Frontal Horn Of Lateral Ventricle Research Articles

Transcranial ultrasonography as a predictor of disease progression in multiple sclerosis

BackgroundDevelopment of novel biomarkers for multiple sclerosis (MS) is of utmost importance to improve the capability to predict disease progression and disability. Transcranial ultrasonography (TCS) is a noninvasive imaging technique that allows the visualization of major parenchymal structures. This study aimed to evaluate the role of parenchymal transcranial sonography as a predictor for disease severity and progression in MS patients. Sixty patients with clinically definite Multiple sclerosis divided into two groups, relapsing–remitting MS (RRMS) group and chronic progressive MS (CPMS) group were included.ResultsThere was a statistically significant increase in the mean diameters of the third ventricle, both frontal horns of lateral ventricle in RRMS and CPMS group compared to control values, and in CPMS group compared to RRMS group. Expanded Disability Status Scale (EDSS) score was significantly positively correlated with the diameter of right frontal horn of lateral ventricle in CPMS group. Linear regression analysis revealed that diameters of right frontal horn of lateral ventricle and third ventricle were independent predictors for MS severity.ConclusionsTCS can be used as a simple noninvasive tool for prediction of disease severity and progression in MS patients.

Validation of brain parenchyma sonography as a marker of neurodegeneration in multiple sclerosis

BackgroundMultiple sclerosis (MS) is widely known to cause brain atrophy due to neurodegeneration. Neuroimaging investigations revealed a direct link between brain atrophy detected by MRI and impairment. Transcranial sonography is a safe, feasible and cost-effective imaging technique. In this study, we aimed to validate B-mode transcranial sonography (TCS) as a marker of neurodegeneration in MS. This study is the first study directed to set cut-off point for brain parenchyma measurement in Egyptian population. An observational, case–control study, conducted on 125 subjects; divided into 2 groups: first group, 71 healthy volunteers and patients’ group (54 patients) with relapsing–remitting multiple sclerosis (RRMS). All studied subjects were assessed using B-mode TCS. Transcranial sonography findings were categorized into: first, assessment of brain atrophy parameters by measuring diameter (cm) of third ventricle and both frontal horns of lateral ventricles. Then, the echogenicity of thalamus and brainstem structures (substantia nigra (SN), red nucleus) planimetric surface area (cm2) were assessed along with their abnormal echogenicity (cm2), while brainstem raphe was assessed semi-quantitatively for its echogenicity (intact or interrupted).ResultsQuantitative measures of brain atrophy: in normal control group the third ventricle diameter mean was 0.2 cm (± 0.08), right and left frontal horn diameter were 0.3 cm (± 0.13) and 0.28 cm (± 0.1), respectively, brain atrophy parameters could differentiate between MS patients and normal control group as a statistically significant (p< 0.001) larger ventricular diameter was found in MS patients. On the other hand, assessment of brain stem structures and thalamus showed no statistical significance between MS patients and normal control except in surface area of both red nuclei.ConclusionsBrain parenchymal sonography may be used as a tool in assessment of neurodegeneration in MS patients.

Assessment of Evan’s Index in North-Western Nigeria using Computerised Tomography

Aim: To determine the Evan’s Index of Nigerians using computerized tomography in Sokoto North-Western Nigeria.&#x0D; Study Design: Retrospective cross- sectional.&#x0D; Place and duration of study: Department of Anatomy Usmanu Danfodiyo University Sokoto and Department of Radiology Usmanu Danfodiyo University Teaching Hospital Sokoto, between January, 2020 and January, 2022.&#x0D; Methodology: Normal brain CT scans of one hundred and seventy-eight subjects from the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital, whose ages ranged from 1 to 70 year. The Evans index was determined by the ratio of the measured distance between the tips of the frontal horns of lateral ventricles and the inner skull tables at the midpoint of the cranium in axial plane.&#x0D; Results: The Evan’s indexes were larger in male than the females and these differences were not statically significant except in the age group 51-60years where statistically significant difference was observed between male and female (p=0.042). The minimum Evan’s index was 0.02cm in male and 0.01 females and the maximum bi-frontal index was 0.40cm in male and 0.38cm in females.&#x0D; Conclusion: The Evan’s indexes and it relation with sex and age in our environment was determined.

