1
|
Hellwig D, Hellwig D, Kaiser HJ, Doherty C, Schneider R, Mull M, Willmes K, Hinckeldey V, Büll U, Thron A, Ringelstein EB, Sabri O. Einfluß morphologischer Veränderungen auf Durchblutung und Stoffwechsel bei zerebraler Mikroangiopathie. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung51 Patienten mit zerebraler Mikroangiopathie wurden mittels Kernspintomographie, 18FDG-PET und 99mTc-HMPAO-SPECT untersucht. Die genaue Zuordnung funktioneller zu den morphologischen Befunden wurde durch ein spezielles Kopf-halterungssystem für PET, SPECT- und KST-Untersuchungen hergestellt. Patienten mit weniger als vier lakunären Infarkten (LI) und ohne bis geringfügigen Deep White Matter Lesions (DWML) im KST wiesen keine signifikant veränderten Werte für rMRGIu und rCBF in grauer oder weißer Substanz auf im Vergleich zu Patienten mit vier oder mehr LI und ausgedehnten DWML. Eine semiquantitative Einteilung der Atrophie (A: keine bis geringfügige; B: mäßige bis schwere) erbrachte für B) im Vergleich zu A) signifikant erniedrigte rCBF- und rMRGIu-Werte in grauer und weißer Substanz. Somit sind bei Patienten mit ZMA nur die Hirnatrophie, jedoch nicht die charakteristischen LI und DWML mit einer meßbaren Erniedrigung von rCBF und rMRGIu korreliert.
Collapse
|
2
|
Küker W, Thiex R, Rohde I, Rohde V, Thron A. Experimental acute intracerebral hemorrhage: Value of MR sequences for a safe diagnosis at 1.5 and 0.5 T. Acta Radiol 2016; 41:544-52. [PMID: 11092473 DOI: 10.1080/028418500127346180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To determine the detectability of intracerebral hematomas with MR imaging at 1.5 T and 0.5 T with fluid attenuated inversion recovery turbo spin-echo (FLAIR) and gradient-echo sequences. Material and Methods: Twenty-seven intracerebral hematomas were created in 25 piglets by injection of venous blood into the brain through a burr hole. All were imaged with T2*-weighted gradient echo sequences (fast field echo, FFE), T2-weighted fluid attenuated inversion recovery turbo spin-echo sequences (FLAIR), T2-weighted turbo spin-echo (TSE) and T1-weighted spin-echo sequences. Follow-up was performed on the 2nd, 4th and 10th postoperative days. Ten animals were additionally investigated with similar sequences at 0.5 T. Histologic correlation was obtained in all cases. Results: T2* FFE sequences detected all acute intracerebral hematomas and demonstrated the size correctly at 1.5 T and 0.5 T. The conspicuity was better at 1.5 T. FLAIR sequences were unreliable in the hyperacute phase at 1.5 T. However, subarachnoid and intraventricular extension was best appreciated with FLAIR images. T2 TSE images were incapable of detecting paraventricular and subarachnoid hemorrhages, but clearly demonstrated intracerebral blood in other locations. T1-weighted images were insensitive to hemorrhage in the acute state but very useful in subacute and chronic hematomas. Conclusion: The safe and reliable diagnosis of intracerebral hemorrhage is probably possible with MR imaging at 1.5 T and 0.5 T even of hematomas less than 90 min old, but requires the application of at least FLAIR, T2* FFE and T1 sequences and is therefore time consuming.
Collapse
Affiliation(s)
- W Küker
- Department of Neuroradiology, University Hospital, Technical University, Aachen, Germany
| | | | | | | | | |
Collapse
|
3
|
Reul J, Spetzger U, Weis J, Von Buelow S, Ince A, Thron A. The Nature of Early Intraluminal Thrombosis in Terminal Aneurysms Occluded with Guglielmi Detachable Coils. Interv Neuroradiol 2016; 4:39-48. [DOI: 10.1177/159101999800400104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/1998] [Accepted: 02/10/1998] [Indexed: 11/17/2022] Open
Abstract
To investigate the early intraluminal thrombotic events after endovascular treatment of terminal aneurysms with detachable coils, and to assess the biological changes over the first three weeks, terminal arterial bifurcation aneurysms were produced microsurgically in 20 rabbits. After a healing period of three weeks, transfemoral angiography was performed and all aneurysms were occluded with Guglielmi Detachable Coils (GDC). Complete (i.e. 100%) occlusion was achieved in ten aneurysms. About 95% occlusion (only a small neck remnant) was seen in eight cases. In two cases, occlusion was about 70–80%. Half of the animals were treated by anticoagulation during and continuously two days after occlusion therapy. Angiographic studies and histological analysis were done for four aneurysms (two without and two with anticoagulation) after 24 – 48 hours, 3 – 4 days, 6 – 7 days, 14 days, and 21 days after the treatment. On macroscopic examination, complete occlusion of the aneurysms by early thrombus formation was found in all cases during the first two days. After three to seven days, recanalization and fibrinolysis were observed, leading to a reopening of the neck, and part of the dome. After three weeks recanalization was found in six out of eight aneurysms, regardless of whether the animal was under anticoagulation. In nine cases, the degree of occlusion was overestimated by angiography compared to the pathological findings. During the early phase after occlusion of an aneurysm with platinum coils, extensive clot formation is induced. Over time due to the natural fibrinolysis, continuous recanalization beginning at the neck takes place. These findings can explain the clinical phenomenon of early thromboembolic complications, and the reopening and regrowth of aneurysms occluded with metallic coils observed at later stages.
Collapse
Affiliation(s)
- J. Reul
- Department of Neuroradiology, Medical Centre, University of Bonn; Germany
| | - U. Spetzger
- Department of Neurosurgery, University Hospital; RWTH Aachen
| | - J. Weis
- Department of Neuropathology, University Hospital; RWTH Aachen
| | | | | | | |
Collapse
|
4
|
Thron A, Krings T, Otto J, Mull M, Schroeder JM. The Transdural Course of Radicular Spinal Cord Veins--A Microangiographical and Microscopical Study. Clin Neuroradiol 2015; 25:361-9. [PMID: 26510557 DOI: 10.1007/s00062-015-0476-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE This study focuses on the following questions: What are the morphological features at the transdural course of radiculomedullary veins? How are these short transdural segments that may harbour pathological arteriovenous shunts connected to the internal vertebral venous plexus? Is the conception of a reflux-impeding mechanism at the transdural segment indispensable and convincing? METHODS A total of 102 radiculospinal veins were studied microscopically at various levels of the spinal canal using serial paraffin and semi-thin sections. In addition, 26 vessels were investigated microangiographically following orthograde (12) or attempted retrograde (14) opacification of the intradural venous segment with barium sulphate. After paraplast-embedding, contact-microradiographs were taken using high-resolution spectroscopic plates. RESULTS At their transdural course, the veins showed narrowing of their lumen accompanied by changes in the vessel wall composition and a tortuous course. Two structurally distinct arrangements of the transdural segment could be identified: A slit type was seen in 60% of the veins studied and a bulge- or nodular type was seen in 35% of the veins. In total, 5% of cases could not be assigned to either one of these types. Reflux to radicular veins from the outside of the dura mater could be produced in 2 out of 14 specimens. The extradural venous plexus, which primarily receives the radicular vein, was composed more frequently of lacunar spaces rather than plexiform blood vessel convolutions. Rare observations were fibrotic, blind ending radiculomedullary veins and continuation of a distinct venous blood vessel after crossing the dura. CONCLUSIONS Reflux from the epidural plexus to radicular veins is not reliably stopped at the dural level and possibly physiological. Different arrangements of the transdural course of the veins appear to be at least appropriate to modulate flow. The purpose for two different types of radicular vein exit is unclear. The clinical impact of disturbed reflux-control is uncertain, which is in stark contrast to the severe consequences resulting from dural arteriovenous shunts. The functional role of the probably predominant epidural venous plexus for the spinal cord blood circulation remains poorly understood.
