Interhemispheric Fissure Research Articles

A Clinical Case Report About an Intracranial Lipoma

Intracranial lipoma is a uncommon congenital malformation, represent less than 0.1% of all intracranial tumors. Result from abnormal persistence and mal-differentiation of meninx primitiva, during embryogenesis. The cases in which the tumor presents an extracranial component are caused by a secondary dehiscence of the skull with evagination of a small tuft of primitive meninges. These lesions are frequently located in the inter-hemispheric fissure in the pericallosal region in 50% of cases, other locations as ambient or quadrigeminal cisterns present an incidence about 20-25%. In half of cases the patients present associate midline brain malformations of varying severity, the most frequent is the agenesia of the corpus callosus. The most accepted theory states that in embryonic phases, mesenchymal alterations at the level of the cranial sutures in the sagittal plane can cause anomalies of the SSS, sinus rectum, tentorium, and parietal bones that would explain the associated anomalies. Majority of intracranial lipomas are detected incidentally, being a third of the asymptomatic cases. As in all other pathologies certain localizations cause specific symptomatology of the involved area. The most common clinical manifestations are headache, epilepsy, mental dysfunctions and cranial nerve deficits. The clinical diagnosis is unclear and it is necessary release complementary exams in every suspected cases. Neuroimaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) make possible identify these lesions. We describe a clinical case about a 79-year-old woman with headache without any other symptoms. Was done CT and MRI that showed a inter-hemispheric lesion located in the pericallosal region, without any other abnormality associated. The development, during the last decades, of neuroimaging and histogenesis techniques increased the knowledge about this pathology and modified the management in recent times. The surgery is contraindicated in the majority of the cases, however still play a role in some cases especially in presence of hydrocephalus, uncontrollable seizures, and bony affectation with cosmetic influence. The medical control of the epilepsy is mandatory. We present a clinical case about pericallosal intracranial lipoma and review the current literature. Taking in account the clinical situation and the imaging findings, we decide for a conservative approach with clinical/neurological and radiological follow-up.

Cavernous Malformations: What They Have Taught Us.

Cavernous Malformations: What They Have Taught Us.

Diploic Bone Channel Drilling Facilitates Dissection of the Midline Dura and Protects the Superior Sagittal Sinus in Hyperostosis Frontalis Interna.

Patients with space-occupying lesions adjacent to thesuperior sagittal sinus (SSS) present several technical considerations.For craniotomies crossing the SSS, a two-part method allows for dissection of the epidural space and dura under direct vision after removing a more lateral parasagittal bone flap. However, when the inner table surface of the medial component of the two-part bone flap is irregular, this can be difficult. We describe a method for channel drilling of the diploic bone, which allows for the piecemeal removal of the inner table using an upbiting rongeur. This article presents the case of meningioma with documented growth and provides a technical note of this techniquetofacilitate safe dissection of the midline dura. A patient presented with headaches and an anterior one-third parasagittal meningioma with documented growth. She selected surgical removal for treatment. A right frontal two-part parasagittal craniotomy was recommended. The preoperative imaging showed that the frontal bone was thick, with irregularity of the inner table. Intraoperatively, a channel was drilled in the diploic space of the bone, leaving the outer table intact. This provided a thin lip of the inner table that could be dissected over a short distance and then removed with a 2-mm upbiting rongeur. This allowed for further dissection of the dura crossing the midline under direct vision and safe secondary bone piece removal. The dura was opened to the edge of the SSS, allowing full exposure of the parasagittal region and interhemispheric fissure, thus limiting retraction of the medial right frontal lobe.The bone flap was removed in two pieces without a dural tear over the midline in spite of inner table irregularities. A Simpson grade 1 removal was accomplished, including excision of the affected falx, and the postoperative course was uncomplicated. In conclusion, diploic bone channel drilling is a technique that can be used to create a thin lip of the inner table, which can be removed piecemeal for safe dissection of the midline dura crossing the midline.

