento, 38123, Italy
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisiere Hospital, 2 Rue Ambroise Pare, Paris, 75010, France
| | - Mattia Barbareschi
- Department of Histopathology, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy
| | - Monica Dallabona
- Division of Neurosurgery, Department of Neurosciences, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy
| | - Franco Chioffi
- Division of Neurosurgery, Department of Neurosciences, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy.,Structural and Functional Connectivity Lab, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui De Chauliac, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, 34295, France.,Institute for Neuroscience of Montpellier, INSERM U1051, Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," Saint Eloi Hospital, Montpellier, France
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Maffei C, Jovicich J, De Benedictis A, Corsini F, Barbareschi M, Chioffi F, Sarubbo S. Topography of the human acoustic radiation as revealed by ex vivo fibers micro-dissection and in vivo diffusion-based tractography. Brain Struct Funct 2017; 223:449-459. [PMID: 28866840 DOI: 10.1007/s00429-017-1471-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/04/2017] [Indexed: 10/18/2022]
Abstract
The acoustic radiation is a compact bundle of fibers conveying auditory information from the medial geniculate nucleus of the thalamus to the auditory cortex. Topographical knowledge of this bundle in primates is scarce and in vivo diffusion-based tractography reconstructions in humans remains challenging, especially with the most widely used MRI acquisition protocols. Therefore, the AR represents a notable anatomical omission in the neurobiological investigation of acoustic and linguistic functional mechanisms in humans. In this study, we combine blunt micro-dissections and advanced diffusion tractography methods to provide novel insights into the topographical anatomy of this bundle in humans. Evidences from ex vivo blunt micro-dissection in three human (two right) hemispheres are compared to the 3D profile of this bundle as reconstructed by tractography techniques in four healthy adult data sets provided by the Human Connectome Project. Both techniques show the unique trajectory of the AR, a transversal course from the midline to the lateral convexity of the posterior temporal lobe. Blunt dissections demonstrated three portions of this bundle that we defined as the genu, stem, and fan, revealing the intimate relationships that each of these components has with neighboring association and projection pathways. Probabilistic tractography and ultra-high b values provided results comparable to blunt micro-dissections and highlighted the main limitations in tracking the AR. This is, to our knowledge, the first ex vivo/in vivo integrated study providing novel and reliable information about the precise anatomy of the AR, which will be important for future investigations in the neuroscientific, clinical, and surgical field.
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Affiliation(s)
- Chiara Maffei
- CIMeC Center for Mind/Brain Sciences, Trento University, Trento, Italy
| | - Jorge Jovicich
- CIMeC Center for Mind/Brain Sciences, Trento University, Trento, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Corsini
- Division of Neurosurgery, Structural and Functional Connectivity Lab (SFC-LSB) Project, Department of Neurosciences, "S. Chiara" Hospital, Trento APSS, 9, Largo Medaglie d'Oro, 38122, Trento, Italy
| | - Mattia Barbareschi
- Department of Histopathology, "S. Chiara" Hospital, Trento APSS, Trento, Italy
| | - Franco Chioffi
- Division of Neurosurgery, Structural and Functional Connectivity Lab (SFC-LSB) Project, Department of Neurosciences, "S. Chiara" Hospital, Trento APSS, 9, Largo Medaglie d'Oro, 38122, Trento, Italy
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab (SFC-LSB) Project, Department of Neurosciences, "S. Chiara" Hospital, Trento APSS, 9, Largo Medaglie d'Oro, 38122, Trento, Italy.
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Rizzi M, Trezza A, Messina G, De Benedictis A, Franzini A, Marras CE. Exploring the brain through posterior hypothalamus surgery for aggressive behavior. Neurosurg Focus 2017; 43:E14. [DOI: 10.3171/2017.6.focus17231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neurological surgery offers an opportunity to study brain functions, through either resection or implanted neuromodulation devices. Pathological aggressive behavior in patients with intellectual disability is a frequent condition that is difficult to treat using either supportive care or pharmacological therapy. The bulk of the laboratory studies performed throughout the 19th century enabled the formulation of hypotheses on brain circuits involved in the generation of emotions. Aggressive behavior was also studied extensively. Lesional radiofrequency surgery of the posterior hypothalamus, which peaked in the 1970s, was shown to be an effective therapy in many reported series. As with other surgical procedures for the treatment of psychiatric disorders, however, this therapy was abandoned for many reasons, including the risk of its misuse. Deep brain stimulation (DBS) offers the possibility of treating neurological and psychoaffective disorders through relatively reversible and adaptable therapy. Deep brain stimulation of the posterior hypothalamus was proposed and performed successfully in 2005 as a treatment for aggressive behavior. Other groups reported positive outcomes using target and parameter settings similar to those of the original study. Both the lesional and DBS approaches enabled researchers to explore the role of the posterior hypothalamus (or posterior hypothalamic area) in the autonomic and emotional systems.