Quantification of T1 and T2 of subarachnoid CSF: Implications for water exchange between CSF andbrain tissues.

To quantify the T1 and T2 values of CSF in the subarachnoid space (SAS) at 3 T and interpret them in the context of water exchange between CSF and brain tissues. CSF T1 was measured using inversion recovery, and CSF T2 was assessed using T2 -preparation. T1 and T2 values in the SAS were compared with those in the frontal horns of lateral ventricles, which have less brain-CSF exchange. Phantom experiments were performed to examine whether there were spatial variations in T1 and T2 that were unrelated to brain-CSF exchange. Simulations were conducted to investigate the relationship between the brain-CSF exchange rate and the apparent T1 and T2 values of SAS CSF. The CSF T1 and T2 values were 4308.7 ± 146.9 ms and 1885.5 ± 67.9 ms, respectively, in the SAS and were 4454.0 ± 187.9 ms and 2372.9 ± 72.0 ms in the frontal horns. The SAS CSF had shorter T1 (p = 0.006) and T2 (p < 0.0001) than CSF in the frontal horns. Phantom experiments showed negligible (< 6 ms for T1 ; < 1 ms for T2 ) spatial variations in T1 and T2 , suggesting that the T1 and T2 differences between SAS and frontal horns were largely attributed to physiological reasons. Simulations revealed that faster brain-CSF exchange rates lead to shorter apparent T1 and T2 of SAS CSF. However, the experimentally observed T2 difference between SAS and frontal horns was greater than that attributable to typical exchange effect, suggesting that the T2 shortening in SAS may reflect a combined effect of exchange and deoxyhemoglobin susceptibility. Quantification of SAS CSF relaxation times may be useful to assess the brain-CSF exchange.

Cavernous Malformations: What They Have Taught Us.

Cavernous Malformations: What They Have Taught Us.

MORPHOMETRIC STUDY OF THE FRONTAL HORN OF LATERAL VENTRICLES OF BRAIN BY IMAGING USING COMPUTERIZED TOMOGRAPHY

Introduction The cerebral ventricular system consists of a series of interconnecting spaces and channels which originate from the central lumen of the embryonic neural tube. The ventricular system lled with cerebrospinal uid, is an essential part of the brain. Understanding the normal anatomy and the variations of the ventricular system of brain is helpful for clinicians, neurosurgeons and radiologists in day-to-day clinical practice1. Aims And Objectives To determine the average dimensions and variations of the frontal horn of the normal lateral ventricles of brain by CT scan. Materials And Methods The study was conducted in individuals who attended the Department of Radiodiagnosis in Government Medical College, Thiruvananthapuram. Those patients whose brain CT scans were read as normal by the radiologist were taken up for the study. A total of 200 CT brain of individuals above 10 years of age were taken during the period from January 2017 to June 2018.100 males and 100 females were included in the study group. Results The length of the frontal horn of lateral ventricle of brain was found to be more on the left side and in male gender. It was also observed to be increasing with age. Conclusion The present study outlines the normal values of the length of frontal horn of the lateral ventricles of brain using Computerized tomography which would aid in the diagnosis and management of neurological disorders.

Relationship between cognitive profile and neuroradiographic parameters in patients with idiopathic normal pressure hydrocephalus.

Background: Normal pressure hydrocephalus (NPH) is a reversible type of dementia, which affects 0.2 to 5.9 percent of elders. It manifests with triad of gait disturbances, urinary incontinence, and cognitive decline. In this study, association between cognitive and neuroradiographic parameters of idiopathic NPH (iNPH) was appraised to find out possible biomarkers for preventive intervention. Methods: In a cross-sectional study, 16 patients with iNPH were evaluated for third and fourth ventricle diameter, diameter of temporal horn of lateral ventricle, Evans index (EI), callosal angle (CA), callosal bowing, and ballooning of frontal horn. The Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) was used to take cognitive profile. Relation between brain magnetic resonance imaging (MRI) indices and cognitive domains was extracted, using generalized linear model (GLM). Results: Patients with mild callosal bowing had better function in memory (P = 0.050) and language (P = 0.001) than those with moderate to severe callosal bowing. Negative or mild ballooning of frontal horn was also associated with higher scores in memory (P = 0.010), executive function (EF) (P = 0.029), and language (P = 0.036) than moderate to severe ballooning of frontal horn. Increased 3rd ventricle diameter was associated with decline in total cognition (P = 0.008), memory (P = 0.019), EF (P = 0.012), and language (P = 0.001). Relation between other radiographic indices and cognitive function was not significant. Conclusion: Third ventricular diameter, rounding of frontal horn of lateral ventricle, and callosal bowing are more accurate neuroradiographic parameters to predict cognitive decline in iNPH.

