Frontal Horn Research Articles

Transcortical approaches to large intraventricular tumors: a prospective case series of 20 patients

BackgroundLarge intraventricular tumors (IVTs) impose technical and surgical challenges, due to their enormous sizes, mass effect, vast extensions, and vascularity.ObjectiveThe authors aim at presenting their results, clinical outcomes, and the surgical strategies in the management of large IVTs through transcortical approaches.MethodsA prospective trial was conducted at the Main Hospital of Alexandria University, Egypt, between August 2018 and October 2020 on 20 patients harboring IVTs larger than 5 cm or bilaterally represented. The variables evaluated included the extent of resection, postoperative neurological deficits, blood loss, surgical approaches, intraoperative challenges, complications, adjuvant therapies, Glasgow Outcome Scale, hydrocephalus, and cerebrospinal fluid (CSF) diversion.ResultsThe study included 20 cases (9 males and 11 females). Mean age at diagnosis was 16.1 years (range 1–45). Mean follow-up was 12 months (range 9–26). Primary tumor locations were ventricular body, atrium, temporal horn, and frontal horn in 11, 5, 3, and 1 cases, respectively. Main pathologies were central neurocytomas (7 patients/35%), ependymomas (3 patients/15%), and subependymal giant cell astrocytoma (SEGA) (3 patients/15%). Excision was gross total (n = 19) and near-total (n = 1). Significant intraoperative bleeding (n = 6). Postoperative minor intraventricular hemorrhage (n = 6), subdural collections (n = 8), hydrocephalus (n = 9), memory affection (n = 4), and motor deficits (n = 4). Postoperative Glasgow Outcome Scale of 5/5 (n = 20), no mortalities were recorded. preoperative seizures (n = 7), new onset postoperative seizures (n = 2).ConclusionSurgical approaches to large tumors of the lateral ventricles should be tailored to the variability of tumor locations, dimensions, extensions, and the individual morbid anatomy, in addition to the surgeon’s experience and preferences. Trans-cortical approaches can provide safe surgical corridors to tackle these challenging subtypes of IVTs with good clinical outcomes, tumor resectability rates, and seizure control.

A Rare Case of Hereditary Spastic Paraplegia: Case Report and Literature Review

Hereditary spastic paraplegia (HSP) is a rare neurodegenerative disorder presenting as lower limb spasticity having two clinical types and various modes of inheritance. A young male patient presented with bilateral lower limb weakness of one-year duration showing both sensory and motor abnormalities on examination. MRI of brain and spine done as part of workup revealed marked atrophy of anterior corpus callosum with abnormal signal intensity at tips of frontal horns of ventricles mimicking the appearance of the ear of a Eurasian lynx. No other abnormality was encountered in the brain or spinal cord in our case. Other imaging abnormalities which can be encountered in such a case include periventricular and central white matter changes as well as spinal cord atrophy. Pathologically this condition is recognised by degeneration of lateral and posterior columns of the spinal cord. The differential diagnosis includes structural, metabolic, neurodegenerative, motor and nutritional deficiency disorders.

Rare Case of Young Patient with Intraventricular Angiomatous Meningioma

Pediatric meningiomas are rare and account for only 2.2% of CNS tumors. In this age group, they are more frequently located in atypical sites, such as, mainly, the ventricular system, with a frequency of 8.8 to 13.6%. Adding this to the fact that the angiomatous subtype constitutes only 2.1% of all meningiomas, the rarity of the case reported here i s corroborated. We report a 17-year-old female patient diagnosed with intraventricular angiomatous meningioma; she underwent surgical resection of the tumor in the body and frontal horn of the right lateral ventricle, and there was no neurological sequela. With a follow-up of 4 years, there was no recurrence and the patient had clinical stability. Intraventricular tumors usually have slow growth and reach considerable size until they cause symptoms and then are diagnosed. In addition, the tumor’s deep location and proximity to eloquent areas make such tumors an neurosurgical challenge. The angiomatous subtype, due to the presence of hypervascularization (consisting of more than 50% of vascular components), may, in some cases, hinder surgical resection as well as be erroneously diagnosed. However, surgical treatment aimed at total resection of the lesion remains the conduct of choice in the case reported here, especially in patients in the first two decades of life, in which the use of radiation is avoided. Specifically when it comes to the surgery, we chose a transcallosal approach that allows a good transoperative visualization of the lesion when located in the body and frontal horn of the lateral ventricle.

