PURPOSE: Current management of pediatric intramedullary ependymoma is extrapolated from adult series since large studies in children are unavailable. This has led us to share our experience with this rare tumor and compare it to the literature and to review and highlight important aspects of current management and point out inconsistencies. METHODS: This is a retrospective analysis of patients with intramedullary ependymoma managed at our institution between 2004 and 2021. RESULTS: During the study period, 5 patients were treated for intramedullary ependymoma. Cases of myxopapillary ependymoma were excluded. The mean age of our cohort was 11.2 years. We identified 4 cases of grade II ependymoma and 1 case of grade III ependymoma. Gross tumor removal (GTR) was achieved in two patients (40%) of patients. One patient was treated with radiotherapy for recurrence and two patients received chemotherapy. There were no cases of recurrence among patients treated with GTR, but in all patients treated with STR. Eighty percent of patients either improved or stayed stable neurologically. During follow-up (mean 73 months), 2 patients died of disease. CONCLUSION: GTR and tumor grade remain the key prognostic factor of long-term tumor-free survival. Many questions prevail regarding outcomes, correct use of adjuvant therapy, and prognostic factors.
- MeSH
- dítě MeSH
- dospělí MeSH
- ependymom * chirurgie patologie MeSH
- kombinovaná terapie MeSH
- lidé MeSH
- nádory míchy * chirurgie patologie MeSH
- neurochirurgické výkony MeSH
- retrospektivní studie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Tumors of the fourth ventricle are frequently treated pathologies in pediatric neurosurgery. Data regarding predictors for permanent neurological deficits, long-term functional outcomes, cerebellar mutism (CM), the extent of resection (EOR), and oncological outcomes are scarce. We attempt to contribute to this topic with an analysis of our institutional cohort. METHODS: A retrospective single-center study of patients aged ≤ 19 years who underwent primary surgical resection of a fourth ventricular tumor over a 15-year period (2006-2021). Predictors analyzed included age, gender, surgical approach, anatomical pattern, tumor grade, EOR, tumor volume, and others as appropriate. RESULTS: One hundred six patients were included (64 males, mean age 7.3 years). The rate of permanent neurological deficit was 24.2%; lateral tumor extension (p = 0.036) and tumor volume greater than 38 cm3 (p = 0.020) were significant predictors. The presence of a deficit was the only significant predictor of reduced (less than 90) Lansky score (p = 0.005). CM occurred in 20.8% of patients and was influenced by medulloblastoma histology (p = 0.011), lateral tumor extension (p = 0.017), and male gender (p = 0.021). No significant difference between the transvermian and telovelar approach in the development of CM was detected (p = 0.478). No significant predictor was found for the EOR. EOR was not found to be a significant predictor of overall survival for both low-grade and high-grade tumors; however, gross total resection (GTR) was protective against tumor recurrence compared to near-total or subtotal resection (p < 0.001). In addition, survival was found to be better in older patients (≥ 7.0 years, p = 0.019). CONCLUSION: The overall rate of postoperative complications remains high due to the eloquent localization. Older patients (> 7 years) have been found to have better outcomes and prognosis. Achieving GTR whenever feasible and safe has been shown to be critical for tumor recurrence. CM was more common in patients with medulloblastoma and in patients with tumors extending through the foramen of Luschka. The telovelar approach uses a safe and anatomically sparing corridor; however, it has not been associated with a lower incidence of CM and neurological sequelae in our series, showing that each case should be assessed on an individual basis.