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Affiliation(s)
- Michele Rizzi
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
- 3“Claudio Munari” Center for Epilepsy Surgery, Niguarda Hospital, Milan
| | - Andrea Trezza
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
- 5Division of Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Messina
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
| | - Alessandro De Benedictis
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
| | - Angelo Franzini
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
| | - Carlo Efisio Marras
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
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De Benedictis A, Trezza A, Carai A, Genovese E, Procaccini E, Messina R, Randi F, Cossu S, Esposito G, Palma P, Amante P, Rizzi M, Marras CE. Robot-assisted procedures in pediatric neurosurgery. Neurosurg Focus 2017; 42:E7. [DOI: 10.3171/2017.2.focus16579] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDuring the last 3 decades, robotic technology has rapidly spread across several surgical fields due to the continuous evolution of its versatility, stability, dexterity, and haptic properties. Neurosurgery pioneered the development of robotics, with the aim of improving the quality of several procedures requiring a high degree of accuracy and safety. Moreover, robot-guided approaches are of special interest in pediatric patients, who often have altered anatomy and challenging relationships between the diseased and eloquent structures. Nevertheless, the use of robots has been rarely reported in children. In this work, the authors describe their experience using the ROSA device (Robotized Stereotactic Assistant) in the neurosurgical management of a pediatric population.METHODSBetween 2011 and 2016, 116 children underwent ROSA-assisted procedures for a variety of diseases (epilepsy, brain tumors, intra- or extraventricular and tumor cysts, obstructive hydrocephalus, and movement and behavioral disorders). Each patient received accurate preoperative planning of optimal trajectories, intraoperative frameless registration, surgical treatment using specific instruments held by the robotic arm, and postoperative CT or MR imaging.RESULTSThe authors performed 128 consecutive surgeries, including implantation of 386 electrodes for stereo-electroencephalography (36 procedures), neuroendoscopy (42 procedures), stereotactic biopsy (26 procedures), pallidotomy (12 procedures), shunt placement (6 procedures), deep brain stimulation procedures (3 procedures), and stereotactic cyst aspiration (3 procedures). For each procedure, the authors analyzed and discussed accuracy, timing, and complications.CONCLUSIONSTo the best their knowledge, the authors present the largest reported series of pediatric neurosurgical cases assisted by robotic support. The ROSA system provided improved safety and feasibility of minimally invasive approaches, thus optimizing the surgical result, while minimizing postoperative morbidity.
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Affiliation(s)
| | - Andrea Trezza
- 1Department of Neuroscience and Neurosurgical Unit and
- 2Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, University of Milano-Bicocca, San Gerardo Hospital, Monza
| | - Andrea Carai
- 1Department of Neuroscience and Neurosurgical Unit and
| | - Elisabetta Genovese
- 3Enterprise Risk Management, Medical Physics Department, Bambino Gesù Children’s Hospital, IRCCS, Rome
| | | | | | - Franco Randi
- 1Department of Neuroscience and Neurosurgical Unit and
| | - Silvia Cossu
- 1Department of Neuroscience and Neurosurgical Unit and
| | | | - Paolo Palma
- 1Department of Neuroscience and Neurosurgical Unit and
| | | | - Michele Rizzi
- 4“Claudio Munari” Center for Epilepsy Surgery, Niguarda Hospital, Milan; and
- 5Department of Neuroscience, University of Parma, Italy
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Carai A, Mastronuzzi A, De Benedictis A, Messina R, Cacchione A, Miele E, Randi F, Esposito G, Trezza A, Colafati GS, Savioli A, Locatelli F, Marras CE. Robot-Assisted Stereotactic Biopsy of Diffuse Intrinsic Pontine Glioma: A Single-Center Experience. World Neurosurg 2017; 101:584-588. [PMID: 28254596 DOI: 10.1016/j.wneu.2017.02.088] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Diffuse intrinsic pontine glioma (DIPG) is a childhood tumor with a dismal prognosis. Emerging molecular signatures have paved the way for stereotactic biopsy in selected centers. We present our experience in DIPG stereotactic needle biopsy using the Robotic Stereotactic-Assisted system (ROSA) in a series of consecutive pediatric patients. METHODS All stereotactic biopsy procedures for DIPG performed during the last year at our institution were considered. All procedures were carried out using the ROSA surgical assistant through a precoronary approach. All children underwent a postoperative computed tomography scan to document possible surgical complications and confirm the site of biopsy. Postoperative clinical changes were recorded to test morbidity of the procedure. RESULTS In the last year, we performed 7 pontine needle biopsies. Specimens were diagnostic and useful for molecular analysis in all cases. No surgical complications were observed. One child showed a transient neurologic worsening related to the biopsy that resolved within 2 weeks. The combination of the precoronary approach and use of the stereotactic ROSA system allowed single-session surgeries in all cases. CONCLUSIONS Pontine biopsy for DIPG is a safe procedure in selected centers. The advantages of the single-session procedure we described might be of particular interest in the pediatric setting.