Prediction of 6 months endoscopic third ventriculostomy success rate in patients with hydrocephalus using a multi-layer perceptron network

ObjectiveDiscrimination between patients most likely to benefit from endoscopic third ventriculostomy (ETV) and those at higher risk of failure is challenging. Compared to other standard models, we have tried to develop a prognostic multi-layer perceptron model based on potentially high-impact new variables for predicting the ETV success score (ETVSS). MethodsClinical and radiological data of 128 patients have been collected, and ETV outcomes were evaluated. The success of ETV was defined as remission of symptoms and not requiring VPS for six months after surgery. Several clinical and radiological features have been used to construct the model. Then the Binary Gravitational Search algorithm was applied to extract the best set of features. Finally, two models were created based on these features, multi-layer perceptron, and logistic regression. ResultsEight variables have been selected (age, callosal angle, bifrontal angle, bicaudate index, subdural hygroma, temporal horn width, third ventricle width, frontal horn width). The neural network model was constructed upon the selected features. The result was AUC:0.913 and accuracy:0.859. Then the BGSA algorithm removed half of the features, and the remaining (Age, Temporal horn width, Bifrontal angle, Frontal horn width) were applied to construct models. The ANN could reach an accuracy of 0.84, AUC:0.858 and Positive Predictive Value (PPV): 0.92, which was higher than the logistic regression model (accuracy:0.80, AUC: 0.819, PPV: 0.89). ConclusionThe research findings have shown that the MLP model is more effective than the classic logistic regression tools in predicting ETV success rate. In this model, two newly added features, the width of the lateral ventricle's temporal horn and the lateral ventricle's frontal horn, yield a relatively high inter-observer reliability.

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.

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.

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

BCL11B-related disorder in two canadian children: Expanding the clinical phenotype

The product of the BCL11B (B-Cell Leukemia 11) gene is a bi-functional transcriptional regulator that can act as either a repressor or an activator. It plays an important role in the development of the nervous, immune, and cutaneous systems, and is also involved in dental and craniofacial development. BCL11B-Related Disorder (BCL11BRD) is a novel rare neurodevelopmental disorder associated with mutations in BCL11B. A total of 17 patients have been described in the literature thus far. The main symptoms of BCL11BRD include global developmental delay, speech impairment, dental anomalies, feeding difficulties, refractive errors, dysmorphic features, and immunological abnormalities. In this report, we describe two Canadian girls, with pathogenic de novo BCL11B variants, both diagnosed via exome sequencing. One of the patients had global developmental delay, dental anomalies, dysmorphic features, dyskinesia and hypotonia; the latter two symptoms have not been previously reported in patients with BCL11BRD. She also had dysgenesis of corpus callosum and dilatation of the frontal horns of lateral ventricles, a brain anomaly that has been previously reported in only one other patient. The second patient had developmental delay, dysmorphic features, spasticity in lower limbs and dental anomalies. Our report contributes to the knowledge of the BCL11BRD, expands the clinical phenotype, and can also aid with genetic counseling of newly identified patients.

Microcephalic osteodysplastic primordial dwarfism type II: Additional nine patients with implications on phenotype and genotype correlation.