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- čtvrtá mozková komora diagnostické zobrazování chirurgie MeSH
- dítě MeSH
- lidé MeSH
- lokální recidiva nádoru chirurgie MeSH
- meduloblastom * chirurgie MeSH
- nádory mozečku * chirurgie etiologie MeSH
- neurochirurgické výkony škodlivé účinky MeSH
- pooperační komplikace epidemiologie etiologie chirurgie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
Human perception and cognition are based predominantly on visual information processing. Much of the information regarding neuronal correlates of visual processing has been derived from functional imaging studies, which have identified a variety of brain areas contributing to visual analysis, recognition, and processing of objects and scenes. However, only two of these areas, namely the parahippocampal place area (PPA) and the lateral occipital complex (LOC), were verified and further characterized by intracranial electroencephalogram (iEEG). iEEG is a unique measurement technique that samples a local neuronal population with high temporal and anatomical resolution. In the present study, we aimed to expand on previous reports and examine brain activity for selectivity of scenes and objects in the broadband high-gamma frequency range (50-150 Hz). We collected iEEG data from 27 epileptic patients while they watched a series of images, containing objects and scenes, and we identified 375 bipolar channels responding to at least one of these two categories. Using K-means clustering, we delineated their brain localization. In addition to the two areas described previously, we detected significant responses in two other scene-selective areas, not yet reported by any electrophysiological studies; namely the occipital place area (OPA) and the retrosplenial complex. Moreover, using iEEG we revealed a much broader network underlying visual processing than that described to date, using specialized functional imaging experimental designs. Here, we report the selective brain areas for scene processing include the posterior collateral sulcus and the anterior temporal region, which were already shown to be related to scene novelty and landmark naming. The object-selective responses appeared in the parietal, frontal, and temporal regions connected with tool use and object recognition. The temporal analyses specified the time course of the category selectivity through the dorsal and ventral visual streams. The receiver operating characteristic analyses identified the PPA and the fusiform portion of the LOC as being the most selective for scenes and objects, respectively. Our findings represent a valuable overview of visual processing selectivity for scenes and objects based on iEEG analyses and thus, contribute to a better understanding of visual processing in the human brain.
- Publikační typ
- časopisecké články MeSH
[This corrects the article DOI: 10.3389/fneur.2018.00184.].
- Publikační typ
- časopisecké články MeSH
- tisková chyba MeSH
Cíl: Přehled možností provedení MR u pacientů s implantovaným vagovým stimulátorem (vagal nerve stimulator; VNS) a způsob chirurgické explantace VNS odpovídající MR protokolu a umožňující následné vyšetření MR bez výrazných omezení. Soubor a metodika: MR vyšetření je možné provést i u pacientů s implantovaným VNS. Lze provést vyšetření hlavy a těla kaudálně od Th8. Musí však být použita pouze lokální radiofrekvenční cívka a před MR musí být generátor VNS přeprogramován. Pokud má pacient generátor a větší část elektrody explantovány, lze provést MR v oblasti celého těla jakýmkoliv MR nastavením. To platí pro situaci, kdy po explantaci zůstane nejvýše 2cm část elektrody - což odpovídá části elektrody na vagovém nervu s fixačními kotvičkami. Výsledky: Od června 2016 do června 2018 jsme explantovali VNS výše uvedeným způsobem u šesti pacientů. Pooperační průběh u všech pacientů byl bez významných komplikací. Pooperační kontrolu jsme provedli pomocí RTG krku a CT 3D zobrazení. Zobrazovací metody ukázaly ponechanou část elektrody na n. vagus ≤ 2 cm. Pooperačně pacienti neměli polykací obtíže, chrapot ani změnu hlasu. Čtyři pacienti následně po zhojení rány již podstoupili MR bez jakýchkoliv obtíží či komplikací. Závěr: Explantace VNS odpovídající MR protokolu s ponecháním části elektrody na n. vagus, tedy vynecháním kompletní preparace celé elektrody na nervu, snižuje riziko komplikací a zkracuje dobu operačního zákroku. Pacientovi můžeme následně bezpečně provádět MR celého těla bez omezení v běžných technických nastaveních.
Aim: An overview of MRI in patients with implanted vagal nerve stimulator (VNS) and the method of surgical explantation of VNS, reflecting the MRI protocol allowing the subsequent MRI examination without significant limitations. Patients and methods: MRI can also be safely performed in patients with the implanted VNS device. Head examination and body examination caudally from Th8 can be performed, but only local radiofrequency coils must be used. Before the MRI, the VNS system must be reprogrammed. If the patient has an explanted generator and the larger part of the electrode, the MRI of the entire body can be performed with any common MRI setting. This applies to a situation where after the explantation there is only a 2-cm part of the electrode left - corresponding to the portion of the electrode on the vagal nerve with fixation anchors. Results: From June 2016 to June 2018, we explanted a VNS with this approach in six patients. Post-operative course of all patients was without complications. Post-operative control was performed using neck X-ray and CT 3D imaging. Imaging methods showed that the remainder of the electrode on the vagal nerve electrode was ≤ 2 cm. Post-operatively, patients did not have swallowing difficulties, hoarseness or voice changes. Four patients have subsequently already undergone MRI without any difficulties or complications. Conclusion: Surgical explantation of VNS according to the MRI protocol, leaving part of the electrode on the vagal nerve and omitting the complete preparation of the entire electrode on the nerve, reduces the risk of complications and shortens the duration of the operation. The patient can afterwards safely undergo the MRI of the entire body without any limitations in normal technical settings.