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Affiliation(s)
- Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Raffaella Messina
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Cacchione
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Evelina Miele
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giacomo Esposito
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Trezza
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | | | - Alessandra Savioli
- Intensive Care Unit, Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Locatelli
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Pediatric Science, University of Pavia, Pavia, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Esposito G, Messina R, Carai A, Colafati GS, Savioli A, Randi F, De Benedictis A, Cossu S, Fontanella MM, Marras CE. Cochleovestibular Nerve Compression Syndrome Caused by Intrameatal Anterior Inferior Cerebellar Artery Loop: Synthesis of Best Evidence for Clinical Decisions. World Neurosurg 2016; 96:556-561. [PMID: 27647022 DOI: 10.1016/j.wneu.2016.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intrameatal cochleovestibular neurovascular conflict is a rare condition with specific clinical and therapeutic implications. Although surgery is commonly indicated in other neurovascular conflicts, for this subset of patients there is little evidence to guide treatment decisions. Moving from a case description, we performed a review of the literature on this topic to systematically present the best available evidence to guide clinical decisions. METHODS We performed a literature review on reported cases of surgically treated intrameatal anterior inferior cerebellar artery (AICA)-cochleovestibular nerve neurovascular conflict, analyzing preoperative clinical data, surgical techniques, and outcomes. We analyzed the levels of evidence using the King's College guidelines. DISCUSSION We found 35 studies of neurovascular compression of the cochleovestibular nerve by AICA for 536 patients operated on to resolve their neurovascular conflict. Only 4 of these studies describe intrameatal AICA neurovascular conflicts, for 9 cases, including our own. Tinnitus was the most frequent symptom (9/9), followed by vertigo (2/9). Our case was the only one showing unilateral hearing loss. Surgery consisted of microsurgical mobilization of the AICA loop performed through a retrosigmoid craniotomy. Tinnitus and vertigo resolved after surgery in all cases, whereas hearing loss did not improve after surgery. CONCLUSIONS Surgical treatment offers the best results for tinnitus and vertigo, but it seems to have no effect on hearing loss, not even at long-term follow-up. Microvascular decompression should be proposed to intrameatal symptomatic patients before the onset of hearing loss.