CSF shunting in myelomeningocele-related hydrocephalus and the role of prenatal imaging.

Hydrocephalus is commonly associated with myelomeningocele (MMC). Indication and timing of cerebrospinal fluid (CSF) shunting are still a topic of discussion. The aim of this study was to investigate whether the analysis of prenatal cerebral imaging studies could provide information that is predictive of the necessity of CSF shunting in the postnatal period. Among 73 infants operated on because of MMC between January 2003 and June 2020, 50 had undergone prenatal and postnatal MRI studies and were considered for analysis. For each patient, frontal horn width, atrial ventricle diameter, third ventricle diameter, and subarachnoid spaces (sinocortical width, craniocortical width, and the interhemispheric width) have been measured on prenatal, postnatal, and a follow-up MRI study. The need of CSF shunting device placement in relation to prenatal and early postnatal MRI data was investigated. Of the 50 infants, 31 (62%) developed a progressive hydrocephalus. Of these, 30 needed a CSF shunt and the majority of them (n=29) was operated on within 28 days after birth. One patient needed CSF shunt implantation at 45 days after birth and one child developed a late progressive hydrocephalus, successfully treated by ETV alone, at 14.2 months of age. All patients with an atrial ventricle diameter greater than 1.9 cm and a 3rd ventricle diameter larger than 0.3 cm on antenatal third trimester imaging have undergone CSF shunting within 1 month after birth. Conversely, all the children that did not undergo a CSF shunt placement showed an atrial cerebral ventricle diameter inferior to 1.2 cm and a 3rd ventricle width < 0.3 cm on antenatal imaging. Frontal horn width and subarachnoid CSF spaces' evolution did not seem to play a role. The prenatal MRI assessment of the associated prenatal ventriculomegaly in MMC provides parameters that have a predictive value heralding the probability of a CSF diversion procedure after birth. In the same way, the analysis of intrauterine MRI studies may identify those subjects that are less at risk of developing a progressive hydrocephalus after birth, therefore encouraging a more cautious attitude towards the early implantation of CSF shunting devices in the current clinical practice.

Effectiveness of a Standardized External Ventricular Drain Placement Protocol for Infection Control

Placement of an external ventricular drain (EVD) is a common procedure routinely completed at bedside by neurosurgical residents. A standardized protocol for placement and maintenance of an EVD is potentially useful. This single-institution retrospective review analyzed all patients who underwent placement of an EVD over a 5-year span using a standardized protocol. A total of 428 EVDs in 381 patients were placed as per this protocol. Overall compliance with the practice protocol was 98.7%. Overall, our infection rate was 1.86% (8 external ventricular drain-related infection [ERIs] over 428 EVDs). There was no difference in age for the ERI cases (median 55, range (50.5-60.5), compared with the non-ERI cases (median of 53, range [38-65]) (P= 0.512). Indications for placement of EVD were hemorrhage (51.9%, n= 198), tumor (16.2%, n= 62), trauma (12.8%, n= 49), hydrocephalus (11.5%, n= 44), cerebellar stroke (2.8%, n= 11), infection (3.1%, n= 12), unknown (1.3%, n= 5). Most EVDs (77.6%, n= 296) were placed bedside by second-year residents (median PGY level 2, interquartile range 1-2.75). Computed tomography confirmed placement in the ipsilateral frontal horn in 72% (n= 277) of EVDs. EVD-related complications were noted in 8.3% of EVDs (n= 32, with 8 infections and 24 tract hemorrhages). The median EVD duration was 10 days; duration of EVD had no statistically significant impact on the risk of an ERI (P= 1). Only replacement of an EVD was associated with an increased risk of infection. Adherence to a standard EVD placement protocol is useful in maintaining a low risk of ERI regardless of the duration of catheter utilization. Replacement of the catheter through the same access hole as the original catheter is associated with an increased risk of ERI.

