AIM: Anterior capsulotomy (AC) is one of the last therapeutic options for obsessive-compulsive disorder (OCD) refractory to conservative treatments. Several forms of cognitive dysfunction have been identified after assessment of neuropsychological outcomes in OCD patients; however, few studies focused on cognitive changes in OCD patients after surgery. In the present study, we evaluated the effects of AC on cognitive performance and mood status in patients with refractory OCD. METHODS: A total of 12 patients underwent bilateral AC between 2012 and 2019 at our institution. The patients (n = 12, female : male 5:7; mean age 39.7 years; duration ≥5 years) were assessed before and 6 months after intervention. The diagnosis of treatment-refractory OCD was based on recommended criteria for surgical treatment. Patients were assessed using a neuropsychological battery and questionnaires focused on anxiety-depressive symptomatology. The Yale-Brown Obsessive Compulsive Scale was administered as a measure of severity of OCD symptoms. RESULTS: We detected a significant decrease of OCD, and anxiety and depressive symptomatology assessed by Yale-Brown Obsessive Compulsive Scale, Beck Depression Inventory, and Beck Anxiety Inventory (P < 0.05) 6 months after AC in eight patients, and a partial decrease in four patients. Four patients underwent repeated AC with more pronounced improvement achieved after the first procedure. We did not detect decline in cognitive performance in any patients, but did find better visual memory performance (P < 0.05). CONCLUSION: AC reduced OCD and anxiety-depressive symptoms, and did not appear to influence cognitive performance, even after repeated surgery.
- MeSH
- Internal Capsule surgery MeSH
- Depression therapy MeSH
- Adult MeSH
- Outcome Assessment, Health Care * MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Neurosurgical Procedures * adverse effects MeSH
- Neuropsychological Tests MeSH
- Obsessive-Compulsive Disorder surgery MeSH
- Postoperative Cognitive Complications * etiology MeSH
- Reoperation * adverse effects MeSH
- Anxiety therapy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Úvod: V diagnostice idiopatického normotenzního hydrocefalu (iNPH) chybí spolehlivý nástroj. Perspektivu má magnetická rezonance (MR). Jednou z modalit MR je zobrazení difuzních tenzorů (DTI). Cílem bylo porovnat parametry DTI u pacientů před operací a po ní a u zdravých dobrovolníků. Metodika a materiál: Pacientům byla provedena MR mozku před operací a 1 rok po operaci. Dále byli vyšetřeni zdraví dobrovolníci. Parametry DTI (frakční anizotropie; FA; průměrná difuzivita; MD) byly měřeny v předním a zadním raménku capsula interna a v corpus callosum (ALIC, PLIC, CC). Do studie bylo zahrnuto 27 pacientů s iNPH a 24 zdravých dobrovolníků. Výsledky: U iNPH pacientů byla MD vyšší ve všech měřených oblastech než u zdravých dobrovolníků (p < 0,05). FA byla u pacientů vyšší jen v PLIC (p < 0,001). Jeden rok po operaci byl patrný pokles hodnoty FA v PLIC (p < 0,001). V jiných oblastech k poklesu FA či MD nedošlo. Hodnota FA v PLIC ani po operaci nedosáhla hodnot zdravých dobrovolníků (0,63 po operaci vs. 0,58 u kontrol). Závěr: Hodnota FA v PLIC je u pacientů s iNPH signifikantně vyšší než u zdravých. Po operaci klesá. Hodnoty MD byly vyšší v ALIC, PLIC i CC. Po operaci pokles nenastává, což odráží stupeň degenerace bílé hmoty u pacientů s iNPH.
Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is a disease with many unanswered questions. General effort is to find a simple and non-invasive diagnostic tool. Magnetic resonance imaging (MRI) is a topic for intensive research. Diffusion tensor imaging (DTI) is one of the MRI modalities. This examination can detect microstructural changes of the cerebral white matter. The aim of this study was to compare the DTI parameters in iNPH patients before and after a surgery and with healthy volunteers. Material and methods: MRI was performed in patients before surgery and 1 year after. We also examined age-matched healthy volunteers. The DTI parameters (fractional anisotropy; FA and mean diffusivity; MD) were measured in the anterior and posterior limb of the internal capsule and in the corpus callosum (ALIC, PLIC, CC). Acquired data were statistically analysed. We enrolled 27 patients with iNPH and 24 healthy volunteers. Results: MD was higher in all measured regions comparing iNPH and healthy volunteers (p < 0.05). FA was higher in the PLIC only (p < 0.001). Comparing our data before surgery and one year after, we found significant decrease of FA in the PLIC (p < 0.001) but FA in this region did not reached the FA level in the healthy volunteers group (0.63 after the surgery vs. 0.58 in volunteers). No other significant change in FA or MD was noticed. Conclusion: This study proved, that the FA in the PLIC is significantly higher in iNPH patients than in healthy volunteers. After the surgery, FA decreased. MD values were significantly higher in iNPH patients in the ALIC, PLIC and CC with no decrease after the surgery. It reflects degeneration of the white matter in iNPH patients.