Cortical atrophy in chronic subdural hematoma from ultra-structures to physical properties

Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluate the extent of cortical atrophy, CT scan images were utilised to develop an index that is the ratio of the maximum diameter sum of 3 cisterns divided by the maximum diameter of the skull at the temporal lobe level. Also, we reported, for the first time, the ultrastructural analyses of the CSDH using a combination of immunohistochemistry methods and transmission electron microscopy techniques. Internal validation was performed to confirm the assessment of the different degrees of cortical atrophy. Relative Cortical Atrophy Index (RCA index) refers to the sum of the maximum diameter of three cisterns (insular cistern, longitudinal cerebral fissure and cerebral sulci greatest) with the temporal bones' greatest internal distance. This index, strongly related to age in healthy controls, is positively correlated to the preoperative and post-operative maximum diameter of hematoma and the midline shift in CSDH patients. On the contrary, it negatively correlates to the Karnofsky Performance Status (KPS). The Area Under the Receiver Operating Characteristics (AUROC) showed that RCA index effectively differentiated cases from controls. Immunohistochemistry analysis showed that the newly formed CD-31 positive microvessels are higher in number than the CD34-positive microvessels in the CSDH inner membrane than in the outer membrane. Ultrastructural observations highlight the presence of a chronic inflammatory state mainly in the CSDH inner membrane. Integrating these results, we have obtained an etiopathogenetic model of CSDH. Cortical atrophy appears to be the triggering factor activating the cascade of transendothelial cellular filtration, inflammation, membrane formation and neovascularisation leading to the CSDH formation.

Mini anterior interhemispheric approach for A3 segment distal anterior cerebral artery aneurysms

IntroductionAneurysms of the A3 segment of the distal anterior cerebral artery (DACA), in relation to the genu of the corpus callosum, are specific sub-group which pose unique surgical challenges due to their discrete anatomical location. We describe a mini-anterior interhemispheric approach which can be safely utilised to clip these aneurysms rather than the traditional bifrontal approach. MethodsRetrospective analysis of the clinical and radiological data of ruptured DACA-A3 aneurysms operated between 2014 and 2021 at our institute. A curvilinear scalp incision within the hairline followed by raising small, unilateral, free frontal bone flap, avoiding the opening of frontal sinus. Superior sagittal sinus is displaced medially, inter-hemispheric dissection carried out with posterior trajectory and small callosotomy is performed. DACA is skeletonised, proximal control is established, and the A3 aneurysm is dissected and clipped. ResultOur cohort of 18 patients had a definite female preponderance (F:M::2:1) with mean age of 55.6 years. On admission three patients were categorized as WFNS Grade I, thirteen in Grade II, and two in Grade III for subarachnoid haemorrhage. All the patients had evidence of blood in the interhemispheric fissure; intraparenchymal haemorrhage was seen in seven, with intraventricular haemorrhage in six patients. Within the A3 segment six aneurysms were infragenu (inferior), eight were at the genu (anterior) and four were supragenu (superior). Two (11.1%) elderly patients succumbed post-surgery following ischemic infarcts and associated complications. At the time of follow-up at 3 months of the remaining sixteen (72.2%) patients, thirteen had a good outcome (mRS 0–3) and three (16.7%) had a poor outcome (mRS > 3). ConclusionThe mini anterior interhemispheric is an effective minimally invasive alternative for A3 segments aneurysms and helps to avoid the complications of the conventional bifrontal interhemispheric approach.

ДОПОЛНИТЕЛЬНАЯ МОТОРНАЯ ОБЛАСТЬ И КЛИНИЧЕСКАЯ КАРТИНА ПРИ ЕЁ ПОРАЖЕНИИ

Methods: The supplementary motor area (SMA) is a cortical region, that is located on the medial surface of the frontal lobe entirely within the interhemispheric fissure between the primary motor cortex (PMC) and prefrontal cortex (PFC). This area is a heterogeneous region in its structure, as well as in its connections with other parts of the brain; on the basis of these differences, the pre-SMA and SMA-proper regions are distinguished in it. Numerous neural connections with other parts of the central nervous system (CNS) suggest the involvement of the SMA in many cognitive functions, and not only in higher motor ones, as previously was thought. In particular, in the dominant hemisphere, the SMA performs the speech function through the frontal oblique fascicle (FOF), a bundle of association fibers that connects the SMA with Broca's area. In the event of various pathologies affecting the SMA and after neurosurgical manipulations in this area, a variety of neurological disorders can occur both motor and verbal. With the damage of this cortical region in the dominant hemisphere, SMA syndrome (akinetic mutism) can occur. This paper provides a review of the anatomical, cytoarchitectonic, and functional features of the SMA, as well as a detailed description of the clinical picture of the lesion of this cortical region. Keywords: Brain, supplementary motor area, SMA syndrome.