PCNT encodes a large coiled- protein localizing to pericentriolar material and is associated with microcephalic osteodysplastic primordial dwarfism type II syndrome (MOPD II). We report our experience of nine new patients from seven unrelated consanguineous Egyptian families with the distinctive clinical features of MOPD II in whom a customized NGS panel showed homozygous truncating variants of PCNT. The NGS panel results were validated thereafter using Sanger sequencing revealing three previously reported and three novel PCNT pathogenic variants. The core phenotype appeared homogeneous to what had been reported before although patients differed in the severity showing inter and intra familial variability. The orodental pattern showed atrophic alveolar ridge (five patients), rootless tooth (four patients), tooth agenesis (three patients), and malformed tooth (three patients). In addition, mesiodens was a novel finding found in one patient. The novel c.9394-1G>T variant was found in two sibs who had tooth agenesis. CNS anomalies with possible vascular sequelae were documented in two male patients (22.2%). Simplified gyral pattern with poor development of the frontal horns of lateral ventricles was seen in four patients and mild thinning of the corpus callosum in two patients. Unilateral coronal craniosynstosis was noted in one patient and thick but short corpus callosum was an unusual finding noted in another. The later has not been reported before. Our results refine the clinical, neuroradiological, and orodental features and expand the molecular spectrum of MOPD II.

Changes in Callosal Angle After Successful Endoscopic Third Ventriculostomy Procedure in Pediatric Patients.

To determine whether callosal angle (CA) measurement, a diagnostic and prognostic tool used for normal-pressure hydrocephalus in adults, is a reliable radiological parameter for evaluating endoscopic third ventriculostomy (ETV) outcomes in pediatric patients. Forty-seven pediatric patients with hydrocephalus who underwent successful ETV in our clinic between 2011 and 2015 were included in this study. Preoperative and postoperative three-month CA, lateral ventricle frontal horn (LVFH) width, Evans' index (EI), and frontal-occipital horn ratio (FOR) parameters were recorded, with changes analyzed using a paired-samples t-test. There were 29 male and 18 female patients included within the cohort. For mean preoperative values, LVFH width was 58.8 ± 14.9 mm, EI was 0.43 ± 0.09, FOR was 0.51 ± 0.74, and CA was 78.5° ± 36.4°. Separately, for mean postoperative values, LVFH width was 54 ± 14.2 mm, EI was 0.39 ± 0.09, FOR was 0.47 ± 0.07, and CA was 104.5° ± 32.6°. The CA was increased and the LVFH width, EI, and FOR were decreased in all patients within three months after surgery. The postoperative three-month change in CA was higher than those observed in the other parameters. Changes in CA after successful ETV were dramatically higher than those in the other ventricular parameters. For this reason, we suggest CA be used as a radiological criterion during early radiological follow-up of patients after ETV.

EP09.07: Prenatal ultrasonographic differential diagnosis of absent cavum septi pellucidi

Cavum septi pellucidi (CSP) is a fluid filled cavity between two thin membranes called septum pellucidum. The CSP is visible on ultrasonography as an anechoic rectangular box along the axial planes. Prenatal ultrasonographic finding of CSP is an important landmark to evaluate the fetal brain and its visualisation convinces of normal central forebrain development. Invisible CSP is rarely isolated and typically associated with other central nervous system malformations such as holoprosencephaly, agenesis of the corpus callosum (ACC), severe hydrocephaly and septo-optic dysplasia (SOD). We performed a retrospective review of absent CSP cases between January 2011 and December 2017. A total 20 cases of absent CSP were found. Of these, 4 fetuses were delivered in our department and the diagnosis was confirmed by postnatal brain ultrasonography and magnetic resonance imaging (MRI): ACC in two cases, isolated absent CSP in one case and SOD in one case. In ACC cases, absent CSP and other ultrasonographic findings such as non-visualisation of pericallosal artery using Doppler in sagittal view, disproportionate enlargement of the occipital horns of lateral ventricles known as tear-drop sign and dilatation of 3rd ventricle helped to investigate ACC. In one patient, prenatal ultrasonography and fetal MRI demonstrated absent CSP and visible optic nerve without other abnormal findings suggestive isolated absent CSP. In a second patient, ultrasonographic coronal plane of brain showed the absent septum pellucidum with downward point of the frontal horns suspecting SOD. Our report provided informative examples for differential diagnosis of absent CSP. If an abnormality of CSP is indentified, stepwise finding of ultrasonographic signs of ACC is needed. Also the visualisation an optic tract and downward pointing of frontal horns of lateral ventricles on ultrasonography are feasible to distinguish isolated absent CSP with SOD. MRI also could be supportive to allow more definitive diagnosis. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Rare Case of Young Patient with Intraventricular Angiomatous Meningioma