- MeSH
- Internal Capsule diagnostic imaging MeSH
- Corpus Callosum diagnostic imaging MeSH
- Diffusion Magnetic Resonance Imaging * MeSH
- Intracranial Pressure physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Hydrocephalus, Normal Pressure * diagnostic imaging diagnosis surgery MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Ventriculoperitoneal Shunt MeSH
- Treatment Outcome MeSH
- Diffusion Tensor Imaging * MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
INTRODUCTION: Olfactory groove schwannomas (OGSs) are extremely rare tumours, particularly in the paediatric population. CASE REPORT: A 13-year-old girl presented with two epileptic seizures, papilloedema and incomplete binasal quadrantanopia. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a large heterogeneously enhancing tumour of the anterior skull base with a prominent dorsal pseudocyst. Interestingly, the pseudocyst embraced the right ICA bifurcation and displaced the optic tracts, optic chiasm and optic nerves and the ipsilateral basal ganglia. The patient underwent surgery via the frontolateral approach, and the tumour was completely removed. The pseudocyst was opened, and its wall was partially resected. It subsequently resolved completely. Histopathological examination yielded the rare diagnosis of schwannoma of the anterior skull base. CONCLUSION: Although extremely rare, olfactory groove schwannomas can be seen in paediatric patients. Our patient is the youngest ever reported with this histopathological diagnosis along with the formation of a large pseudocyst.
- MeSH
- Internal Capsule pathology MeSH
- Humans MeSH
- Adolescent MeSH
- Skull Base Neoplasms pathology surgery MeSH
- Neurilemmoma pathology surgery MeSH
- Optic Tract pathology MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Konvenční terapie (psychofarmaka a psychoterapie) obsedantně-kompulzivní poruchy (OCD) u značné části pacientů selhává. Hluboká mozková stimulace (DBS - deep brain stimulation) je neuromodulační neurochirurgická metoda, při které jsou sterotakticky implantovány elektrody do hlubokých oblastí mozku. DBS je perspektivní metoda pro pacienty s obsedantně-kompulzivní poruchou, kteří jsou rezistentní ke konvenční léčbě, tj. pro pacienty, kteří neodpovídají na léčbu alespoň dvěma preparáty zvyšujícími serotoninergní transmisi, z nichž jeden byl klomipramin, dále na augmentaci antipsychotikem 2. generace a kteří dále nereagovali na psychoterapii. Důležitá je dokumentace adekvátní léčby, za kterou se v případě farmakoterapie považuje alespoň 12týdenní podávání vysokých dávek, v případě psychoterapie jsou nejsilnější důkazy pro behaviorální techniky typu expozice a zábrana odpovědi, která mají být vedeny terapeutem (tj. ne formou samostatného tréninku) alespoň 20krát po dobu 1 hodiny. V současností je schválená indikace chronické stimulace oblasti ventrálního striáta a ventrální části předního raménka capsula interna. Touto oblastí prochází dráhy spojující orbitofrontální kortex se subkortikálními strukturami, což jsou oblastí, které jsou zapojené do patofyziologie nemoci, jsou hyperaktivní. Tyto dráhy jsou cílem neurochirurgických zákroků u refrakterních pacientů, a DBS je tedy reverzibilní alternativou těchto přístupů. Dle dosavadních údajů dochází k významné redukci tíže symptomů (obsedantně-kompulzivních, depresivních i úzkostných) spojené se zlepšením kvality života a sociálních kompetencí pacientů. Léčba je minimálně invazivní, dobře tolerovaná, doposud hlášené nežádoucí účinky byly reverzibilní a dobře ovlivnitelné úpravou stimulačních parametrů či dobře léčitelné. Velmi důležité je však pečlivé zvážení každého případu, jeho historie i psychosociálního kontextu refrakterní symptomatiky, velmi citlivé jsou etické souvislosti přístupu, kterým musí být věnována patřičná pozornost.
Conventional therapy (medication and psychotherapy) often fails in patients with obsessive-compulsive disorder. Deep brain stimulation (DBS) is a neuromodulation surgical treatment. The electrodes are stereotactically implanted into deep brain structures. DBS is a suitable method for patients whose OCD symptoms are resistant to conventional treatment, i.e. for patients who do not respond to at least two treatment trials with serotoninergic agents, (one of them should be clomipramine), to the augmentation with 2nd generation antipsychotic agent, and who did not respond to psychotherapy. Great attention should be paid to the documentation of adequate treatment trials. In the case of pharmacotherapy, at least of twelve weeks of administration of high doses is considered adequate; in the case of psychotherapy, adequate approach includes behavioral techniques of exposition and response prevention, that should be performed during at least twenty one hour sessions supervised by a therapist. At present chronic stimulation of a region in the vicinity of ventral striatum and ventral part of anterior capsula interna is approved for the treatment of OCD. Tracts that connect orbitofrontal cortex with subcortical structures (involved in the pathogenesis of OCD) go through this region. These tracts are the target of neurosurgical approaches in refractory patients - DBS can be understood as a reversibile alternative of the lesional surgery. According to the available data, the DBS causes reduction of symptom severity (obsessions-compulsions, depression, anxiety), improvement in quality of life and social competencies of patients. This therapy is minimally invasive, well tolerated. The reported side effects were reversible and easily correctible either by the stimulation parameter adjustment or other treatment. It is important to carefully judge every case, its history and psychosocial context of refractory symptoms. Finally, we should not forget the ethical issues.