Диагностические критерии формирования морфологических изменений головного мозга у детей с перинатальным гипоксическим поражением нервной системы

Objective. To determine the diagnostic criteria of morphological changes in children with perinatal hypoxic brain injury. Patients and Methods. The study included 58 full-term newborns with severe hypoxic brain damages who, according to MRI of brain performed on 2–10 days of life, had low rates of diffusion processes of the white matter of the cerebral hemispheres – diffusion coefficient (Ds) of less than 1.35 × 10–3 mm2/s. Children received treatment in the intensive care unit of the regional perinatal center of Krasnodar Children's Clinical Hospital. Follow-up MRI was performed at the 4th week of life. Observation of children was carried out up to 2 years of age. Results. Denominated destructive changes in the nervous tissue with multicystic encephalomalacia were identified in 23 (40%) newborns (group 1). The range of values of Ds of the white matter of cerebral hemispheres in children of the 1st group was 0.60–1.11 × 10–3 m2/s. In the remaining 35 (60%) children (group 2), hypoxic brain damage was manifested by the expansion of the subarachnoid space, the interhemispheric fissure, and the lateral ventricles. These changes were reflected in a decrease in the volume of brain parenchyma with the persistent neurological deficiency in the future (disorders of psycho-speech development, cerebral palsy, structural epilepsy). The range of values of the Ds of the white matter of the cerebral hemispheres in children of the second group was 1.14–1.35 × 10–3 mm2/s. Conclusions. Using the modern high-tech methods of neuroimaging makes it possible to determine the diagnostic criteria for damaging effects of hypoxia in children with perinatal brain injury and in early stage to identify morphological changes in brain tissue. Key words: hypoxia, brain, children, magnetic resonance imaging, neurological outcome

Surgical Approaches to the Third Ventricle: An Update.

The third ventricle is located in the deepest part of the brain and is delimited by both telencephalic and diencephalic structures. Its location makes every surgical procedure inside or around it quite challenging, due to the distance from the surface to the fragility of the neurovascular structures that is necessary to dissect before entering its cavity and to the narrow surgical corridors through which it is necessary to work. Its geometric localization inside the cranial cavity and the anatomical relationship with the interhemispheric fissure offers nevertheless to the surgeon an impressive variety of surgical approaches, which allow to reach every millimeter of the third ventricle lumen. Mastering properly all these approaches requires an impressive anatomical knowledge, the best available technology, and most refined technical skills, making the surgery of the third ventricle a point of excellence in the evolution of each neurosurgeon. The development of neuronavigation and neuroendoscopy has been a revolution in neurosurgery in the last 20years and offered special advantages for the surgery of the third ventricle. In fact, the narrow corridors of approach make the precision of the neuronavigation and the enlightenment and magnification of the neuroendoscopy especially useful to reach the third ventricle cavity and working inside or around it. This chapter reviews the history of the surgery of the third ventricle and offers an update of the variety of surgical corridors identified and of the technology now available to properly work through them and inside the third ventricle cavity.

Emergency Medicine Images: Headache After a Lumbar Puncture

A 34-year-old man presented to the emergency department for a persistent, positional headache 3 weeks after a routine lumbar puncture (LP) for the workup of multiple sclerosis. The headache started gradually approximately 1 week after the uneventful LP and consistently improved with lying flat and worsened when upright. At a previous ED visit for this headache, an epidural blood patch was considered for postdural puncture headache (PDPH); however, the anesthesia service did not think a blood patch would be better than conservative treatment, given the usual benign course and the expectation for near-term resolution of symptoms with PDPH. With the patient experiencing persistent symptoms affecting his daily activities despite home analgesics, the ED clinician ordered a noncontrast head computed tomography scan (CT) (Figures 1 and 2). Figure 2Coronal noncontrast head computed tomographyt. There are bilateral convexity subdural hematomas (arrows) and subdural hematoma along the interhemispheric fissure (chevrons). The lateral ventricles partially effaced. View Large Image Figure Viewer Download Hi-res image Brian J. Ahern is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX. ORCID identifier: http://orcid.org/0000-0002-5701-3561. Lisa M. Jin is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX. Sean M. Sylvia is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX.