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Affiliation(s)
- Giacomo Esposito
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaella Messina
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Alessandra Savioli
- Intensive Care Unit, Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Cossu
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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De Benedictis A, Petit L, Descoteaux M, Marras CE, Barbareschi M, Corsini F, Dallabona M, Chioffi F, Sarubbo S. New insights in the homotopic and heterotopic connectivity of the frontal portion of the human corpus callosum revealed by microdissection and diffusion tractography. Hum Brain Mapp 2016; 37:4718-4735. [PMID: 27500966 DOI: 10.1002/hbm.23339] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/12/2016] [Accepted: 07/26/2016] [Indexed: 12/16/2022] Open
Abstract
Extensive studies revealed that the human corpus callosum (CC) plays a crucial role in providing large-scale bi-hemispheric integration of sensory, motor and cognitive processing, especially within the frontal lobe. However, the literature lacks of conclusive data regarding the structural macroscopic connectivity of the frontal CC. In this study, a novel microdissection approach was adopted, to expose the frontal fibers of CC from the dorsum to the lateral cortex in eight hemispheres and in one entire brain. Post-mortem results were then combined with data from advanced constrained spherical deconvolution in 130 healthy subjects. We demonstrated as the frontal CC provides dense inter-hemispheric connections. In particular, we found three types of fronto-callosal fibers, having a dorso-ventral organization. First, the dorso-medial CC fibers subserve homotopic connections between the homologous medial cortices of the superior frontal gyrus. Second, the ventro-lateral CC fibers subserve homotopic connections between lateral frontal cortices, including both the middle frontal gyrus and the inferior frontal gyrus, as well as heterotopic connections between the medial and lateral frontal cortices. Third, the ventro-striatal CC fibers connect the medial and lateral frontal cortices with the contralateral putamen and caudate nucleus. We also highlighted an intricate crossing of CC fibers with the main association pathways terminating in the lateral regions of the frontal lobes. This combined approach of ex vivo microdissection and in vivo diffusion tractography allowed demonstrating a previously unappreciated three-dimensional architecture of the anterior frontal CC, thus clarifying the functional role of the CC in mediating the inter-hemispheric connectivity. Hum Brain Mapp 37:4718-4735, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alessandro De Benedictis
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital - IRCCS, 4 Piazza Sant'Onofrio, Roma, 00165, Italy
| | - Laurent Petit
- Groupe D'Imagerie Neurofonctionnelle, Institut Des Maladies Neurodégénératives - UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital - IRCCS, 4 Piazza Sant'Onofrio, Roma, 00165, Italy
| | - Mattia Barbareschi
- Department of Histopathology, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy
| | - Francesco Corsini
- Department of Neurosciences, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy.,Structural and Functional Connectivity Lab, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy
| | - Monica Dallabona
- Department of Neurosciences, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy.,Structural and Functional Connectivity Lab, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy
| | - Franco Chioffi
- Department of Neurosciences, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy.,Structural and Functional Connectivity Lab, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy
| | - Silvio Sarubbo
- Department of Neurosciences, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy.,Structural and Functional Connectivity Lab, Division of Neurosurgery, "S. Chiara" Hospital, Trento APSS - 9 Largo Medaglie D'Oro, Trento, 38122, Italy
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Esposito G, dell'Anna VA, Marrazzo A, Carai A, Messina R, De Benedictis A, Randi F, Cacchione A, Miele E, Colafati GS, Tornesello A, Po A, Ferretti E, Mastronuzzi A, Fontanella MM, Marras CE. NS-25IMPACT OF MEDULLOBLASTOMA MOLECULAR SUBGROUP ON POST-OPERATIVE PSEUDOMENINGOCELE AND NEED FOR VENTRICULAR SHUNTING. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now078.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Carai A, De Benedictis A, Messina R, Randi F, Savioli A, Mastronuzzi A, Marras CE. NS-03ROBOT-ASSISTED STEREOTACTIC BIOPSY IN DIPG. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now078.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Randi F, Carai A, Amante G, De Benedictis A, Messina R, Savioli A, Mastronuzzi A, Marras CE. NS-01PEDIATRIC INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING IN POSTERIOR FOSSA SURGERY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now078.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Cacchione A, Mastronuzzi A, Cefalo MG, Colafati GS, Diomedi-Camassei F, Rizzi M, De Benedictis A, Carai A. Pediatric spinal glioblastoma of the conus medullaris: a case report of long survival. Chin J Cancer 2016; 35:44. [PMID: 27160742 PMCID: PMC4862181 DOI: 10.1186/s40880-016-0107-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/01/2016] [Indexed: 11/23/2022]
Abstract
High-grade gliomas of the spinal cord represent a rare entity in children. Their biology, behavior, and controversial treatment options have been discussed in a few pediatric cases. These tumors are associated with severe disability and poor prognosis. We report a case of a 4-year-old child diagnosed with an isolated glioblastoma multiforme of the conus medullaris. The patient underwent subtotal surgical excision, followed by adjuvant radiotherapy and oral chemotherapy. He is alive with mild neurologic deficits at 52 months after diagnosis. We describe the peculiar characteristics of this rare condition in pediatric oncology. We also provide an overview of current multidisciplinary therapeutic approaches and prognostic factors for this disease.