Collapse
Affiliation(s)
- A Thron
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Technical University Aachen, Pauwelsstraße 30, 52057, Aachen, Germany. .,, Theaterstr. 31, 52062, Aachen, Germany.
| | - T Krings
- UHN Division of Neuroradiology, Toronto Western Hospital, University of Toronto, 399 Barhurst St 3MCL-429, M5T 2S8, Toronto, ON, Canada
| | - J Otto
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Technical University Aachen, Pauwelsstraße 30, 52057, Aachen, Germany
| | - M Mull
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Technical University Aachen, Pauwelsstraße 30, 52057, Aachen, Germany
| | - J M Schroeder
- Institute of Neuropathology, University Hospital Technical University Aachen, Pauwelsstraße 30, 52057, Aachen, Germany
| |
Collapse
|
5
|
Zielen S, Thron A, Hammer E, Linde R, Zissler U, Rosewich M, Schubert R. Bronchiale Inflammation bei Patienten mit schweren humoralen Immundefekten. Pneumologie 2013. [DOI: 10.1055/s-0033-1334764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
6
|
Nijenhuis R, Krings T, Mull M, Thron A, Wilmink J, Backes W. Non-invasive Spinal Cord Angiography for Imaging Vascular Spinal Cord Malformations. Neuroradiol J 2009. [DOI: 10.1177/19714009090220s119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- R.J. Nijenhuis
- Departments of Radiology, Maastricht University Hospital; Maastricht, The Netherlands
- St. Elisabeth Hospital; Tilburg, The Netherlands
| | - T. Krings
- Departments of Neuroradiology, University Hospital Aachen; Aachen, Germany
- University of Toronto, Toronto Western Hospital; Toronto, Ontario, Canada
| | - M. Mull
- Departments of Neuroradiology, University Hospital Aachen; Aachen, Germany
| | - A. Thron
- Departments of Neuroradiology, University Hospital Aachen; Aachen, Germany
| | - J.T. Wilmink
- Departments of Radiology, Maastricht University Hospital; Maastricht, The Netherlands
| | - W.H. Backes
- Departments of Radiology, Maastricht University Hospital; Maastricht, The Netherlands
| |
Collapse
|
7
|
Mühlenbruch G, Das M, Mommertz G, Schaaf M, Langer S, Mahnken AH, Wildberger JE, Thron A, Günther RW, Krings T. Comparison of dual-source CT angiography and MR angiography in preoperative evaluation of intra- and extracranial vessels: a pilot study. Eur Radiol 2009; 20:469-76. [PMID: 19697041 DOI: 10.1007/s00330-009-1547-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 06/02/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
Abstract
Besides the assessment of carotid artery stenosis, evaluation of the vascular anatomy and lesions within both the extra- and intracranial arteries is crucial for proper clinical evaluation, treatment choice and planning. The purpose of our study was to evaluate the potential of dual-source CTA and 3T-MRA. In 16 symptomatic CAS patients, contrast-enhanced DSCT and 3T-MRA examinations were performed. For DSCT a dual-energy protocol with a 64 x 0.6-mm collimation was applied. In 3T-MRA intracranial high-resolution unenhanced TOF and extracranial contrast-enhanced MRA were performed. All examinations were analyzed for relevant morphologic and pathologic features or anomalies, and a total of 624 vessel segments were scored. All examinations were of diagnostic image quality with good to excellent vessel visibility. Almost all intracranial arteries were significantly better visualized by MRA compared to CTA (five of six vessels, p < 0.05). DSCT however allowed for further morphological carotid stenosis description, especially with respect to calcification. Although MRA proved to be superior in visualization of smaller intracranial arteries, all pre-interventionally relevant information could be perceived from DSCT. DSCT and MRA may both be regarded as a reliable, fast, pre-interventional imaging investigation in patients with carotid artery stenosis.
Collapse
Affiliation(s)
- Georg Mühlenbruch
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, Pauwelsstr. 30, 52057 Aachen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Bürgel U, Mädler B, Honey C, Thron A, Gilsbach J, Coenen V. Fiber Tracking with Distinct Software Tools Results in a Clear Diversity in Anatomical Fiber Tract Portrayal. ACTA ACUST UNITED AC 2009; 70:27-35. [PMID: 19191204 DOI: 10.1055/s-0028-1087212] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
Isensee* C, Reul J, Thron A. Thrombose als Sinus transversus als Ursache temporaler Blutungen. Stellenwert von MRT und Angiographie. Akt Neurol 2008. [DOI: 10.1055/s-2007-1018045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT, Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR Am J Neuroradiol 2007; 28:1249-58. [PMID: 17698524 PMCID: PMC7977648 DOI: 10.3174/ajnr.a0612] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this work was to study the validity of MR angiography (MRA) for identification of spinal arteriovenous (AV) abnormalities. MATERIALS AND METHODS Thirty-four consecutive patients with suspicion of spinal vascular abnormalities underwent digital subtraction angiography (DSA) after MRA. The level and side of the suspected spinal dural arteriovenous fistula (SDAVF) and the feeding arteries in spinal arteriovenous malformations (SAVMs) were determined from the MRA and compared with DSA. RESULTS DSA revealed SDAVF in 20 abnormalities of which 19 were spinal and 1 was tentorial with spinal drainage, as well as SAVM in 11 patients. In 3 patients, MRA and DSA were both normal. For detection of spinal arteriovenous abnormalities, neither false-positive nor false-negative MRA results were obtained. The MRA-derived level of the feeding artery in SDAVF agreed with DSA in 14 of 19 cases. In 5 cases, a mismatch of 1 vertebral level (not side) was noted for the feeding artery. For the tentorial AVF, only the spinal drainage was depicted; the feeding artery was outside the MRA field of view. In intradural SAVM, the main feeding artery was identified by MRA in 10 of 11 patients. MRA could differentiate between glomerular and fistulous SAVM in 4 of 6 cases and between sacral SDAVF and filum terminale SAVM in 2 of 5 cases. CONCLUSIONS MRA reliably detects or excludes various types of spinal AV abnormalities and localizes the (predominant) arterial feeder of most spinal AV shunts. Although classification of the subtype of SAVMs remains difficult, with MRA it greatly helps to focus subsequent DSA.