AbstractPediatric meningiomas are rare and account for only 2.2% of the central nervous system (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 is 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 were no neurological sequelae. With a follow-up of 26 months, there was no recurrence and the patient had clinical stability. Intraventricular tumors usually have slow growth and reach a considerable size until they cause symptoms and then are diagnosed. In addition, the deep location of the tumor and its proximity to eloquent areas make these tumors a neurosurgical challenge. The angiomatous subtype, due to the presence of hypervascularization (consisting of &gt; 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 transcalosal approach that allows a good transoperative visualization of the lesion when located in the body and frontal horn of the lateral ventricle.

Curative effect and complication of neuronavigation guided puncture ventricle peritoneal shunt and traditional ventriculoperitoneal shunt for hydrocephalus

Objective To compare the accuracy of placement of ventricular shunt tube, the efficacy and complications of the neuronavigation-assisted ventriculoperitoneal shunt (group A) and traditional ventriculoperitoneal shunt (group B). Methods A retrospective study was made on 40 cases of hydrocephalus managed with neuronavigation-assisted ventriculoperitoneal shunt or ventriculoperitoneal shunt from January 2012 to June 2016. There were 18 cases [12 males, 6 females; (47.5±8.5) years of age] in group A and 22 cases [14 males, 8 females; (44.5±7.5) years of age] in group B. Therapeutic effect and complications were analyzed postoperatively. The accuracy rate in ventricular end shunt placement that was free from the frontal horn of lateral ventricle and flush the Moro hole had also been studied. Results The position of ventricular shunt of all the patients were postoperative timely review of the CT view, and hospital outpatient follow-up periodical for 3-24 months after discharge from hospital. Patients with postoperative timely review of head CT and found that group A of ventricular end of the shunt tube position reach a set position in 16 cases, 2 cases had not reached the set position, the accuracy rate was 88.89%. There were 8 cases in group B reach to the set position and 14 cases did not and the accuracy rate was 36.36%. After the statistical analysis there were significant differences (P 0.05). Postoperative complications included bleeding, infection, obstruction of the shunt, excessive shunt, shunt insufficiency and so on. During follow-up, group A appeared excessive shunt in 1 case; group B incision infection in 1 case, 4 cases of shunt obstruction, excessive shunt in 1 case, 2 cases of deficiency of shunt. Two groups of patients were recovery well through the drainage tube pressure adjustment or set it once again. The incidence of complications in group A was 5.56%, group B was 36.36%. There was no significant difference between group A and group B (P>0.05). In group A, there was no obstruction of shunt tube, ventricular end of the shunt tube blockage occurred in 4 cases in group B, the incidence rate was 18.18%(P>0.05). Conclusion Neuronavigation guided ventriculoperitoneal shunt placement to the accuracy of position setting has significant advantages over traditional ventriculoperitoneal shunt in the ventricular end of the shunt tube and it has some advantages in reducing postoperative complications. Key words: Neuronavigation; Hydrocephalus; Postoperative complications; Ventriculoperitoneal shunt

Transcranial Brain Sonography in Parkinson's Disease and Other Parkinsonian Disorders: a Hospital Study from Tuzla, Bosnia and Herzegovina.