Evans index among adult Ghanaians on normal head computerized tomography scan

IntroductionNormal-Pressure Hydrocephalus (NPH) is a neurological condition which is made up of a clinical triad of gait disturbance, dementia and urinary incontinence and can be reversed by ventricular shunting. Currently, some guidelines suggest the use of Evans’ index (EI) for diagnosis of hydrocephalus radiologically. Most of the studies are based on the Western population data. None of these studies have been performed in the Ghanaian population setting yet. The aim of this study was to quantitatively establish normal borderline value for Evans Index in the Ghanaian adult population with respect to age and sex. MethodsThis study was retrospectively conducted on normal enhanced head CT scan images of 266 males and 241 females. EI was calculated as the linear ratio of Maximum Anterior Horn Width (MAHW) of the frontal horns of the lateral ventricles at the level of foramina of Monroe and the Maximum Intracranial Diameter (MICD) of the inner skull. Student T-test, ANOVA and Pearson's correlation were used to analyze the data. A test for a relationship was performed with a scatter plot and a linear regression was performed based on age, sex and different EI of ventricular size. ResultsThe mean and median value of EI was 0.24 ± 0.02. There was no statistically significant difference in the EI values between males and females, (p-value = 0.61). A steady increase in EI with age was observed. There was a strong correlation coefficient r = 0.89 of EI and age, which suggested a strong linear relationship between EI and Age. The overall linear relationship model was EI = 0.1879 + 0.0011∗Age. ConclusionsThe mean EI of 0.24 ± 0.02 in our study agrees with adapted international guidelines cut-off value for normal adult patients of (<0.30) and can be a useful tool in determining ventricular enlargement particularly in resource limited settings.

Variability of Normal Pressure Hydrocephalus Imaging Biomarkers with Respect to Section Plane Angulation: How Wrong a Radiologist Can Be?

Systematic analysis of angulation-related variability of idiopathic normal pressure hydrocephalus imaging biomarkers has not been published yet. Our aim was to evaluate the variability of these radiologic biomarkers with respect to imaging plane angulation. Eighty subjects (35 with clinically confirmed idiopathic normal pressure hydrocephalus and 45 age- and sex-matched healthy controls) were prospectively enrolled in a 3T brain MR imaging study. Two independent readers assessed 12 radiologic idiopathic normal pressure hydrocephalus biomarkers on sections aligned parallel or perpendicular to the bicallosal, bicommissural, hypophysis-fastigium, and brain stem vertical lines, respectively. Disproportionately enlarged subarachnoid space hydrocephalus, simplified callosal angle, frontal horn diameter, z-Evans Index, and cella media vertical width did not show significant systematic differences in any of 6 section plane combinations studied. The remaining 7 biomarkers (including the Evans Index and callosal angle) showed significant differences in up to 4 of 6 mutually compared section plane combinations. The values obtained from sections aligned with the brain stem vertical line (parallel to the posterior brain stem margin) showed the most deviating results from other section angulations. Seven of 12 idiopathic normal pressure hydrocephalus biomarkers including the frequently used Evans Index and callosal angle showed statistically significant deviations when measured on sections whose angulations differed or did not comply with the proper section definition published in the original literature. Strict adherence to the methodology of idiopathic normal pressure hydrocephalus biomarker assessment is, therefore, essential to avoid an incorrect diagnosis. Increased radiologic and clinical attention should be paid to the biomarkers showing low angulation-related variability yet high specificity for idiopathic normal pressure hydrocephalus-related morphologic changes such as the z-Evans Index, frontal horn diameter, or disproportionately enlarged subarachnoid space hydrocephalus.