Collapse
Affiliation(s)
- M Mull
- Department of Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
Vascular malformations of the spinal cord and its meninges are rare diseases which comprise true inborn cavernomas and arteriovenous malformations (AVM), including perimedullary fistulae, glomerular and juvenile AVMs, and presumably acquired dural arteriovenous fistulae. This article gives an overview of the imaging features on magnetic resonance imaging (MRI) and digital subtraction angiography of both typical and atypical findings to describe the wide variety of possible pathological entities encountered. Clinical differential diagnoses, the neurological symptomatology and potential therapeutic approaches of these diseases, which may vary depending on the underlying pathology, are given. Although MRI constitutes the first choice diagnostic modality for suspected spinal vascular malformations, we conclude that the definite diagnosis of the disease and thus the choice of the appropriate therapeutic approach rests on selective spinal angiography which should be performed at a specialized center. Treatment in symptomatic patients offers an improvement in prognosis. Microsurgical treatment is recommended for symptomatic spinal cord cavernomas. Dural arteriovenous shunts can either be treated by microsurgical or endovascular approaches, the former being a simple, quick and secure approach to obliterate the fistula while the latter is technically demanding. In spinal arteriovenous malformations of both the fistulous and the glomerular type, the endovascular approach is the method of first choice; in selected cases, surgery or a combined therapy may be necessary.
Collapse
Affiliation(s)
- A Bostroem
- Department of Neurosurgery, University Hospital (RWTH), Aachen, Germany.
| | | | | | | |
Collapse
|
12
|
Harrer J, Parker G, Krings T, Haroon H, Buckley D, Roberts C, Noth J, Thron A, Jackson A. Assessment of microvascular characteristics of meningeomas with T1-weighted dynamic contrast-enhanced MRI. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Abstract
OBJECT Hemorrhages caused by hemangioblastomas are very rare and mostly located in the subarachnoid space. Intraparenchymal bleedings due to hemangioblastomas are even less frequent, and these hemorrhages are almost exclusively located in the supratentorial brain, cerebellum and spinal cord. We report the first case of a brainstem hemorrhage due to a hemangioblastoma of the medulla oblongata. CASE REPORT A 47-year-old woman presented with acute onset of headache, anarthria, inability to swallow, left-sided hemiparesis and hemidysesthesia with varying states of vigilance, finally developing acute respiratory failure. Cranial computed tomography (CT) scanning and magnetic resonance imaging (MRI) revealed a small hemangioblastoma of the posterior medulla oblongata causing intraparenchymal hemorrhage and acute occlusive hydrocephalus due to intraventricular hematoma extension. RESULT After implantation of an external ventricular catheter to treat acute hydrocephalus, the hemangioblastoma as well as its associated hemorrhage could be removed in toto via a microsurgical posterior median suboccipital approach with minimal foramen magnum enlargement. During the follow-up period of six months postoperatively the patient showed good recovery with only slight residual neurological deficits. CONCLUSION The most common causes of brainstem hemorrhages are arterial hypertension and cavernous hemangiomas. However, hemangioblastomas should not be ignored as a possible differential diagnosis for intraparenchymal brainstem hemorrhage. While the prognosis in hypertensive brainstem bleedings is mostly disastrous and surgery rarely indicated, an operative therapy should be considered in cases of hemorrhages caused by underlying tumors. Especially in the treatment of hemangioblastoma, the surgical management strategy is crucial for a successful result. Therefore, the authors recommend including the search for hemangioblastomas into the diagnostic workup in patients with brainstem hemorrhages.
Collapse
Affiliation(s)
- Y-M Ryang
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany.
| | | | | | | | | |
Collapse
|
14
|
Stracke CP, Spuentrup E, Reinacher P, Thron A, Krings T. Time Resolved 3D MRA. Applications for Interventional Neuroradiology. Interv Neuroradiol 2006; 12:223-31. [PMID: 20569575 DOI: 10.1177/159101990601200304] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 08/15/2006] [Indexed: 11/16/2022] Open
Abstract
SUMMARY The decision for endovascular treatment of cranial dural AV fistulae and angiomas and their follow-up after treatment is usually based on conventional DSA. New techniques of magnetic resonance angiography (MRA) facilitate high temporal and spatial resolution images.The purpose of this study was to evaluate the applicability and clinical use of a newly developed 3D dynamic MRA protocol on a 3T scanner for neurointerventional planning and decisionmaking. Using a 3T whole body scanner, a three-dimensional dynamic contrast enhanced MRA sequence with parallel imaging, and intelligent kspace readout (Keyhole and "CENTRA" kspace filling) was added to structural MRI and time-of-flight MRA in seven patients. DSA was performed in each patient following MR examination. In all patients MRA allowed the identification and correct classification of the vascular lesion. Hemodynamic characteristics and venous architecture were clearly demonstrated. Larger feeding arteries could be identified in all cases. Smaller feeding vessels were overlooked in dynamic MRA and only depicted in conventional DSA High temporal and spatial resolution 3D MRA may correctly identify and classify fistulae and angiomas and help to reduce the number of pre- or post-interventional invasive diagnostic angiograms.
Collapse
Affiliation(s)
- C P Stracke
- Departments of Neuroradiology and Neurosurgery, University Hospital of the Technical University, Aachen, Germany -
| | | | | | | | | |
Collapse
|
15
|
Krings T, Finney J, Niggemann P, Reinacher P, Lück N, Drexler A, Lovell J, Meyer A, Sehra R, Schauerte P, Reinges M, Hans FJ, Thron A. Magnetic versus manual guidewire manipulation in neuroradiology: in vitro results. Neuroradiology 2006; 48:394-401. [PMID: 16622696 DOI: 10.1007/s00234-006-0082-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 03/02/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Standard microguidewires used in interventional neuroradiology have a predefined shape of the tip that cannot be changed while the guidewire is in the vessel. We evaluated a novel magnetic navigation system (MNS) that generates a magnetic field to control the deflection of a microguidewire that can be used to reshape the guidewire tip in vivo without removing the wire from the body, thereby potentially facilitating navigation along tortuous paths or multiple acute curves. METHOD The MNS consists of two permanent magnets positioned on either side of the fluoroscopy table that create a constant precisely controlled magnetic field in the defined region of interest. This field enables omnidirectional rotation of a 0.014-inch magnetic microguidewire (MG). Speed of navigation, accuracy in a tortuous vessel anatomy and the potential for navigating into in vitro aneurysms were tested by four investigators with differing experience in neurointervention and compared to navigation with a standard, manually controlled microguidewire (SG). RESULTS Navigation using MG was faster (P=0.0056) and more accurate (0.2 mistakes per trial vs. 2.6 mistakes per trial) only in less-experienced investigators. There were no statistically significant differences between the MG and the SG in the hands of experienced investigators. One aneurysm with an acute angulation from the carrier vessel could be navigated only with the MG while the SG failed, even after multiple reshaping manoeuvres. CONCLUSION Our findings suggest that magnetic navigation seems to be easier, more accurate and faster in the hands of less-experienced investigators. We consider that the features of the MNS may improve the efficacy and safety of challenging neurointerventional procedures.