Introduction:Transcranial sonography (TCS) is a relatively new ultrasound modality which could display echogenicity of human brain tissue through the intact skull. TCS may be useful in differentiation of idiopathic Parkinson’s disease (PD) from other parkinsonian disorders. Therefore, we studied different ultrasound markers by TCS in individuals with Parkinson’s disease.Patients and Methods:We performed TCS in 44 patients with PD and 22 patients with other parkinsonian disorders. Echogenic sizes of the substantia nigra (SN) and the lentiform nuclei (LN), as well as the width of the third ventricle and the frontal horns of the lateral ventricle, were measured. We also analyzed the echogenicity of the brainstem raphe (BR).Results:An unilateral hyperechogenic SN was observed in 31 (70%) patients with PD and only in 2 patients (9%) with other parkinsonian disorders (P<0.0001). Hyperechogenicity of the LN was no observed in patients with PD; however, it was present in 7 (32%) patients with other parkinsonian disorders (P=0.0002). Diameter of third ventricle (8.6+/-2.2 mm vs. 6.9+/-1.7mm, P=0.001), right (18.5+/-2.6 mm vs. 16.5+/-2.3 mm, P=0.003) and left frontal horn of lateral ventricle (19.0+/-3.7 mm vs. 16.2+/-2.6 mm, P=0.0006) was significantly wider in patients with other parkinsonian disorders compared with patients with PD. There was no difference in presence of hypoechogenic or interrupted BR in patients with PD and patients with other parkinsonian disorders (39% vs. 27%, P=0.4).Conclusion:TCS is a promising diagnostic technique and can be very helpful in differentiating between idiopathic Parkinson’s disease and other parkinsonian disorders.

Persistent Brain Herniation after Decompressive Hemicraniectomy: Role of Lumbar Drainage for Cranioplasty. Case Report

Hydrocephalus and ex-vacuo ventricular dilatations which cause persistent brain herniation with impossibility to perform cranioplasty, are well known late complications after decompressive hemicraniectomy; concerning the physiopathologic mechanism leading to these complications, there are several theories. We report the particular case of a patient suffering from persistent brain herniation after decompressive hemicraniectomy, due to development of subdural hygroma, intraparenchymal multiple liquoral cysts and only mild enlargement of frontal horn of right lateral ventricle. A fifty-five years old male patient was treated with decompressive right hemicraniectomy for acute hemispheric swelling consequent to right internal carotid artery dissecation. After several months, evaluating the patient for cranioplasty, brain herniation was clinically evident and brain MRI confirmed it due to subdural hygroma, intraparenchymal multiple liquoral cysts and mild enlargement of frontal horn of right lateral ventricle. According to several reported theories, communication between right frontal horn of lateral ventricle, intraparenchymal liquoral cysts and subdural hygroma was supposed, and CSF lumbar drainage was placed. Regression of brain herniation was achieved and cranioplasty was possible; after few days lumbar drainage was removed: neither operative, nor short and long follow-up period complications were observed. Temporary CSF lumbar drainage resulted effective to obtain regression of a particular case of persistent brain herniation developed after decompressive hemicraniectomy; moreover this safe procedure, not previously described to forerun cranioplasty surgery to our knowledge, allowed performing cranioplasty in absence of complications and avoiding temporary or permanent ventricular shunts which present a major rate of risks and possible complications.

Sexual Dimorphism of Ventricles of the Brain in Rajasthan Population

40 Male and 40 Female, normal adult age between 25 to 35 were selected for study. Their Ventricles of the Brain were studied with C.T Scan. Mean Values Height of Fourth Ventricle of males was 1.476 cm (SD ±0.008) and Females was 1.121 cm (SD ±0.013) and t=test result was 147.07 cm which was statistically highly significant (P < 0.001) Mean Value of width of fourth Ventricle of male was 1.628 cm (SD ±0.016) and females was 1.235 cm (SD ±0.014) and t=test Value was 118.30 cm which was statistically highly significant (P < 0.001) mean value of length of Right frontal horn of lateral ventricle of male was 3.265 cm (SD ±0.014) and female was 2.944 (SD ±0.159) and value of t=test was 12.68 cm which was highly significant P value (P < 0.001) and mean Value of length of left front horn of lateral ventricles in males 3.315 cm (SD ±0.012) t=test value was 148.63 cm which was highly significant P value (P < 0.001). Classification of Functional coefficient of a) Height of Fourth Ventricle in males was 7.72 E3 while in Females 5.23 E3. b) Width of Male fourth Ventricle coefficient was 2.37 E while female was 1.15 E. c) Coefficient Values of length of Right frontal horn of lateral ventricle in males was 171.9 and in females 148.6. d) Coefficient Values length of left frontal horn of lateral ventricle in males was 2.75 E4 and in Females was 2.52 E4.