Brain morphometry and its relevance in cerebral small vessel disease

Cerebral small vessel disease (CSVD) is a heterogeneous group of disorders which affect small perforating vessels of the brain. Clinically CSVD manifest with various constellations of symptoms, like cognitive, functional, affective as well as lacunar stroke or intracerebral hemorrhage. It is responsible for 25 % of all strokes and are the second contributor to dementia after Alzheimer’s disease. The gold standard for CSVD diagnostic is neuroimaging. The main key features are white matter hyperintensity (WMH), lacunes, enlarged perivascular spaces (EPVS), brain atrophy. Brain atrophy have been recognized to play a synergistic role in both cerebrovascular and neurodegenerative disorders occurring in the aging brain. It reflects a final common pathway for pathological processes, which progress in time. CSVD progression results in gradual decrease of brain volume, which is seen as changes of ventricles size and cortical sulci span of the brain. But not much is known about its extent, correlates and consequences. The aim of the research is to investigate whether brain morphometric changes correlate with CSVD features. In this study, we included 129 CSVD patients and 165 non-CSVD controls, both with acute stroke. All participants underwent neuroimaging assessment with magnetic resonance imaging (MRI) and computed tomography (CT). We used both univariate and multivariate regression analysis, as well as correlation analysis to identify differences in brain morphometric parameters between groups. Multivariable regression analysis, adjusted for age and sex, revealed significant impact of Evans index (OR 1.09, 95 %; CI 1.01-1.16, p=0.018), the third ventricle index (OR 1.42, 95 %; CI 1.21-1.67, p<0.001), Schaltenbrand and Nürnberger index (OR 1.42, 95 %; CI 1.21-1.67, p<0.001), the fourth ventricle index (OR 1.31, 95 %; CI 1.13-1.51, p<0,001), bicaudate index (OR 1.19, 95 %; CI 1.10-1.30, p<0.001), cella media index (Schiersmann’s index) (OR 0.55, 95 %; CI 0.42-0.72, p<0.001), Huckman number (OR 1.05, 95 %; CI 1.02-1.08, p<0.001), width of the longitudinal cerebral fissure in the anterior part of the frontal lobes (OR 1.46, 95 %; CI 1.22-1.75, p<0.001), width of the left insular cistern (OR 1.24, 95 %; CI 1.11-1.39, p<0.001), width of the right insular cistern (OR 1.31, 95 %; CI 1.17-1.46, p<0.001), width of the right and left insular cisterns in sum (OR 1.17, 95 %; CI 1.10-1.25, p<0.001), width of the cerebral fissure in the area of the skull vault (OR 1.49, 95 %; CI 1.21-1.84, p<0.001) on the CSVD presence. Width of the longitudinal cerebral fissure in the anterior part of the frontal lobes in CSVD was 6.13±1.56 mm vs 5.10±1.38 mm in non-CSVD, p<0.001 and width of the right and left insular cisterns in sum in CSVD was 16.98±4.60 mm vs 13.41±4.16 mm in non-CSVD, p<0.001. Width of the cerebral fissure in the area of the skull vault (parietal cortex) was also greater in CSVD patients: 5.04±1.85 mm vs 4.12±1.29 mm, p<0.001. Thus, all ventricular and cortical indices were increased in the group of patients with CSVD. Our results indicate that morphometric indicators of the brain are closely related to CSVD and can be useful for predicting the consequences of a stroke and ascertaining the decline of cognitive functions.

Complete corpus callosotomy using a frameless navigation probe through a minicraniotomy in children with medically refractory epilepsy: A case series and technical note.