Collapse
Affiliation(s)
- T Krings
- Department of Neuroradiology, University Hospital Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Krings T, Willmes K, Becker R, Meister IG, Hans FJ, Reinges MHT, Mull M, Thron A. Silent microemboli related to diagnostic cerebral angiography: a matter of operator’s experience and patient’s disease. Neuroradiology 2006; 48:387-93. [PMID: 16586116 DOI: 10.1007/s00234-006-0074-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 01/23/2006] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of the present investigation was to elucidate in a large consecutive patient cohort whether the level of training has an effect on the number of microemboli detected by diffusion-weighted imaging (DWI) and which additional risk factors can be identified. METHODS A total of 107 consecutive patients in whom a diagnostic cerebral angiography had been performed were prospectively investigated with DWI; 51 angiographies were performed by experienced neuroradiologists, 56 by neuroradiologists in training. RESULTS In 12 patients (11.1%), a total of 17 new lesions without any clinically overt neurological symptoms were identified. Of these, 12 patients, 11 (91.7%) with 16 lesions were investigated by junior neuroradiologists. In 11 of 12 patients with DWI abnormalities (91.7%), risk factors could be identified (atherosclerotic vessel wall disease, vasculitis, hypercoagulable states). Experienced neuroradiologists performed 21 of 48 angiographies (43.8%) on patients with the above-mentioned risk factors, whereas junior neuroradiologists performed 27 angiographies in this subgroup (46.2%). The rate of diffusion abnormalities in patients with risk factors was 11/48 (22.9%) - considerably higher than in patients without risk factors (1/59; 1.7%). CONCLUSION The level of experience and the nature of the underlying disease are predictors of the occurrence of cerebral ischemic events following neuroangiography. Alternative diagnostic modalities should be employed in patients who are investigated for diseases with the highest risk of angiographic complications (i.e., vasculitis, and arteriosclerotic vessel wall disease). If diagnostic angiography remains necessary in these patients, the highest level of practitioner training is necessary to ensure good patient outcome.
Collapse
Affiliation(s)
- T Krings
- Department of Neuroradiology, University Hospital of Technical University Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Harrer J, Parker GJM, Krings T, Haroon HA, Buckley DL, Roberts C, Noth J, Thron A, Jackson A. Assessment of microvascular characteristics of meningeomas with T1-weighted dynamic contrast-enhanced MRI. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
18
|
Sturm W, Schmenk B, Fimm B, Specht K, Weis S, Thron A, Willmes K. Spatial attention: more than intrinsic alerting? Exp Brain Res 2005; 171:16-25. [PMID: 16307253 DOI: 10.1007/s00221-005-0253-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 09/13/2005] [Indexed: 11/30/2022]
Abstract
It has been proposed that the right hemisphere alerting network co-activates, either directly or via the brainstem, the attention system in the parietal cortex involved in spatial attention. The observation that impaired alertness and sustained attention can predict the outcome of neglect might suggest such a relationship, too. In the present fMRI study, we intended to analyse and compare the functional anatomy of two attentional conditions both involving intrinsic (endogenous) alerting and fixation but differing with respect to the degree of spatially distributed attention by using the same paradigm under two different attentional conditions. In a group of ten participants, both a focused and a distributed visuospatial attention condition evoked similar patterns of activation in dorsolateral prefrontal regions, in the anterior cingulate gyrus, in the superior and inferior parietal cortex as well as in the superior temporal gyrus and in the thalamus. These activation foci were stronger in the right hemisphere under both conditions. After subtraction of the alertness condition with focused spatial attention, distributed spatial attention with stimuli appearing at unpredictable locations within both visual fields induced additional bilateral activations only in the left and right superior parietal cortex and in the right precuneus suggesting that these regions are specific for a more widespread dispersion of spatial attention.
Collapse
Affiliation(s)
- W Sturm
- Neurological Clinic, Neuropsychology, University Hospital RWTH Aachen University, Pauwelsstr 30, D-52074 Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
19
|
Schlangen C, Dafotakis M, Block F, Thron A. Spinale Ischämie als Komplikation einer cervicalen paravertebralen Kortikoid-Infiltration. Akt Neurol 2005. [DOI: 10.1055/s-2005-919498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
20
|
Kosinski C, Stolz E, Thron A, Wessels T, Roettger C. Gerinnungsdiagnostik I - was ist sinnvoll: D-Dimere in der Akutdiagnostik? Akt Neurol 2005. [DOI: 10.1055/s-2005-919226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
21
|
Mull M, Thron A, Kosinski C. Bildgebung - was ist sinnvoll? Fallstricke bei MRT, MRA und CTA. Akt Neurol 2005. [DOI: 10.1055/s-2005-919225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
22
|
Hans FJ, Möller-Hartmann W, Brunn A, Schmitz-Rode T, Thron A, Krings T. Treatment of wide-necked aneurysms with balloon-expandable polyurethane-covered stentgrafts: experience in an animal model. Acta Neurochir (Wien) 2005; 147:871-6. [PMID: 15770349 DOI: 10.1007/s00701-005-0503-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Accepted: 01/19/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Endovascular treatment of intracranial wide-necked aneurysms employing stentgrafts might constitute a promising alternative to established neurosurgical or endovascular treatment options. However, there is uncertainity concerning long-term vessel patency and biocompatibility of the covering material used for these stentgrafts. The objective of our study was, therefore, to evaluate in an animal model of wide necked aneurysms, which changes within the parent vessel wall are present after stentgraft placement using polyurethane as the covering material. METHODS Wide-necked aneurysms were created in rabbits by distal ligation and intraluminal incubation of the right common carotid artery with elastase. All 10 animals were treated with polyurethane covered stentgrafts. Angiography and histological analyses were performed including immunohistochemical investigations for estimating the proliferation of the intima and possible inflammatory infiltration of the vessel wall after one (n = 5) and three months (n = 5) observation. RESULTS Stentgrafts led to a complete and stable aneurysm occlusion in all but one animal in which the stent was initially misplaced. In one animal, the stentgraft was completely occluded as visible both at angiography and on histological examination. Here, old thrombus was found within the stent although the animal was on antiplatelet therapy. The other stentgrafts remained patent and demonstrated only minimal proliferative carrier vessel wall changes and no in-stent stenosis. CONCLUSIONS In previous animal models using Dacron covered stentgrafts, a poor short term patency rate due to the limited biocompatibility was found. We found, that Polyurethane seemed to have less adverse effects upon the vessel wall. However, a longer follow-up period is necessary to exclude delayed stenosis of the parent vessels. Stentgrafts may, therefore, play a role in broad based aneurysms, dissecting aneurysms or pseudoaneurysms, however, vessel sacrifice using permanent balloon occlusion may be a safer and better established alternative compared to the use of stentgrafts.
Collapse
Affiliation(s)
- F J Hans
- Department of Neurosurgery, University Hospital of the University of Technology, Aachen, Germany
| | | | | | | | | | | |
Collapse
|
23
|
Thron A. Die Hirnvenenthrombose und ihre Folgen. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
24
|
Niggemann P, Krings T, Hans F, Thron A. Fifteen-year follow-up of a patient with beta thalassaemia and extramedullary haematopoietic tissue compressing the spinal cord. Neuroradiology 2005; 47:263-6. [PMID: 15812633 DOI: 10.1007/s00234-005-1357-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 11/16/2004] [Indexed: 11/29/2022]
Abstract
A long-term follow-up of a patient with beta thalassaemia with intra- and extraspinal extramedullary haematopoietic tissue compressing the spinal cord is presented. Extramedullary haematopoietic nodules are a rare cause of spinal cord compression and should be included in the differential diagnosis, especially in patients from Mediterranean countries. Treatment with radiation therapy solely failed, giving rise to the need of surgical intervention. Surgical decompression of the spine and the removal of the culprit lesion compressing the spine were performed. Postinterventional radiation therapy was applied to the spine. A relapse had to be treated again by surgical means combined with postinterventional radiation therapy. A complete relief of the symptoms and control of the lesion could be obtained.