The topology of ventricle surfaces and its application in the analysis of hydrocephalic ventricles: a proof-of-concept study.

The cerebral ventricles deform in a non-uniform fashion in response to increased CSF volume and/or pressure in hydrocephalic syndromes. Current research is focused on volumetric analyses, while topological analysis of ventricular surfaces remains understudied. We developed a method of quantitatively modeling the curvature of ventricular surfaces to analyze changes in ventricular surfaces in normal pressure hydrocephalus (NPH)and Alzheimer's disease (AD), using the left frontal horn as an example. Twenty-one patients with NPH were recruited from our institution, and 21 healthy controls (HC) and patients with Alzheimer's disease (AD) were identified from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. On T1-weighted fine-cut magnetic resonance sequences, 3D Slicer was used to segment the left frontal horn. Next, the mean curvatures at a set of points on the ventricular surface were determined. The frontal horns were scaled and centered into normalized volumes, allowing for pooling across the study subjects. The frontal horn was divided into superolateral, superomedial, inferolateral, and inferomedial surfaces, and locoregional mean curvatures were analyzed. Statistical comparisons were made between NPH, AD, and HC groups. Significant differences in the mean curvature of lateral surfaces of the ventricles distinguished patterns of distortion between all three cohorts. Significant flattening of the superomedial surface discriminated NPH from HC and AD. However, significant rounding of the inferomedial surface compared to controls was a distinguishing feature of NPH alone. NPH ventricles deform non-uniformly. The pattern of surface distortion may be used as an additional tool to differentiate between these hydrocephalic conditions.

Morphometric Study of Frontal Horn of Lateral Ventricle of Brain and Its Correlation with Age, Gender and Side among Adults in the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia, 2019

Background: Knowledge of the frontal horn size is necessary for the initial and precise analysis of Ventriculomegaly. Therefore, having a baseline reference value of the frontal horn size will be beneficial in a huge vary of medical pathologies. The purpose of this study was to determine the frontal horn of lateral ventricle size and its correlation with age among adult patients in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019. Methods: Hospital-based cross-sectional study design was conducted on 169 patients in the age group of 20-79 years in the University of Gondar Comprehensive Specialized Hospital. The study participants were assessed by way of structured questionnaires and checklists. Radiological residents were performed computerized tomography measurements of the frontal horn of lateral ventricle size. The data were entered using EPI INFO version 7 and analyzed by SPSS version 20. By Pearson’s product moment correlation coefficients, the correlations of frontal horn size with associated factors were evaluated. A paired t-test (between left and right side), independent t-test (between male and female) ANOVA (mean the difference between age groups) were performed. The p-value of less than 0.05was considered being significant. Results: The mean right and left frontal horn length, width, and frontal horn tips diameter were 27.57 (±3.72) mm, 28.47 (±3.77) mm, and 4.90 (±1.54) mm, 5.08 (±1.58) mm, and 30.36 (±3.04) mm, respectively. In relation to gender, the measurement of the frontal horn is greater in males as compared to females. Conclusion: In total, 169 patients satisfied the inclusion criteria. This study found a direct relationship between the frontal horn of lateral ventricle size with the age of both male and female adult participants. In all measurements, the frontal horn of the lateral ventricle size of male participants was greater than that of female participants.

Study of Normal Values of Evan’s Index on Brain CT Scan in Individuals attending Nepal Medical College Teaching Hospital, Kathmandu, Nepal