- MeSH
- Antipsychotic Agents therapeutic use MeSH
- Internal Capsule surgery MeSH
- Financing, Organized MeSH
- Deep Brain Stimulation * methods adverse effects MeSH
- Drug Resistance MeSH
- Humans MeSH
- Brain surgery MeSH
- Neurosurgical Procedures methods MeSH
- Treatment Failure MeSH
- Obsessive-Compulsive Disorder * surgery physiopathology psychology MeSH
- Psychosurgery methods MeSH
- Psychotherapy MeSH
- Eligibility Determination MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: The anatomy and somatotopy of the pyramidal tract during its course in the internal capsule has recently been discussed by many publications. However, the reports on the anatomy of the clinically more important supraventricular portion of the tract are scarce. The objective of this study is to investigate the anatomy and somatotopy of the supraventricular portion of the pyramidal tract. METHODS: In 13 patients undergoing surgery with subcortical electric stimulation for tumors located in the supraventricular white matter close to the pyramidal tract (as depicted by diffusion tensor tracking [DTT]), the relationship between the position of the stimulation point and the motor response in the arm or leg was analyzed. Additionally, the somatotopic organization of the tract was studied using separate tracking of arm and leg fibers in 20 healthy hemispheres. Finally, the course of the tract was studied by dissecting 15 previously frozen human hemispheres. RESULTS: In most cases, subcortical stimulation during the resection of tumors located behind and in front of the pyramidal tract elicited leg and arm movement, respectively. This association of stimulation point position with motor response type was significant. A DTT study of the somatotopy demonstrated a varying degree of rotation of the leg and arm fibers from mediolateral to posteroanterior configuration. Anatomic dissections demonstrated a folding-fan like structure of the pyramidal tract with a similar rotation pattern. CONCLUSION: The pyramidal tract undergoes a large part of its rotation from mediolateral to posteroanterior configuration during its course in the supraventricular white matter, although interindividual differences exist.
- MeSH
- Internal Capsule anatomy & histology physiology surgery MeSH
- Humans MeSH
- Brain Mapping methods MeSH
- Brain Neoplasms surgery MeSH
- Neuroanatomy methods MeSH
- Pyramidal Tracts anatomy & histology physiology surgery MeSH
- Retrospective Studies MeSH
- Diffusion Tensor Imaging methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Neuronální úbytek jako charakteristický rys Alzheimerovy nemoci (AN) se může nepřímo posuzovat na magnetické rezonanci (MR) podle celkové nebo regionální atrofie mozku. Mediotemporální atrofie je pro AN typická, leč nespecifická. Ke zvýšení diagnostické vý¬ těžnosti z jednorázového MR vyšetření jsme se zaměřiU na vybrané oblasti mozkové kůry a bílé hmoty. U 20 pacientů s pravděpodobnou AN a 20 kontrolních seniorů jsme změřili tloušťku, šířku či výšku následujících oblastí v obou hemisférach: a) šedá hmota mozková - entorinální kůra (EC), dvě oblasti frontální kůry (dorsálně Fl, ventrálně F2), temporální (T) kůra a okcipitální kůra, b) bílá hmota mozková - capsula interna (CI), corpus callosum. Oproti kontrolním seniorům měli pacienti s AN významně atrofovány tyto oblasti: pravá a levá EC, levá F2 kůra, pravá T kůra a všechny oblasti měřené bílé hmoty, nejvíce levá capsula interna. Významná asymetrie u AN byla prokázána pro EC a F2 kůru. AN vede k difúzni atrofii mozku, z níž největší úbytek mozkové tkáně nastává v oblasti EC oboustranně a v levé CI. Degenerativní proces postihuje nerovnoměrně pravou a levou hemisféru, především v kůře EC a F2.
Neuronal loss as a feature of Alzheimer's disease (AD) may be indirectly assessed on magnetic resonance (MR) according to the total or regional brain atrophy. Mediotemporal atrophy is typical for AD, but not specific. To increase the diagnostic yield from a single MR examination, we focused on selected areas of the cortex and the white matter. We measured the thickness, the width or the height of the following areas in both hemispheres in 20 patients with probable AD and 20 control elderly people: a) the grey matter – entorhinal cortex (EC), two frontal cortical areas (dorsal F1, ventral F2), temporal (T) cortex and occipital cortex, b) the white matter – internal capsule (CI), corpus callosum. Compared to control elderly patients, AD patients had significantly atrophied following areas: right and left EC, left F2 cortex, right T cortex, and all parts measured in the white matter, the most pronounced change being in the left internal capsule. A significant asymmetry in AD was observed for the EC and F2 cortices. AD results in a diffuse brain atrophy, from which the greatest loss of brain tissue occurs in the EC bilaterally and the left CI. A degenerative process disproportionately affects the right and left hemisphere, especially in the EC and F2 cortices.