Collapse
Affiliation(s)
- P Niggemann
- Department of Neuroradiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, D 52057 Aachen, Germany.
| | | | | | | |
Collapse
|
25
|
|
26
|
Häusler M, Anhuf D, Schüler H, Ramaekers VT, Thron A, Zerres K, Möller-Hartmann W. White-matter disease in 18q deletion (18q?) syndrome: magnetic resonance spectroscopy indicates demyelination or increased myelin turnover rather than dysmyelination. Neuroradiology 2005; 47:83-6. [PMID: 15645149 DOI: 10.1007/s00234-004-1309-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Accepted: 08/24/2004] [Indexed: 10/25/2022]
Abstract
Proton magnetic resonance spectroscopic data ((1)H-MR spectroscopy) of patients with 18q deletion syndrome have not yet been reported. (1)H-MR spectroscopy, performed in an affected 2-year-old girl with markedly delayed neuromotor development and typical supratentorial white-matter disease (WMD), showed an increase of choline and alpha-glutamate concentrations. Eight months later, simultaneously with clinical improvement, alpha-glutamate had normalised whereas choline remained slightly increased. Active demyelination or increased myelin turnover might contribute to the hitherto unexplained WMD of this rare disorder.
Collapse
Affiliation(s)
- M Häusler
- Department of Pediatrics, University Hospital of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
27
|
Meister IG, Krings T, Foltys H, Boroojerdi B, Müller M, Töpper R, Thron A. Playing piano in the mind--an fMRI study on music imagery and performance in pianists. ACTA ACUST UNITED AC 2004; 19:219-28. [PMID: 15062860 DOI: 10.1016/j.cogbrainres.2003.12.005] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2003] [Indexed: 11/22/2022]
Abstract
Reading of musical notes and playing piano is a very complex motor task which requires years of practice. In addition to motor skills, rapid and effective visuomotor transformation as well as processing of the different components of music like pitch, rhythm and musical texture are involved. The aim of the present study was the investigation of the cortical network which mediates music performance compared to music imagery in 12 music academy students playing the right hand part of a Bartok piece using functional magnetic resonance imaging (fMRI). In both conditions, fMRI activations of a bilateral frontoparietal network comprising the premotor areas, the precuneus and the medial part of Brodmann Area 40 were found. During music performance but not during imagery the contralateral primary motor cortex and posterior parietal cortex (PPC) bilaterally was active. This reflects the role of primary motor cortex for motor execution but not imagery and the higher visuomotor integration requirements during music performance compared to simulation. The notion that the same areas are involved in visuomotor transformation/motor planning and music processing emphasizes the multimodal properties of cortical areas involved in music and motor imagery in musicians.
Collapse
Affiliation(s)
- I G Meister
- Department of Neurology, University Hospital Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
28
|
Gouzoulis-Mayfrank E, Fischermann T, Thron A, Möller-Hartmann W, Daumann J. Memory deficits and altered hippocampal function in ecstasy (MDMA) users: evidence from neuropsychological, functional imaging (fMRI) and MR-spectroscopy studies. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
29
|
Daumann J, Schnitker R, Thron A, Gouzoulis-Mayfrank E. Neural correlates of working memory in pure and polyvalent ecstasy (MDMA) users. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
30
|
Reinges MHT, Krings T, Kränzlein H, Hans FJ, Thron A, Gilsbach JM. Functional and Diffusion-Weighted Magnetic Resonance Imaging for Visualization of the Postthalamic Visual Fiber Tracts and the Visual Cortex. ACTA ACUST UNITED AC 2004; 47:160-4. [PMID: 15343432 DOI: 10.1055/s-2004-818525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Diffusion-weighted magnetic resonance imaging (MRI) offers the possibility to study the course of the cerebral white matter tracts whereas functional MRI (fMRI) provides information about the specific functions of cortical areas. We evaluated the combination of fMRI and diffusion-weighted MRI to detect cortical visual areas with their corresponding visual fiber tracts in 15 healthy controls (age: 23 - 53 years, male : female = 8 : 7). We demonstrated activation within the primary visual cortex and white matter bundles connecting the lateral geniculate body and the striate cortex in all subjects investigated. Additional activation could be appreciated in some subjects within the lateral geniculate bodies (n = 2) and the motion-sensitive area V5 (n = 3). The combination of diffusion-weighted and functional imaging allows visualization of the origin, direction and functionality of large white matter tracts. This will prove helpful for imaging structural connectivity within the brain during functional imaging. Moreover, this technique might provide important information for neurosurgical patients presenting with space-occupying lesions close to the cortical and subcortical visual system since this technique can -- in contrast to diffusion tensor imaging -- easily be adopted into a neuronavigation system and can be performed on all MR scanners capable of diffusion-weighted imaging without specific post-processing programs.
Collapse
Affiliation(s)
- M H T Reinges
- Department of Neurosurgery, University Hospital, University of Technology, Aachen, Germany.
| | | | | | | | | | | |
Collapse
|
31
|
Fang JL, Krings T, Weidemann J, Meister IG, Thron A. Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints. Neuroradiology 2004; 46:359-62. [PMID: 15103431 DOI: 10.1007/s00234-003-1125-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Accepted: 10/02/2003] [Indexed: 10/26/2022]
Abstract
The cerebral activation pattern due to acupuncture is not completely understood. Although the effect of acupuncture on cerebral haemodynamics has been studied, no previous report has focused on different puncture and stimulation methods. We used functional MRI (fMRI) in 15 healthy subjects to investigate cortical activation during stimulation of two real acupoints (Liv3 and G40) and one sham point, needled in a random and, for the subjects, blinded order employing rotating and non-rotating methods, using a blocked paradigm on a 1.5 tesla imager. Compared to the non-rotating stimulation method, during rotating stimulation of the real acupoints, we observed an increase in activation in both secondary somatosensory cortical areas, frontal areas, the right side of the thalamus and the left side of the cerebellum; no such effects of the needling technique were seen while stimulating the sham point. The observation that rotating the needle strengthened the effects of acupuncture only at real acupoints suggests that, as claimed in Chinese traditional medicine, stimulation of these acupoints has a specific effect on cortical neuronal activity, absent with sham acupoints. These specific cerebral activation patterns might explain the therapeutic effects of acupuncture in certain subjects.