Ventriculographic indices are obtained by using Evan’s Index. Evan’s Index is a ratio which compares the maximum width of the frontal horns of the lateral ventricle to the maximum transverse diameter of the inner table of the skull and serves as an indirect marker of ventricular volume. Evan’s Index has been extensively used in the diagnosis of idiopathic normal pressure hydrocephalus, in the assessment of outcome of patients having shunt placement which is the primary mode of treatment. This study was aimed to find out the normal values of Evan’s Index on brain CT scan in individuals attending Nepal medical college teaching hospital, Kathmandu, Nepal. A total of 500 individuals CT (250 males and 250 females) were finally selected. The ages were ranged between 5 to 80 years old. The mean Evan’s Index in the studied population was 0.253 ± 0.037 in males, 0.250 ± 0.034 in the females and an overall mean of 0.251 ± 0.035. There was no significant statistical difference in the Evans ratio between male and females (P = 0.274). This study shows that Evan’s Index was higher in individuals who were 60 years and above in both males and females. The very small standard deviations appreciated in the result suggest that Evan’s index can be calculated fairly accurately.

A case of lobar holoprosencephaly: brain and facial typical features

The figures illustrate the case of a pregnant woman with a fetus with lobar holoprosencephaly (HPE). She was referred to our center after a first-level midtrimester scan for a suspected diagnosis of corpus callosum agenesis. The karyotype with chromosomal microarray analysis showed no anomalies. We present the neurosonography images acquired at 21 and 26 weeks of gestation, which allow us to hypothesize the existence of lobar HPE. This diagnosis was challenging especially during the 21 weeks ultrasound, where the communications between the frontal horns was less evident.

A Giant Frontal Meningioma with Psychiatric Symptoms in a Young Woman: A Case Report

Background:Frontal meningioma is often asymptomatic but patients might experience psychiatric symptoms. Since symptoms are atypical in giant meningioma, to the best of our knowledge, we present a rare clinical scenario. Case Presentation: A 24-year old female patient with no medical history presented with two months of depressive symptoms, personality changes such as easy irritability, and feelings of frustration and mental depression, as well as forgetfulness and blurred vision. Brain magnetic resonance imaging (MRI) revealed a well-defined markedly enhancing lesion in the left frontal region measuring 65 x 70 x 70 mm with mass effects to the adjacent brain tissue and associated surrounding edema which was pressed to the frontal horn of the lateral ventricle. The patient underwent frontal unilateral craniotomy and excision of the tumor. After surgery, the quality of life was improved. Conclusion: Meningioma with psychiatric symptoms is quite rare. This clinical case helps clinicians avoid missing symptoms and use appropriate management strategies for patients with giant meningiomas.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

Morphometric Study of Lateral Ventricles of Brain by MRI in Healthy Adults in Northern Zone of Bangladesh

Background &amp; Objective: The present study was done to provide information about the morphometric measurement of lateral ventricles of human brain in relation to age and sex in northern Bangladeshi people.&#x0D; Methods: This cross-sectional study was conducted in the Department of Anatomy, Rajshahi Medical College, Rajshahi over a period one year from July 2014 to June 2015. All patients attending at Radiology &amp; Imaging Department of Rajshahi Medical College Hospital and at different private hospitals and clinics of Rajshahi city and had normal MRI scan of brain were the study population. A total of 60 individuals of both sexes and age ranging between 18-50 years were included in the study. Having obtained ethical clearance from the Ethical Committee and verbal consent from the patients, the data collection was commenced. Patients were asked to lie on the MRI table in supine position with head fixed and coil placed around the head. MRI was done with MRI machine (Airis II Hitachi 0.3 Tesla) and images were taken by T1WI, T2WI, STAIR, FLAIR. Images were taken from axial, sagittal and coronal planes with sequence slice thickness being 7 mm. From the images of axial slices, six proper slices were selected.&#x0D; Result: Age distribution of the subjects with respect to sex shows that nearly two-thirds (63.3%) of the female subjects were 30 or younger than 30 years old, whereas 50% of the male subjects were early middle-aged (p = 0.110). The mean lengths of frontal horn of right and left lateral ventricles in male subjects were significantly greater than those in female subjects (p = 0.002 and p = 0.001 respectively). Likewise, the right and left ventricular bodies in male subjects were significantly longer than those of their female counterparts (p = 0.033 and p = 0.012 respectively). The length of frontal horn of the lateral ventricles was found to increase with age up to 40 years in both right and left ventricles and then it began to decrease. The mean lengths of frontal horn of right and left lateral ventricles at ages ≤ 30, 31-40 and &gt; 40 years were 27.25, 28.74 and 26.0 mm and 27.57, 28.93 and 27.19 mm respectively. While the three measures of length of frontal horn of right lateral ventricles were significantly heterogeneous (p = 0.049), the three measures of length of frontal horn of left lateral ventricles were not significantly different (p = 0.141).The mean lengths of body of right and left lateral ventricles at different ages were 40.40, 43.98, 45.11 mm and 41.06, 44.52 and 45.21 mm respectively (p = 0.001 andp = 0.001 respectively).&#x0D; Conclusion: The present study concluded that the lateral ventricles vary in size within certain limit according to age, sex and laterality. All the parameters of lateral ventricles (lengths of frontal horn, length of ventricular body) were significantly larger in males than those in females. While the length of frontal horn of the lateral ventricles (of both sides) increases in size up to the age of 40 years and thereafter regresses, the length of ventricular body bears a linear relationship with age throughout life-span.&#x0D; Ibrahim Card Med J 2020; 10 (1&amp;2): 45-50