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Affiliation(s)
- Antonella Cacchione
- Department of Pediatric Hematology-Oncology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Angela Mastronuzzi
- Department of Pediatric Hematology-Oncology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Maria Giuseppina Cefalo
- Department of Pediatric Hematology-Oncology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | | | | | - Michele Rizzi
- Department of Neurosurgery, Fondazione Istituto Neurologico "Carlo Besta", IRCCS, Milan, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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Pietrafusa N, de Palma L, De Benedictis A, Trivisano M, Marras CE, Vigevano F, Specchio N. Ictal vomiting as a sign of temporal lobe epilepsy confirmed by stereo-EEG and surgical outcome. Epilepsy Behav 2015; 53:112-6. [PMID: 26558713 DOI: 10.1016/j.yebeh.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022]
Abstract
Vomiting is uncommon in patients with epilepsy and has been reported in both idiopathic and symptomatic epilepsies. It is presumed to originate in the anterior part of the temporal lobe or insula. To date, 44 cases of nonidiopathic focal epilepsy and seizures associated with ictal vomiting have been reported. Of the 44 cases, eight were studied using invasive exploration (3 stereo-EEG/5 subdural grids). Here, we report a 4-year-and-7-month-old patient with a history of febrile convulsion in the second year of life and who developed episodes of vomiting and complex partial seizures at 3 years of age. Scalp EEG showed no electrical modification during vomiting while the complex partial seizure displayed a clear right temporal origin. Brain MR showed hippocampal volume reduction with mild diffuse blurring of the temporal lobe. Stereoelectroencephalography study confirmed the mesiotemporal origin of the seizures and showed that the episodes of vomiting were strictly related to an ictal discharge originating in the mesial temporal structures without insular diffusion. The patient is now seizure-free (18 months) after removal of the right anterior and mesial temporal structures. In all the reported patients, seizures seemed to start in mesial temporal structures. The grid subgroup is more homogeneous, and the most prominent characteristic (4/5) is the involvement of both mesial and lateral temporal structures at the time of vomiting. In the S-EEG group, there is evidence of involvement of either the anterior temporal structures alone (2/3) or both insular cortices (1/3). Our case confirms that vomiting could occur when the ictal discharge is limited to the anterior temporal structure without insular involvement. Regarding the pathophysiology of vomiting, the role of subcortical structures such as the dorsal vagal complex and the central pattern generators (CPG) located in the reticular area is well established. Vomiting as an epileptic phenomenon seems to be related to the involvement of temporal structures, mainly mesial structures (amygdala) and with an uncertain role of the insula. An intriguing hypothesis is that the ictal discharge in mesial structures determines seizure manifestation that could be explained not only by tonic activation of the cortex, but also by 'release' (reduction of inhibition?) of the CPG responsible for involuntary motor behaviors.
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Affiliation(s)
- Nicola Pietrafusa
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Luca de Palma
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marina Trivisano
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Federico Vigevano
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Nicola Specchio
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Rizzi M, De Benedictis A, Messina G, Cordella R, Marchesi D, Messina R, Penner F, Franzini A, Marras CE. Comparative analysis of explanted DBS electrodes. Acta Neurochir (Wien) 2015; 157:2135-41. [PMID: 26347045 DOI: 10.1007/s00701-015-2572-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hardware-related complications frequently occur in deep brain stimulation. Microscopy and spectroscopy techniques are effective methods for characterizing the morphological and chemical basis of malfunctioning DBS electrodes. A previous report by our team revealed the morphological and chemical alterations on a malfunctioning explanted electrode when it was compared to a new device. The aim of this preliminary study was to verify whether these morphological and chemical alterations in the materials were a direct result of the hardware malfunctioning or if the failure was correlated to a degradation process over time. METHODS Two DBS electrodes were removed from two patients for reasons other than DBS system impairment and were analyzed by a scanning electron microscope and by an energy-dispersive X-ray spectroscopy. The results were compared to a malfunctioning device and to a new device, previously analyzed by our group. RESULTS The analysis revealed that the wear of the polyurethane external part of all the electrodes was directly correlated with the duration of implantation period. Moreover, these alterations were independent from the electrodes functioning and from parameters used during therapy. CONCLUSIONS This is the first study done that demonstrates a time-related degradation in the external layer of DBS electrodes. The analyses of morphological and chemical properties of the implanted devices are relevant for predicting the possibility of hardware's impairment as well as to improve the bio-stability of DBS systems.