Collapse
Affiliation(s)
- J L Fang
- Department of Radiology, Guang An Men Hospital, China Academy of Traditional Chinese Medicine, Bei Xian Ge 5, 100053 Peking, China
| | | | | | | | | |
Collapse
|
32
|
Dammert S, Krings T, Moller-Hartmann W, Ueffing E, Hans FJ, Willmes K, Mull M, Thron A. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography. Neuroradiology 2004; 46:427-34. [PMID: 15105978 DOI: 10.1007/s00234-003-1155-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 11/29/2003] [Indexed: 10/26/2022]
Abstract
We assessed the diagnostic accuracy of multislice CT in detection of intracranial aneurysms in patients presenting with subarachnoid or intracranial haemorrhage. Multislice CT and multiplanar digital subtraction angiography (DSA) images were obtained in 50 consecutive patients presenting with subarachnoid (SAH) and/or intracranial haemorrhage and reviewed by three neuroradiologists for the number, size and site of any aneurysms. The CT data were assessed using multiplanar reformats (MPR), maximum-intensity projections (MIP), surface-shaded display (SSD) and volume-rendering (VRT). In conventional angiography 51 aneurysms were detected in 41 patients. CT angiography (CTA) showed up to 48 aneurysms in 39 patients, depending on the observer. The overall sensitivity of multislice CT was 83.3% for small (< 4 mm), 90.6% for medium-size (5-12 mm) and 100% for large (> 13 mm) aneurysms. The sensitivity of multislice CTA to medium-size and large intracranial aneurysm is within the upper part of the range reported for helical single-slice CT. However, as small aneurysms may not be found, DSA remains the standard technique for investigation of SAH.
Collapse
Affiliation(s)
- S Dammert
- Department of Neuroradiology, University Hospital of the Technical University Aachen, Pauwelsstrasse 30, 52057, Aachen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Thiex R, Hans FJ, Krings T, Möller-Hartmann W, Brunn A, Scherer K, Gilsbach JM, Thron A. Haemorrhagic tracheal necrosis as a lethal complication of an aneurysm model in rabbits via endoluminal incubation with elastase. Acta Neurochir (Wien) 2004; 146:285-9; discussion 289. [PMID: 15015052 DOI: 10.1007/s00701-003-0198-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND We describe a lethal complication of an aneurysm model in rabbits for saccular aneurysmal creation via endoluminal incubation with elastase. METHOD In 24 anaesthetized female New Zealand White rabbits, the right common carotid artery (CCA) was ligated distally to the arteriotomy. A 4F sheath was then placed retrograde into the CCA, and its origin was occluded endoluminally using a 2F Fogarty balloon. Elastase was incubated above the balloon in the separated vessel lumen for the duration of 20 minutes. Two weeks later, digital subtraction angiography was performed for aneurysm control. Two animals were then sacrificed and the aneurysm studied on histology. All animals that died within the experiment were examined post-mortem. FINDINGS Following this protocol, an aneurysm with a mean size of 7.6 x 3.2 mm could be created in 11 out of 24 animals. 9 out of 13 animals with lethal outcome died from haemorrhagic necrosis of the trachea with subsequent pulmonary complications. DSA releaved an arterial branch originating from the proximal CCA in a near 90 degree-angle aiming at the trachea. INTERPRETATION The endoluminal incubation with elastase is suitable for aneurysm creation of reproducible size that are suited to test new endovascular devices such as stents and new coils. One should always be aware of an arterial branch of the CCA supplying the trachea. In case of elastase instillation into this branch, lethal haemorrhagic necrosis of the trachea occurs. Bearing this complication in mind, we have experienced a minimal loss of animals in subsequent studies.
Collapse
Affiliation(s)
- R Thiex
- Department of Neurosurgery, Aachen University, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Krings T, Mull M, Reinges MHT, Thron A. Double spinal dural arteriovenous fistulas: case report and review of the literature. Neuroradiology 2004; 46:238-42. [PMID: 15034701 DOI: 10.1007/s00234-003-1147-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Accepted: 11/11/2003] [Indexed: 11/26/2022]
Abstract
Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation. It mainly affects men after the fifth decade and is usually an acquired lesion with an unknown etiology. We report on a patient with the unusual finding of two separate SDAVFs at the level of L1 on the right and L2 on the left side. Initial selective spinal digital subtraction angiography (DSA) was terminated with demonstration of a SDAVF at the level of L1 but incomplete demonstration of all segmental arteries. Due to a recurrent deterioration of the patient's neurological status, and persistent pathological vessels seen on MRI, a second spinal DSA was performed 6 years later, demonstrating the second fistula at the level of L2 on the left side with a separate venous drainage pattern. A retrospective analysis of the angiographic films suggested that both fistulas had already been present 6 years previously. This conclusion is justified because of a transient and faint opacification of the left L2 fistula demonstrated on the films after injection of the right L2 segmental artery. We conclude that in the case of incomplete angiography and persistent clinical and MR findings not only reopening of the treated SDAVF has to be taken into account but also the existence of a second fistula. Since this is the first case of a double fistula in our series of 129 SDAVFs, and given the few reported cases of double SDAVFs, we do not think that completion of selective spinal DSA has to be postulated routinely after a fistula has been found. However, repeat angiography should be performed in patients who continue to deteriorate, fail to improve with persisting MRI pathologies, or demonstrate delayed deterioration after a period of improvement.
Collapse
Affiliation(s)
- T Krings
- Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | | | |
Collapse
|
35
|
Thiex R, Thron A, Uhl E. Delayed oedema in the pyramidal tracts remote from intracerebral missile path following gunshot injury. Neuroradiology 2003; 46:140-3. [PMID: 14689125 DOI: 10.1007/s00234-003-1141-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2003] [Accepted: 10/23/2003] [Indexed: 12/01/2022]
Abstract
A 60-year-old man developed a severe left hemiparesis and central facial palsy, accompanied by somnolence and dysarthria 9 days after a gunshot wound to the right temporal region, from which he slowly recovered over 3 months. MRI disclosed bilateral oedema of the pyramidal tracts. This was interpreted as a consequence of the impact of the pressure wave caused by the bullet, after excluding an infectious or vascular cause.
Collapse
Affiliation(s)
- R Thiex
- Department of Neurosurgery, Aachen University, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | |
Collapse
|
36
|
Möller-Hartmann W, Krings T, Stein KP, Dreeskamp A, Meetz A, Thiex R, Hans FJ, Gilsbach JM, Thron A. Aberrant origin of the superior thyroid artery and the tracheoesophageal branch from the common carotid artery: a source of failure in elastase-induced aneurysms in rabbits. AJR Am J Roentgenol 2003; 181:739-41. [PMID: 12933472 DOI: 10.2214/ajr.181.3.1810739] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- W Möller-Hartmann
- Department of Neuroradiology, University Hospital of the Technical University, Pauwelsstr. 30, Aachen D-52057, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Hans FJ, Krings T, Möller-Hartmann W, Thiex R, Pfeffer J, Scherer K, Brunn A, Dreeskamp H, Stein KP, Meetz A, Gilsbach JM, Thron A. Endovascular treatment of experimentally induced aneurysms in rabbits using stents: a feasibility study. Neuroradiology 2003; 45:430-4. [PMID: 12761602 DOI: 10.1007/s00234-003-1008-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 04/03/2003] [Indexed: 11/29/2022]
Abstract
Although Guglielmi detachable coil (GDC) systems have been generally accepted for treatment of intracranial aneurysms, primary stenting of aneurysms using porous stents or implantation of coils after stent placement remains experimental. Testing of these new methods requires an animal model which imitates human aneurysms in size, configuration and neck morphology. We assessed in detail the technical requirements of and steps for transfemoral stent treatment of experimentally induced aneurysms at the top of the brachiocephalic trunk in rabbits. We created aneurysms in ten rabbits by distal ligation and intraluminal digestion of the right common carotid artery with elastase. We treated five animals with porous stents alone, and five with stents plus coiling via the meshes of the stent, which permitted dense packing of coils. No complications related to the procedures occurred. In all animals, even in those treated solely with porous stents, total occlusion of the aneurysm was achieved. Our animal model can be suitable for testing the biocompatibility and occlusion rate of new methods and devices for the treatment of experimental aneurysms.