Sonographic hypoechogenicity of brainstem raphe nucleus is correlated with electroencephalographic spike frequency in patients with epilepsy

BackgroundBrainstem raphe nucleus (BRN) hypoechogenicity in transcranial sonography (TCS) has been demonstrated in patients with major depression, possibly representing a sonographic manifestation of serotonergic dysfunction in depression. Most patients with epilepsy with comorbid depression exhibit hypoechogenic BRN in TCS. However, the role of BRN in the pathogenesis of epilepsy is unclear. This study aimed to evaluate the correlation of BRN echogenicity with epilepsy itself, and the echogenicity of other midbrain structures and the size of lateral ventricle (LV) will also be evaluated in patients with epilepsy. MethodsThirty-six patients with epilepsy without depression and 37 healthy controls were recruited. Sonographic echogenicity of BRN, caudate nucleus (CN), lentiform nucleus (LN), substantia nigra (SN), and the width of frontal horns of the lateral ventricles (LV) and the third ventricle (TV) were evaluated with TCS. The frequency of interictal epileptiform discharges (IEDs) was assessed with ambulatory electroencephalogram (AEEG). ResultsHypoechogenicity of BRN was depicted in 36.1% of patients with epilepsy and 18.9% of controls, showing no significant difference. Patients with epilepsy with BRN hypoechogenicity had higher epileptic discharge index (EDI) than those with normal BRN echogenecity. Especially, higher EDI in patients with BRN hypoechogenicity was observed during the sleep period but not during awake period. The width of TV was significantly larger in patients with epilepsy than that in controls. We did not find any difference between patients with epilepsy and controls in the echogenicity of CN, LN, and SN, as well as in the width of frontal horn of LV. ConclusionsHypoechogenic BRN is correlated with a high frequency of epileptic discharges in electroencephalogram (EEG), especially during sleep period but not during awake period, indicating that BRN alterations may play a potential role in the pathogenesis of epilepsy in association with sleep cycle.

Giant central nervous system tuberculoma in pediatric patients: surgical case series

Central nervous system tuberculoma is rare and challenging situation. Clinical records of patients with pathologically proven tuberculoma were retrospectively reviewed. Clinical presentation, lesion location, radiological characteristics, perioperative and surgical management, and outcome is summarized and analyzed. Eight patients were included and there was one girl. Age ranged from 3 to 14 years with mean age 9.8 years. Clinical duration ranged from 20 days to 2 years, and 3 patients had previous lung tuberculosis with anti-TB treatment. The lesion was in cerebellum in 6 cases, including 1 involving basal ganglia and 1 involving thalamus. The lesion was in basal ganglia, thalamus, and third ventricle in 1 case, and in T12-L1 spinal cord in another. Cerebellar lesion was resected via paramedian suboccipital approach in 5 patients, basal ganglia lesion via trans-cortical frontal horn approach in 2 patients, and intra-spinal lesion via trans-laminar approach in 1 patient. Follow-up ranged from 10 to 24 months. Of the 8 patients, 6 returned to normal life. One patient had cerebellar lesion resected and the thalamic lesion reduced in size after anti-TB treatment. One patient died from TB spreading. Our data showed that most patients can be successfully treated by resection of the lesion. Low T2 signal, ring shaped enhancement and peripheral edema strongly suggest tuberculoma. Empirical anti-TB treatment should be initiated perioperatively.