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Specchio N, Rizzi M, Trivisano M, Fusco L, Rebessi E, Cappelletti S, De Palma L, Villani F, Savioli A, De Benedictis A, Marras CE, Vigevano F, Delalande O. Acute intralesional recording in hypothalamic hamartoma: description of 4 cases. Acta Neurol Belg 2015; 115:233-9. [PMID: 25300188 DOI: 10.1007/s13760-014-0374-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Abstract
Hypothalamic hamartomas (HHs) are intrinsically epileptogenic lesions associated to medically intractable focal epilepsy mainly characterized by gelastic and focal seizures. Intralesional recording with deep electrodes has documented the presence of ictal discharge arising from inside the lesion. Nevertheless interictal and ictal scalp EEG is poorly informative and non-localizing in a great deal of cases. HH disconnection leads to seizure remission in most cases. To describe the intralesional EEG recordings and to compare them with concomitant scalp EEG and with previous cases reported in literature. We reviewed the medical records of 17 children affected by drug-resistant focal epilepsy associated to HH. We recorded intralesional electrical activity during stereo-endoscopic disconnection in three cases and during deep brain stimulation implantation in one. We also correlated it with the simultaneous scalp-EEG recording. Acute intralesional recordings in our cases confirmed the presence of epileptiform abnormalities intermingled with low-voltage activity, mostly on the same side of the HH attachment. Paroxysmal activity recorded inside the HH was always evident. Mapping of HH epileptogenic activity could be useful to confirm the usefulness of disconnection procedure. This should consider on-site recording from the HH and if abnormalities are detected safely proceed to disconnection of the HH.
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Affiliation(s)
- Nicola Specchio
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, P.za S. Onofrio, 4 00165, Rome, Italy,
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Sarubbo S, De Benedictis A, Merler S, Mandonnet E, Balbi S, Granieri E, Duffau H. Towards a functional atlas of human white matter. Hum Brain Mapp 2015; 36:3117-36. [PMID: 25959791 DOI: 10.1002/hbm.22832] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Although diffusion tensor imaging (DTI) and postmortem dissections improved the knowledge of white matter (WM) anatomy, functional information is lacking. Our aims are: to provide a subcortical atlas of human brain functions; to elucidate the functional roles of different bundles; to provide a probabilistic resection map of WM. EXPERIMENTAL DESIGN We studied 130 patients who underwent awake surgery for gliomas (82 left; 48 right) with electrostimulation mapping at cortical and subcortical levels. Different aspects of language, sensori-motor, spatial cognition, and visual functions were monitored. 339 regions of interest (ROIs) including the functional response errors collected during stimulation were co-registered in the MNI space, as well as the resections' areas and residual tumors. Functional response errors and resection areas were matched with DTI and cortical atlases. Subcortical maps for each function and a probability map of resection were computed. PRINCIPAL OBSERVATIONS The medial part of dorsal stream (arcuate fasciculus) subserves phonological processing; its lateral part [indirect anterior portion of the superior longitudinal fascicle (SLF)] subserves speech planning. The ventral stream subserves language semantics and matches with the inferior fronto-occipital fascicle. Reading deficits match with the inferior longitudinal fascicle. Anomias match with the indirect posterior portion of the SLF. Frontal WM underpins motor planning and execution. Right parietal WM subserves spatial cognition. Sensori-motor and visual fibers were the most preserved bundles. CONCLUSIONS We report the first anatomo-functional atlas of WM connectivity in humans by correlating cognitive data, electrostimulation, and DTI. We provide a valuable tool for cognitive neurosciences and clinical applications.
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Affiliation(s)
- Silvio Sarubbo
- Department of Neurosciences, Division of Neurosurgery, "S. Chiara" Hospital, Trento, Italy.,Department of Biomedical and Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, "S. Anna" University-Hospital, Ferrara, Italy
| | - Alessandro De Benedictis
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital-IRCCS, Roma, Italy
| | | | | | - Sergio Balbi
- Department of Biotechnologies and Life Sciences, Ph.D. School in Surgery and Surgical Biotechnologies, University of Insubria, Varese, Italy
| | - Enrico Granieri
- Department of Biomedical and Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, "S. Anna" University-Hospital, Ferrara, Italy
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," INSERM U1051, Institute for Neuroscience of Montpellier, Saint Eloi Hospital, Montpellier, France
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