Collapse
Affiliation(s)
- F J Hans
- Department of Neurosurgery, University Hospital of the University of Technology, Pauwelsstrasse 30, 52057, Aachen, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Möller-Hartmann W, Krings T, Hans FJ, Thiex R, Meetz A, Stein K, Dreeskamp H, Gilsbach JM, Thron A. Endovascular treatment of experimental aneurysms in rabbits using Guglielmi detachable coils -- a feasibility study. Neuroradiology 2002; 44:946-9. [PMID: 12428133 DOI: 10.1007/s00234-002-0870-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2002] [Accepted: 07/03/2002] [Indexed: 11/28/2022]
Abstract
The Guglielmi detachable coil (GDC) has been generally accepted for treatment of intracranial aneurysms. Preclinical testing of new coil developments requires animal models of aneurysms which imitate human aneurysms in size, configuration and neck morphology. We assessed in detail the technical requirements and steps for transfemoral treatment of experimentally induced aneurysms at the top of the brachiocephalic trunk (TBC) in rabbits. We created aneurysms in five rabbits by distal ligation and intraluminal incubation of the right common carotid artery with elastase. All animals were treated successfully 2-3 weeks after induction of the aneurysm, with dense packing of the coils. No complications related to the procedures occurred. The study demonstrates that our animal model can be a suitable method for testing the biocompatibility and occlusion rate of new embolic materials.
Collapse
Affiliation(s)
- W Möller-Hartmann
- Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
This manuscript reviews the current stance and the pertinent problems of transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) as brain mapping methodologies. The missing structure-function relation limits the use of TMS, whereas the uncertainty about the functional significance of activated cortical regions might render interpretation of fMRI studies difficult. Advances in image processing, however, allowed for 3- dimensional real-time visual guidance of TMS and integration with fMRI data. We describe the method used to coregister TMS and fMRI and present examples where a multimodality neuroimaging approach might add to our understanding of normal and pathological brain function.
Collapse
Affiliation(s)
- T Krings
- Department Of Neuroradiology, University Hospital of the RWTH Aachen Medical School, Aachen, Germany.
| | | | | | | | | |
Collapse
|
40
|
Krings T, Schreckenberger M, Rohde V, Spetzger U, Sabri O, Reinges MHT, Hans FJ, Meyer PT, Möller-Hartmann W, Gilsbach JM, Buell U, Thron A. Functional MRI and 18F FDG-positron emission tomography for presurgical planning: comparison with electrical cortical stimulation. Acta Neurochir (Wien) 2002; 144:889-99; discussion 899. [PMID: 12376770 DOI: 10.1007/s00701-002-0992-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In patients with mass lesions near "eloquent" cortical areas different preoperative mapping techniques can be used. Two of the most widely used approaches include positron emission tomography (PET) and functional MRI (fMRI). We employed both methods in the same patients undergoing presurgical evaluation and compared the results to those obtained by direct electrical cortical stimulation (DECS). METHOD 22 patients with tumours of different aetiology near the central region were investigated. FMRI was performed using a T2(*)-weighted gradient-echo BOLD sequence at 1.5 T, PET was performed after injection of 122-301 MBq (18)F-Fluorodeoxyglucose (18-FDG) under rest and activation conditions. DECS was performed in all patients with recordings of muscles primarily involved in the investigated tasks. FINDINGS In 19 patients all three modalities could be compared, 1 patient demonstrated discordance between fMRI and PET with DECS speaking in favour of fMRI, 6 patients had neighbouring results of PET and fMRI (between 1-2 cm distance), 12 patients had overlapping results. INTERPRETATION The high incidence of neighbouring results is presumably related to fMRI specific artefacts. Advantages of fMRI are: Higher spatial and temporal resolution, more and different functional runs, shorter examination time, wider availability, longitudinal examinations, non-invasiveness and cost-effectiveness, easy registration to anatomical images. Advantages of PET are: higher signal-to-noise ratio, lesser susceptibility to artefacts (motion, draining veins), evaluation of tumour metabolism. It is our opinion that the neurosurgeon has to decide on a case-by-case basis which study suits his specific needs in the presurgical evaluation of his patient.
Collapse
Affiliation(s)
- T Krings
- Department of Neurosurgery, and the Interdisciplinary Center for Clinical Research, Central Nervous System, University Hospital of the Technical University, Aachen, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Möller-Hartmann W, Krings T, Brunn A, Korinth M, Thron A. Erratum to: Proton magnetic resonance spectroscopy of neurocytoma outside the ventricular region – case report and review of the literature. Neuroradiology 2002. [DOI: 10.1007/s00234-002-0764-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
42
|
Krings T, Reinges MHT, Willmes K, Nuerk HC, Meister IG, Gilsbach JM, Thron A. Factors related to the magnitude of T2* MR signal changes during functional imaging. Neuroradiology 2002; 44:459-66. [PMID: 12070718 DOI: 10.1007/s00234-002-0795-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2001] [Accepted: 02/18/2002] [Indexed: 11/29/2022]
Abstract
Our aim was to determine whether age, sex, the degree of weakness, anticonvulsants, the histology of the underlying lesion(s), the presence of oedema or the distance of the lesion from the motor region have an impact on the blood oxygenation level-dependent (BOLD) signal strength and therefore on the validity of functional MRI (fMRI). We studied 98 patients with masses near the central region imaged for surgical planning at 1.5 tesla, employing a BOLD sequence during a motor task. We calculated percentage signal change in the primary motor cortex between rest and activation and carried out multiple linear regression to examine the impact of the above factors on signal strength. Using a stepwise analysis strategy, the distance of the lesion from the motor region had the strongest influence (r=0.653, P<0.001). The factor with largest uncorrelated additional impact on signal change was the presence of oedema. Both predictors together formed a highly significant multiple r=0.739 ( P<0.001). No other predictive factor was identified (all P>0.20). Disturbances of cerebral blood flow and metabolism induced by the tumour were presumed to be the causes of a decrease in signal in the adjacent cortex.