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- dítě MeSH
- epilepsie * klasifikace MeSH
- lidé MeSH
- terminologie jako téma MeSH
- záchvaty * klasifikace MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
Komise pro klasifikaci a terminologii Mezinárodní ligy proti epilepsii (ILAE) publikovala po předchozí rozsáhlé diskuzi v r. 2017 dva klíčové dokumenty – novou klasifikaci epileptických záchvatů a novou klasifikaci epilepsií. V textu předkládáme část zdůvodnění a komentářů vycházející z originální anglické verze obou dokumentů a zejména českou verzi terminologie doporučenou výborem České ligy proti epilepsii.
Following the discussion at all levels, ILAE Commission for Classification and Terminology has published in 2017 two position papers onclassification of the epileptic seizures and on classification of the epilepsies. In the text we present translation of some parts of the originalposition papers and the Czech version of the terminology and classification that is recommended by the Czech League against Epilepsy.
- MeSH
- epilepsie * etiologie klasifikace MeSH
- lidé MeSH
- terminologie jako téma MeSH
- záchvaty * etiologie klasifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Between seizures, irritative network generates frequent brief synchronous activity, which manifests on the EEG as interictal epileptiform discharges (IEDs). Recent insights into the mechanism of IEDs at the microscopic level have demonstrated a high variance in the recruitment of neuronal populations generating IEDs and a high variability in the trajectories through which IEDs propagate across the brain. These phenomena represent one of the major constraints for precise characterization of network organization and for the utilization of IEDs during presurgical evaluations. We have developed a new approach to dissect human neocortical irritative networks and quantify their properties. We have demonstrated that irritative network has modular nature and it is composed of multiple independent sub-regions, each with specific IED propagation trajectories and differing in the extent of IED activity generated. The global activity of the irritative network is determined by long-term and circadian fluctuations in sub-region spatiotemporal properties. Also, the most active sub-region co-localizes with the seizure onset zone in 12/14 cases. This study demonstrates that principles of recruitment variability and propagation are conserved at the macroscopic level and that they determine irritative network properties in humans. Functional stratification of the irritative network increases the diagnostic yield of intracranial investigations with the potential to improve the outcomes of surgical treatment of neocortical epilepsy.
- Publikační typ
- časopisecké články MeSH
Error detection in motor behavior is a fundamental cognitive function heavily relying on local cortical information processing. Neural activity in the high-gamma frequency band (HGB) closely reflects such local cortical processing, but little is known about its role in error processing, particularly in the healthy human brain. Here we characterize the error-related response of the human brain based on data obtained with noninvasive EEG optimized for HGB mapping in 31 healthy subjects (15 females, 16 males), and additional intracranial EEG data from 9 epilepsy patients (4 females, 5 males). Our findings reveal a multiscale picture of the global and local dynamics of error-related HGB activity in the human brain. On the global level as reflected in the noninvasive EEG, the error-related response started with an early component dominated by anterior brain regions, followed by a shift to parietal regions, and a subsequent phase characterized by sustained parietal HGB activity. This phase lasted for more than 1 s after the error onset. On the local level reflected in the intracranial EEG, a cascade of both transient and sustained error-related responses involved an even more extended network, spanning beyond frontal and parietal regions to the insula and the hippocampus. HGB mapping appeared especially well suited to investigate late, sustained components of the error response, possibly linked to downstream functional stages such as error-related learning and behavioral adaptation. Our findings establish the basic spatio-temporal properties of HGB activity as a neural correlate of error processing, complementing traditional error-related potential studies.
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- dospělí MeSH
- elektroencefalografie MeSH
- elektrokortikografie MeSH
- gama rytmus EEG fyziologie MeSH
- lidé MeSH
- mapování mozku metody MeSH
- mladý dospělý MeSH
- mozek fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