Predictors of cervical myelopathy and hydrocephalus in young children with achondroplasia

BackgroundCervical myelopathy and hydrocephalus occasionally occur in young children with achondroplasia. However, these conditions are not evaluated in a timely manner in many cases. The current study presents significant predictors for cervical myelopathy and hydrocephalus in young children with achondroplasia.MethodsA retrospective analysis of 65 patients with achondroplasia who visited Seoul National University Children’s Hospital since 2012 was performed. The patients were divided into groups according to the presence of cervical myelopathy and hydrocephalus, and differences in foramen magnum parameters and ventricular parameters by magnetic resonance imaging between groups were analyzed. Predictors for cervical myelopathy and hydrocephalus were analyzed, and the cut-off points for significant ones were calculated.ResultsThe group with cervical myelopathy showed foramen magnum parameters that indicated significantly lower cord thickness than in the group without cervical myelopathy, and the group with hydrocephalus showed significantly higher ventricular parameters and ‘Posterior indentation’ grade than the group without hydrocephalus. ‘Cord constriction ratio’ (OR 5199.90, p = 0.001) for cervical myelopathy and ‘Frontal horn width’ (OR 1.14, p = 0.001) and ‘Posterior indentation’ grade (grade 1: OR 9.25, p = 0.06; grade 2: OR 18.50, p = 0.01) for hydrocephalus were significant predictors. The cut-off points for cervical myelopathy were ‘Cord constriction ratio’ of 0.25 and ‘FM AP’ of 8 mm (AUC 0.821 and 0.862, respectively) and ‘Frontal horn width’ of 50 mm and ‘Posterior indentation’ grade of 0 (AUC 0.788 and 0.758, respectively) for hydrocephalus.Conclusion‘Cord constriction ratio’ for cervical myelopathy and ‘Frontal horn width’ and ‘Posterior indentation’ grade for hydrocephalus were significant predictors and may be used as useful parameters for management. ‘Posterior indentation’ grade may also be used to determine the treatment method for hydrocephalus.

Exploiting lamina terminalis appearance and motion in prediction of hydrocephalus using convolutional LSTM network

BackgroundEvaluation of the lamina terminalis (LT) is crucial for non-invasive evaluation of the CSF diversion for the treatment of hydrocephalus. Together with deep learning algorithms, morphological and physiological analyses of the LT may play an important role in the management of hydrocephalus. AimWe aim to show that exploiting the motion of LT can contribute to the evaluation of hydrocephalus using deep learning algorithms. MethodsThe dataset contains 61 True-fisp data with routine sequences 37 of which are labeled as ‘hydrocephalus’ and the others as ‘normal condition’. A fifteen-year experienced neuroradiologist divided data into two groups. The first group, ‘hydrocephalus’, consists of patients with typical MRI findings (ventriculomegaly, enlargement of the third ventricular recesses and lateral ventricular horns, decreased mamillo-pontine distance, reduced frontal horn angle, thinning/elevation of the corpus callosum, and non-dilated convexity sulci), and the second group contains samples that did not show any symptoms or neurologic abnormality and labeled as ‘normal condition’. The region of interest was determined by the radiologist supervisor to cover the LT. To achieve our purpose, we used both spatial and spatio-temporal analysis with two different deep learning architectures. We utilized Convolutional Neural Networks (CNN) for spatial and Convolutional Long Short-Term Memory (ConvLSTM) models for spatio-temporal analysis using an ROI around LT on sagittal True-fisp images. ResultsOur results show that 80.7% classification accuracy was achieved with the ConvLSTM model exploiting LT motion, whereas 76.5% and 71.6% accuracies were obtained by the 2D CNN model using all frames, and only the first frame from only spatial information, respectively. ConclusionWe suggest that the motion of the LT can be used as an additional attribute to the spatial information to evaluate the hydrocephalus.