Medically refractory epilepsy constitutes up to one-third of the epilepsy pediatric patients. Corpus callosotomy (CC) has been used for the treatment of medically refractory epilepsy in children with atonic seizures and generalized tonic-clonic (GTC) seizures. In this case series study, we are describing a novel technique for CC using the frameless navigation probe through a minicraniotomy. Thirteen pediatric patients with the diagnosis of medically refractory epilepsy predominantly GTC with drop attack who underwent extensive Phase I. An L-shape was done, then through a 4 × 3 cm craniotomy, we were able to open the interhemispheric fissure until the corpus callosum is visualized. The Stealth probe is then used to go down to the midline raphe which is followed anteriorly then traced posteriorly to the anterior border of the vein of Galen. Finally, the Stealth probe is used to confirm the completeness of the callosotomy. The procedure was accomplished successfully with no intraoperative complications; mean surgical time is 3 h:07 m. The mean follow-up was 31.5 months. All patients achieved significant seizure control. No patients experienced worsening of their atonic seizures after surgery compared with their preoperative state; however, six patients achieved Engel Class I, four patients achieved Engel Class II, and three patients achieved Engel Class III. Complete CC using a frameless navigation probe is a novel and effective technique for the treatment of medically refractory epilepsy with a very good surgical and seizure outcomes, minimal neurological morbidity, minimal blood loss, and short OR time.

Development of Haptic Interface for Neurosurgical Simulators with Micro Scissors Module for Displaying the Cutting Force

Introduction of surgical simulators, which enable repeated learning of new surgical techniques, is advancing and they are desired in the field of neurosurgery. This study aims to make a two-fold contribution. First is the development of a haptic interface, which can be used while changing the operative tools necessary for training the cerebral fissure opening technique while using both the hands. Second is to develop a module for the haptic interface, which can display the cutting force when using micro scissors. To realize the operation with both the hands, the haptic interfaces for the right and left hands are designed so that they do not interfere. In addition, surgical tools, such as retractors, micro dissectors, and micro scissors, can be exchanged. In the cutting experiment carried out prior to the development of the haptic interface, it was clarified that the force when the dura mater was cut using micro scissors was 0.5 N. For comparison, the cutting forces required to cut two and three sheets of paper were measured to be 0.4 N and 0.6 N, respectively. The developed micro scissors module was designed using one motor and planetary gear mechanism. The gear mechanism is designed such that the right and left handles rotate in reverse directions around the rotation axis of the micro scissors using only one motor. This mechanism enables the micro scissors to cut the virtual tissues in the middle of the blade. The developed module could display a force of 0.4 N.

Marked Reduction of Cerebral Vasospasm with Intrathecal Urokinase Infusion Therapy after Endovascular Coil Embolization of the Aneurysmal Subarachnoid Hemorrhage: A Case Series.

Delayed cerebral vasospasms after subarachnoid hemorrhage (SAH) are a risk factor for poor prognosis after successful treatment of ruptured intracranial aneurysms. Different strategies to remove clots from the subarachnoid space and prevent vasospasms have different outcomes. Intrathecal urokinase infusion therapy combined with endovascular treatment (EVT) can reduce the incidence of symptomatic vasospasms. To analyze the relationship between symptomatic vasospasms and residual SAHs after urokinase infusion therapy, we retrospectively reviewed the records of 348 consecutive patients managed with EVT and intrathecal urokinase infusion therapy for aneurysmal SAH at our institution between 2010 and 2021. Among them, 163 patients met the study criteria and were classified into two groups according to the presence of residual SAH in the cisterns, Sylvian fissures, and frontal interhemispheric fissure. The incidence of symptomatic vasospasms and the clinical outcomes were assessed. In total, eight (5.0%) patients developed symptomatic vasospasms. Patients with symptomatic vasospasms had a significantly higher incidence of residual SAH in the Sylvian or frontal interhemispheric fissures than those without (P <.0001). No patient with SAHs resolved by urokinase infusion therapy developed symptomatic vasospasms. However, the two groups did not differ significantly in terms of modified Rankin scale scores at discharge. Treatment with intrathecal urokinase infusion after EVT for aneurysmal SAH can substantially reduce the risk of clinically evident vasospasms.

