[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to identify the anatomy of pineal region venous complex using neuronavigation software when distorted by the presence of a space-occupying lesion and to describe the anatomical relationship between lesion and veins. Moreover we discuss its influence on the choice of the surgical strategy.
Of the 33 patients treated at our Institute for pineal region tumors between 2003 and 2008 we used the neuronavigation software to depict the venous system of the pineal region in 14 patients. We focused on depiction of the basal vein of Rosenthal (BV), the internal cerebral vein (ICV) and the vein of Galen: connection patterns between the veins and the type of anatomical distortion caused by the lesion were investigated and classified.
Using the neuronavigation software for three-dimensional (3D) reconstruction of MRI images the ICV was clearly depicted in all patients on both sides (100%). Last segment of the BV was identified in 25 sides on a total of 28 (89.3%) and absent in 3 of the 28 sides (10.7%). Studying the distortion effect of the tumor on the galenic venous system, three directions of displacement were observed: craniocaudal, anteroposterior and lateral. Seven patients presented a cranial dislocation, 5 patients caudal dislocation and there was no craniocaudal shift in 2 patients. Considering the anteroposterior displacement: 3 subjects showed an anterior shift of the veins, 5 subjects posterior shift and no anterioposterior shift was present in 6 patients. Only 2 of the 14 patients presented lateral displacement of the veins. The principal approaches used in this series were: supracerebellar infratentorial and interhemispheric parieto-occipital. The craniocaudal displacement of the pineal veins seems to be the most important for the choice of the approach.
The galenic venous system has a central role in the surgery pineal region tumors. Our study demonstrates that the architecture of the pineal veins and their anatomical relationship with the lesion can be depicted with great accuracy by using 3D neuronavigation software in order to facilitate surgical planning and intraoperative orientation.
Full-text · Article · Feb 2011 · Clinical neurology and neurosurgery
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to demonstrate the anatomy of the quadrigeminal cistern, define the anatomic landmarks, and measure the extension of the cistern in the living by using magnetic resonance (MR) cisternography with 3-dimensional reconstruction.
The quadrigeminal cistern was examined in 38 patients. We focused on measurements of the superior, posterior, and lateral limits; the anterior and posterior maximal rostrocaudal diameter; the distance between the right and left superior colliculus and the right and left inferior colliculus; and the angle between the quadrigeminal plate and pineal gland.
The highest variability was observed for the posterior rostrocaudal diameter with a standard deviation of 3.1 and a range from 8 to 21.1 mm followed by the anterior-posterior diameter with a standard deviation of 2.8 and a range from 6.4 to 16.5 mm. In all cases the distance between the right and left superior colliculus (13.3 +/- 1.8 mm; mean +/- SD) was longer than the distance between the right and left inferior colliculus (11.4 +/- 1.3 mm; mean +/- SD). We classified 2 types of cisterns: closed cisterns with angles between the quadrigeminal plate and the pineal gland ranging from 39 degrees to 63 degrees and open cisterns with angles ranging from 63 degrees to 76 degrees . The analysis of variability by age and sex showed no significant differences.
The MR cisternography with 3-dimensional reconstruction was a simple and noninvasive tool providing detailed anatomic information in the living. It allowed measurement of the high variability of morphology of the quadrigeminal cistern. We defined the lateral landmarks and identified the lateral limit of the cistern. We classified the different shapes of the quadrigeminal cistern as open or closed cisterns. This can be helpful in the choice of the surgical approach to the lesions arising in this area.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to delineate the anatomy of the precentral cerebellar vein, superior vermian vein, and internal occipital vein using reconstructions of computed tomographic and magnetic resonance imaging scans with navigation software. These data were compared with previous anatomic and angiographic findings to show the resolution and accuracy of the system.
We retrospectively reviewed 100 patients with intracranial pathologies (50 computed tomographic scans with contrast and 50 magnetic resonance imaging scans with gadolinium) using a neuronavigation workstation for 3-dimensional reconstruction. Particular attention was paid to depiction of the precentral cerebellar vein, superior vermian vein, and internal occipital vein. The data were reviewed and analyzed.
The precentral cerebellar vein, superior vermian vein, and its tributary, the supraculminate vein, were depicted in 52 (52%) patients. The internal occipital vein was delineated on 99 (49.5%) sides and joined the basal vein and vein of Galen in 39 (39.4%) and 60 (60.6%) hemispheres, respectively. Comparing these results with previous angiographic studies, the ability of the neuronavigation system for depicting these vessels is similar to that of digital subtraction angiography.
This study illustrates the possibility of depicting the small vessels draining into the pineal region venous complex using 3-dimensional neuronavigation with an accuracy comparable to that of digital subtraction angiography. This tool provides important information for both surgical planning and intraoperative orientation.
[Show abstract][Hide abstract] ABSTRACT: Aicardi syndrome is an X-linked dominant disorder characterized by the pathognonomic association of three clinical signs: agenesis of the corpus callosum, infantile spasms, and chorioretinal lacunae. This is a severe syndrome with an estimated survival rate of 76% at 6 years and 40% at 14 years and a maximum developmental level like a 12-month-old baby in 91% of cases. We illustrate a case of Aicardi syndrome with bilateral, small chorioretinal lacunae, infantile spasms with a typical hypsarrhythmia, defects of thoracic vertebra and bilateral absence of the 12th rib associated with an arachnoid cyst of the quadrigeminal cistern, and presence of the corpus callosum with a favorable outcome.
Full-text · Article · May 2009 · Child s Nervous System
[Show abstract][Hide abstract] ABSTRACT: Objective: To validate the use of selective percutaneous thermocoagulation of the Gasserian ganglion in the treatment of trigeminal neuralgia. Methods: 1860 patients with trigeminal neuralgia (TN) were studied over a period of 26 years. Diagnosis was idiophatic (ITN) (97%), atypical (ATN) (2%) or symptomatic TN (STN) (1%). Patients underwent percutaneous thermocoagulation of the gasserian ganglion. Results: Immediate pain relief was observed in 1784 (98.9%) patients with ITN, in 13 (68.4%) patients with STN, and in 6 (16.2%) patients with ATN. Recurrence was observed in 25% of patients with ITN, 40% of with STN, and 67% of patients with ATN. Major side effects included transient dysesthesia (58%), and masseter weakness (14%). Patients with ITN treated at 75-80°C did not differ significantly from their cohort treated at 65-70°C in terms of immediate pain relief. Recurrence was more common in the group treated at the lower temperature. Facial hypoalgesia was more sustained in patients treated at the higher temperature over a 6-year period (t(0) = 62%, t(1year) = 64%, t(6years) = 34%), compared to their cohorts treated at the lower temperature (t(0) = 54%, t(1year) = 30%, t(6years) = 9%). Conclusions: Our study shows that selective percutaneous thermocoagulation of the Gasserian ganglion is a valid treatment for ITN.