White matter hyperintensities and patterns of atrophy in early onset Alzheimer’s disease with causative gene mutations

ObjectiveWhite matter hyperintensities could be found in many degenerative dementias including Alzheimer’s disease (AD). Pathogenesis of white matter hyperintensities in AD is complicated. We aim to identify the features of white matter hyperintensities and the atrophy pattern in early onset Alzheimer’s disease with causative gene mutations. Methods7 AD dementia patients with causative mutations were included and the clinical history, neuropsychology, neuroimaging,APOE genotype and whole-genome sequencing (WGS) were analyzed. Axial T1-weighted images and Fluid attenuated inversion recovery (FLAIR) were analyzed with visual rating scale to examine cortical atrophy and white matter hyperintensities. Results5 female and 2 male patients with 4PSEN1, 2PSEN2 and 1APP mutation were included. The average age of onset was 46.7y/o (44–52) and the duration of disease was 28.6 months (8−60). Clinical phenotype included memory loss (100 %), visual/spatial disorder (100 %), executive dysfunction (100 %), calculation disorder (85.7 %), disorientation (85.7 %), language problem (57.1 %), personality change (28.6 %) and movement disorder (14.3 %). The grading of posterior cortex atrophy was higher than medial temporal lobe atrophy. Periventricular hyperintensities surrounding occipital and frontal horn of ventricle and sub-ventricular bands were most common, while small foci of lesions were also detected in deep white matter, sub-cortical and juxta-cortical area. Mutations carriers in the APP gene or PSEN1 gene postcodon 200 had more severe white matter hyperintensities than other mutations. ConclusionWhite matter hyperintensities were found in early onset AD with causative mutations. The severity was related to genotypes and spatial distributions. Axon degeneration following neuronal loss and ischemic injury might be the pathogenesis of white matter damage. Severer atrophy in the posterior cortex than medial temporal lobe can present in early onset AD.

Navigated Endoport in the Purely Endoscopic Microsurgery of Intraventricular and Other Deep-Seated Brain Lesions: A Case Report

&lt;p&gt;&lt;strong&gt;Objective. &lt;/strong&gt;Brain parenchyma retraction is often necessary to reach various deep brain lesions during surgery. In order to minimise the incidence of the brain retraction injury, an endoport system may be employed. We present a report of a navigated endoport system in conjunction with an purely endoscopic microsurgery that was used in a patient with a deep-seated subependymoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Report. &lt;/strong&gt;A navigated endoport with purely endoscopic microsurgery were used in a patient with a tumour&lt;/p&gt;&lt;p&gt;located in the frontal horn of the left lateral ventricle. The endoport channel was made of a polyvinyl sheet that was cut into a 7 cm square, rolled into a tubular structure that was wrapped around the neuronavigational probe, and inserted in the access trajectory to the tumour. The endoport tube was then expanded with a balloon to a diameter of 7 mm and a surgical corridor was thus formed. During the purely endoscopic microsurgical lesionectomy, the tumour was completely removed from the frontal horn. The foramen of Monro was released and the septum pellucidum was perforated for better cerebrospinal fluid circulation. Histopathological examination confirmed the tumour as subependymoma. The recovery of the patient was unremarkable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion. &lt;/strong&gt;The expandable endoport system supplemented with neuronavigation is a safe and efficient option for deep-seated tumour removal. The tubular shape of the retractor enables standard microsurgical techniques through minimally invasive approaches and offers an excellent visualization of the underlying lesion.&lt;/p&gt;