Spectrum of intracranial and spinal epidermoids including unusual locations and imaging findings: A pictorial review.

Intracranial and spinal epidermoids are benign slow-growing congenital lesions. They are predominantly intradural, extra-axial in location, with intra-axial locations (intra-parenchymal and spinal intramedullary) being rare. The most common locations of intradural epidermoids are cerebellopontine angle cistern followed by supra- and para-sellar regions, and fourth ventricle. Less common locations include inter-hemispheric fissure, sylvian fissure, lateral ventricle, intracerebral, velum interpositum cistern, superior cerebellar cistern and pineal gland. They can also be extradural, usually arising in the diploic space of the calvaria, though they are less common. Magnetic resonance imaging is the primary modality for diagnosis and knowing the extent of the lesion. In this pictorial review, we intend to illustrate their classical and unusual locations, atypical imaging findings including calcifications, rare complications like haemorrhage or spontaneous rupture.

Transventricular endoscopic approach to the anterior interhemispheric fissure for neurocysticercosis: illustrative cases.

Neurocysticercosis (NCC) is a global public health problem. It is a complex disease to manage and a cause of great morbidity and mortality in affected patients. Conventional surgical approaches have been used for many years, but currently, minimally invasive approaches are being used with good results. The authors present a case of NCC in the anterior interhemispheric fissure that was treated with a transventricular endoscopic approach. A 32-year-old male patient was admitted for persistent moderate headache and dizziness. Gadolinium-enhanced magnetic resonance imaging (MRI) showed multiple parenchymal, ventricular, and subarachnoid cystic lesions, especially in the anterior interhemispheric space. A transventricular endoscopic approach was selected and applied. There were no complications during surgery. Pathological analysis confirmed the diagnosis of NCC. Control MRI demonstrated the absence of cysts in the anterior interhemispheric space. Minimally invasive approaches are an excellent alternative for patients with NCC, especially if a patient requires more than one surgery.

The Ipsilateral Interhemispheric Transprecuneal Approach to the Atrium: Technical Considerations and Clinical Outcome on a Series of 7 Patients.

Surgical removal of tumors of the atrium is challenging due to their deep location, vascularization, and to their complex three-dimensional relationships with the highly functional white matter fibers of the region. To assess the feasibility and the effectiveness of the ipsilateral interhemispheric transprecuneus approach (IITA) for tumors involving the atrium and the posterior third of the temporal horn, a retrospective chart review of all patients who had undergone a surgical treatment for intraventricular tumors between January 2008 and January 2017 was performed, and the step-by-step approach is described. Ten patients affected by lesions of the atrium of the lateral ventricle underwent surgical treatment, seven of which were approached through the IITA. The mean age was 42.8 years (range 6-63 years). The symptoms presented included severe, drug-resistant headache (90%), lateral homonymous hemianopsia (50%), seizures (30%), and speech disturbances (30%). Histological examinations revealed seven patients with meningioma (70%), one with a metastasis (10%), one with a choroid plexus papilloma (10%) and one with a cavernoma (10%). In all cases, a gross total removal was obtained. All patients had a significant improvement in their headache. Two patients experienced a worsening of the pre-operative visual disturbances, while two patients had a significant improvement. No patients without pre-operative visual disturbances described a post-operative worsening of visual symptoms. The IITA represents a feasible approach for tumors of the atrium. The three-quarter prone position facilitates the enlargement of the interhemispheric fissure by increasing the working angle and facilitating the exposure of the lateral wall of the atrium.

