Navigation-assisted transcortical transventricular approach for paraventricular cavernoma:A technical note and review of the literature

The surgery of paraventricular cavernoma remains a challenge for the neurosurgeon.Few approaches have been specially described for paraventricular cavernoma in literature.We present a patient with a symptomatic paraventricular cavernoma in the dorsal portion of the right lateral ventricles roof causing ventricular hemorrhage,and review his surgical approaches.This patient underwent a navigationassisted transcortical transventricular approach resulting in a complete resection without any neurologic deficits.The approach allows a safe and effective resection of paraventricular cavernomas.

Emotion and cognitive function assessment of patients with central neurocytoma resection through transcortical frontal approach： a 5-year postoperative follow-up study

Background Central neurocytoma accounts for 0.1% of primary brain tumor that often occurs in young adults. Surgery is the main treatment for central neurocytoma and the rate of 5-year survival reaches up to over 90%. This study aimed to assess the effect of transcortical frontal approach to surgical resection of central neurocytoma on emotion and cognitive function 5 years after surgery. Methods Telephone following-up visits were used in this study. By means of neuropsychological testing, assayed emotion, memory and abstract thinking ability of 18 patients undergoing central neurocytoma resection by transcortical frontal approach for 5 years or more, with another 21 normal cases as control group were enrolled. The data were analyzed statisticaJly by paired t test with SPSS11.5. Results Patients whose central neurocytoma was removed by transcortical frontal approach were not affected on calculating ability 5 years after operation while ability of memory declined sharply （P=-0.000）, the older, the more sharply （P=0.036）. Ability of abstract thinking was significantly reduced （P=0.000）, the older, the more significantly as well （P=-0.012）; additionally, anxiety and depression occurred in patients rather more than those of control group （P=0.000）, especially cognitive impairment. Conclusions Transcortical frontal approach for surgical resection of central neurocytoma has certain long-term influence on patients＇ life quality, vulnerable to anxiety, depression and cognitive impairment, the severity of which was correlated to age. Therefore, imDrovina suroical aoDroach will be of value for better Iona-term life aualitv of oatients.

INTRAOPERATIVE LOCALIZATION OF CORTICAL MOTOR EVOKED POTENTIALS IN CENTRAL SULCUS LESIONS

Objective To study direct cortical electrical stimulation technique for the recording of motor evoked potentials under general anesthesia in central sulcus lesions. Methods The largest N20-P25 response was recorded from postcentral gyrus by intraoperative monitoring of cortical motor evoked potentials in 10 patients with intracranial lesions near or in the central area. The muscles of upper extremity in all patients were activated by delivering stimulus to cortical areas continuously. Moving the cortical electrodes forward, the largest P20-N25 response, SEP phase reversal,was obtained as a motor center stimulus. In this site of cortex, a short train stimulation elicited reproducible muscle action potentials that could be observed from the oscilloscope without averaging.Results MEPs can be recorded, pre-and post-operatively, without motor deficits of upper limbs in all patients.Conclusion This technique seems to be preferable for intraoperative localization of motor evoked potentials in central sulcus lesions under total intravenous anesthesia.

Rethinking the standard trans-cortical approaches in the light of superficial white matter anatomy

A better comprehension of the superficial white matter organization is important in order to minimize potential and avoidable damage to long or intermediate association fibre bundles during every step of a surgical approach.We recently proposed a technique for cadaver specimen preparation,which seems able to identify a more systematic organization of the superficial white matter terminations.Moreover,the use of the physiological intracranial vascular network for the fixation process allowed us to constantly show main vascular landmarks associated with white matter structures.Hence three examples of standard approaches to eloquent areas are herein reanalyzed starting from the first superficial layer.New insights into the possible surgical trajectories and subsequent quantitative damages of both vessels and white matter fibres can help readapt even the most standard and widely accepted approach trough the brain cortex.A more detailed study of these fine anatomical details may become in the near future a fundamental part of the neurosurgical training and the preoperative planning.

Linguistic Characteristics of Mandarin-Speaking Huntington’s Disease Patients

Objective Linguistic problem is common in Huntington’s disease(HD)patients.It has been studied before in native speakers of alphabetic languages,such as English.As a hieroglyphic language,Chinese differs from alphabetic languages in terms of phonology,morphology,semantics and syntax.We aimed to investigate the linguistic characteristics of manifest HD in native speakers of Mandarin.Meanwhile,we expected to explore the linguistic differences associated with cortical or subcortical pathology.Methods Five HD patients and five Alzheimer’s disease(AD)patients matched in age,gender,disease course and educational level were enrolled.All the participants were Mandarin native speakers.All finished history inquiry,physical examination,basic test,genetic test and neuropsychological assessment.Language evaluation was performed by Aphasia Battery of Chinese.Results HD patients had a mean disease course of 5.4±2.97(range,2-10)years.They showed a linguistic disorder close to transcortical motor aphasia.They exhibited prominent phonological impairment,as well as slight semantic and syntactic abnormality.Tonic errors were found in speech.Character structural errors and substitutions were detected in writing.In comparison,AD patients showed a more severe linguistic impairment,characterized by global aphasia with more semantic errors.Conclusion Mandarin-speaking HD patients have a transcortical motor aphasia-like disturbance with prominent phonological impairment,whereas AD patients have a more severe global aphasia with salient semantic impairment.

Case Report of a Septum Pellucidum Cavernoma Surgically Resected via Inferior Parietal Approach and Short Literature Review

Background and Importance: Cavernomas of the septum pellucidum represent an extremely rare subtype of CNS cavernous angiomas which are a rare subtype of CNS tumors. Intraventricular cavernomas of the body of the lateral ventricle are usually treated by the transcallosal approach. Clinical Presentation: We present a case of a fifty-eight year old man with a septum pellucidum cavernoma successfully treated operatively by means of the inferior parietal transcortical transventricular approach. This unusual and scarcely documented tumor was situated at the posterior third of the septum pellucidum. The patient had a good recovery with no focal deficit. Conclusion: Septum pellucidum cavernomas are extremely rare lesions. Inferior parietal transcortical approach is a safe alternative to the commonly used transcallosal approach for lesions of the posterior half of the septum pellucidum.