Surgical treatment of tumors of the supplementary motor area

Background. The supplementary motor area is a part of the medial frontal cortex, that is located just anterior to the primary motor cortex entirely within the interhemispheric fissure. This area belongs traditionally to the secondary motor cortex and perhaps it is the least studied motor region of the brain. While functions and symptoms of a damage to the primary motor and the premotor cortex areas have been well known and described for a long time, study of the supplementary motor area has been limited to fundamental neuroimaging and electrophysiological researches, and a practical side of the issue and clinical significance of this region remained outside the interest of researchers.Aim. To present the anatomical and functional features of the supplementary motor area, the clinical symptoms of its lesion, to analyze all the data available today and aspects of surgical treatment of tumors in this region.Materials and methods. A search in scientific databases (PubMed, etc.) led to the selection and analysis of sixty-two literary sources. The review is mainly devoted to the aspects and risk factors of surgical treatment of pathologies localized in this region.Results. According to its anatomical and functional characteristics, the supplementary motor area is a heterogeneous region - it has two separate subregions in it. In addition to the motor function of the supplementary motor area, its role has also been reliably established in the implementation of working memory processes, language, perceptual, cognitive and other functions. Such a number of functions performed by the supplementary motor area is associated with numerous neural connections of this area. For example, the frontal aslant tract has been described recently, and it connects medial part of the superior frontal gyrus with the pars opercularis of the inferior frontal gyrus. This tract, apparently, is associated with the implementation of language function in the dominant hemisphere and function of working memory in the non-dominant hemisphere.When the supplementary motor area is affected, various neurological motor and speech symptoms can occur, in particular, the supplementary motor area syndrome, which is characterized by the development of akinetic mutism in patients and, in most cases, is completely reversible within a few days or months. Among all pathologies in this area, tumors are most common, especially gliomas, which can also manifest themselves with various clinical symptoms both in the preoperative and postoperative periods.Conclusion. Critically important preoperative planning, informing the patient about the spatio-temporal picture of the predicted postoperative clinical disorders and the timing of rehabilitation are critically important. It is recommended to use methods of intraoperative neuronavigation, as well as intraoperative neurophysiological monitoring. It is necessary to further study the supplementary motor area and the peculiarities of its surgery in order to standardize approaches to the treatment of pathologies.

DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMOR: A RARE CAUSE OF MALIGNANT PLEURAL EFFUSION

DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMOR: A RARE CAUSE OF MALIGNANT PLEURAL EFFUSION

3D-Printed Porous Titanium Root-Analogue Implant for the Treatment of Longitudinal Fracture of Mandibular Molars with Periapical Periodontitis: A Case Report

Customized porous titanium root-analogue implant (RAI) can be produced using CBCT data acquisition and three-dimensional image processing, combined with selective laser melting (SLM) technology. However, there is no report on the treatment of chronic periapical periodontitis with RAI. We report a case of longitudinal fissure of mandibular molars with periapical periodontitis and immediately implanted RAI after extraction. After a continuous observation for one year, it was found that the bone around the root grew into RAI and achieved a good effect of osseointegration. This report describes a situation in which traditional immediate implantation is untreatable, and the use of customized porous titanium RAI may open up new indications for immediate implantation.

Distribution and progression of cerebral amyloid angiopathy in early-onset V30M (p.V50M) hereditary ATTR amyloidosis

Background Cerebral amyloid angiopathy (CAA) is becoming the most common and serious complications in long-lived hereditary ATTR amyloidosis patients. It is therefore imperative to elucidate the characteristics of ATTR-type CAA and develop useful biomarkers. Methods We enrolled 34 ATTRv amyloidosis patients with the V30M (p.V50M) variant for analysis with three-dimensional stereotactic surface projection z score imaging of Pittsburgh compound B (PiB)-PET. Results Eight patients exhibited central nervous system (CNS) symptoms. Seven patients suffered transient focal neurologic episodes, and 2 patients each experienced cerebellar haemorrhages or cognitive decline. The amount of 11C-PiB accumulation increased as a function of disease duration. 11C-PiB-PET abnormalities were seen at 8 years from onset and were associated with CNS manifestations from 12 years. The annual increase rate of the standardised uptake value ratio (SUVR) in female patients was significantly higher than in male patients. CNS amyloid deposition started in the upper middle surface of the cerebellar cortex, and then spread out over the entire surface of the cerebellum, Sylvian fissure, and anterior part of the longitudinal fissure of the cerebrum. Conclusions PiB-PET is a useful biomarker for the early detection and treatment evaluation of ATTR-type CAA. Female gender is associated with more rapid progression of ATTR-type CAA.