Collapse
Affiliation(s)
- T Krings
- Department of Neuroradiology and Interdisciplinary Centre for Clinical Research - Central Nervous System, University Hospital of the Technical University Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
43
|
Krombach GA, Rohde V, Haage P, Struffert T, Kilbinger M, Thron A. Virtual endoscopy combined with intraoperative neuronavigation for planning of endoscopic surgery in patients with occlusive hydrocephalus and intracranial cysts. Neuroradiology 2002; 44:279-85. [PMID: 11914801 DOI: 10.1007/s00234-001-0731-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2001] [Accepted: 07/24/2001] [Indexed: 10/27/2022]
Abstract
We assessed the clinical value of MR ventriculoscopy (virtual endoscopy, VE) combined with image-guided frameless stereotaxy for endoscopic surgery of occlusive hydrocephalus and intracranial cysts. VE was obtained in 20 patients with hydrocephalus and three with intracranial cysts. All surgical operations were endoscopic. The path of the rigid endoscope to the target point was planned using neuronavigation. VE was carried out along the same trajectory retrospectively in 20 cases and prospectively in three. The results were analysed for demonstration of anatomical landmarks and structures at risk. VE was successful in all patients. Possible obstacles to endoscopic access to the lamina terminalis and the basal cisterns and structures at risk, such as the basilar artery, were clearly shown in relation to the direction of the endoscope. However, the floor of the third ventricle and septum pellucidum were not clearly seen and possible abnormalities could therefore not be appreciated. VE can provide realistic simulation of endoscopic third ventriculostomy and cystostomy. The appropriate trepanation point and trajectory of the endoscope can be assessed with regard to the size of the foramen of Monro and the position of vulnerable structures. This simulated trajectory can be adapted to the field of operation by image-guided neuronavigation. This regime may potentially reduce the risk of damage to intracranial structures.
Collapse
Affiliation(s)
- G A Krombach
- Department of Diagnostic Radiology, University of Technology, Pauwelsstrasse 30, 52070 Aachen, Germany.
| | | | | | | | | | | |
Collapse
|
44
|
Möller-Hartmann W, Krings T, Brunn A, Korinth M, Thron A. Proton magnetic resonance spectroscopy of neurocytoma outside the ventricular region--case report and review of the literature. Neuroradiology 2002; 44:230-4. [PMID: 11942378 DOI: 10.1007/s002340100700] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Central neurocytoma is classically considered as an intraventricular benign tumour, largely based on data from small retrospective series and single case reports. We report on a 16-year-old girl who suffered from a large parietooccipital tumour that was diagnosed histologically as central neurocytoma. The features of CT, MRI and proton MR spectroscopy studies are discussed. This is the first report on spectroscopic findings in a case of extraventricular neurocytoma. As well as elevated choline (Cho), the tumour spectrum showed strongly decreased N-acetylaspartate (NAA). NAA is assumed to be produced in mature neurons, and we therefore expected to find high amounts of NAA in this well-differentiated tumour, which was histologically composed of mature neuronal tissue. This observation leads to the conclusion that even the highly differentiated cells of neurocytomas are too immature to produce NAA.
Collapse
Affiliation(s)
- W Möller-Hartmann
- Department of Neuroradiology, University Hospital, University of Technology, Aachen, Germany.
| | | | | | | | | |
Collapse
|
45
|
Hoeller M, Krings T, Reinges MHT, Hans FJ, Gilsbach JM, Thron A. Movement artefacts and MR BOLD signal increase during different paradigms for mapping the sensorimotor cortex. Acta Neurochir (Wien) 2002; 144:279-84; discussion 284. [PMID: 11956941 DOI: 10.1007/s007010200036] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The authors evaluated the impact of motion artefacts on presurgical mapping of the sensorimotor cortex with functional magnetic resonance imaging (fMRI). Different mapping paradigms were compared with regard to the frequency of motion artefacts and the resulting signal increase. METHOD 94 surgical candidates with mass lesions near the central region were investigated using BOLD(1)-contrast T2(*) weighted multislice multi-echo EPI gradient echo sequences on a 1,5 T Philips Gyroscan. Three functional paradigms were performed: a) repetitive self-paced clenching of the hand to a fist (68 runs); b) repetitive finger-to-thumb opposition (46 runs); c) sensory stimulation by repetitive brushing of the palm (15 runs). Task-related haemodynamic changes were identified by statistical analysis with the Kolmogorov-Smirnov-test. MR signal increase in percent was calculated for each of the paradigms. Motion artefacts were rated on a scale from 1 to 3. FINDINGS Severe motion artefacts occurred in 8 hand clenching runs and in 2 finger opposition runs. Artefacts were more pronounced in hand clenching than in finger opposition. There were no motion artefacts in any of the sensory stimulation runs. Concerning the percent MR signal change there was no significant difference between hand clenching and finger opposition (T-test: p>0,5) but a highly significant difference (p<0,0001) between both motor tasks and the sensory paradigm (hand clenching: 2.68+/-0.75; finger opposition: 2.76+/-0.79; sensory stimulation: 1.72+/-0.65). INTERPRETATION Sensory stimulation causes by far less artefacts than motor paradigms but it also has to be considered less sensitive as it produces a smaller MR signal increase. Therefore in presurgical evaluation sensory stimulation should be kept in reserve for cases in whom motion artefacts are very likely to occur, i.e. patients with severe forms of paresis.
Collapse
Affiliation(s)
- M Hoeller
- Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Germany
| | | | | | | | | | | |
Collapse
|
46
|
Krings T, Töpper R, Willmes K, Reinges MHT, Gilsbach JM, Thron A. Activation in primary and secondary motor areas in patients with CNS neoplasms and weakness. Neurology 2002; 58:381-90. [PMID: 11839836 DOI: 10.1212/wnl.58.3.381] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To demonstrate whether cortical activation within different cortical motor regions in neurosurgical patients varies with the degree of paresis induced by mass lesions near the central region. METHODS A total of 110 patients with brain tumors infiltrating the central region and with varying degrees of paresis were investigated employing fMRI during the performance of hand motor tasks. The percent signal change between rest and activation was calculated for four cortical regions: primary motor cortex (M1), supplementary motor area, premotor area, and superior parietal lobule. RESULTS Significant decreases in activation with increasing degrees of paresis were found in M1, whereas significant increases in activation were noted in secondary motor areas that were not affected by the tumor. CONCLUSIONS The signal loss in areas adjacent to tumor tissue may relate either to tumor-induced changes in cerebral hemodynamics or to a direct loss of cortical neurons resulting in a lesser degree of hemodynamic changes after motor activation. The increase in activation within secondary motor areas with increasing degrees of paresis supports the growing evidence of a practice- and lesion-dependent reorganization of the cortical motor system and the ability of the brain to modulate its excitatory output according to external demands.
Collapse
Affiliation(s)
- T Krings
- Department of Neuroradiology, Clinic for Neurosurgery, University Hospital of the University of Technology-Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | | | | | | | |
Collapse
|
47
|
Krings T, Lukas R, Reul J, Spetzger U, Reinges MH, Gilsbach JM, Thron A. Diagnostic and therapeutic management of spinal arachnoid cysts. Acta Neurochir (Wien) 2002; 143:227-34; discussion 234-5. [PMID: 11460910 DOI: 10.1007/s007010170102] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The wide variety of intraspinal cystic lesions necessitates different elaborate diagnostic procedures to choose the right therapeutic management in symptomatic patients. Based on the case reports of seven patients with symptomatic spinal arachnoid cysts we discuss the aetiology, diagnostic procedures and therapeutic management of extra- and intradural spinal cysts. METHOD All patients underwent MRI, Myelography and CT-Myelography during diagnostic evaluation. During surgery the cyst was resected and the communication between the cyst and the subarachnoid space was closed. FINDINGS Two patients were identified with intradural, five with extradural spinal arachnoid cysts. Postoperative outcome was favourable in those patients without preoperative cord damage. INTERPRETATION MRI is the diagnostic procedure of first choice because of its potential to demonstrate the exact localisation, extent and relationship of the arachnoid cyst to the spinal cord. Cord atrophy secondary to compression can be visualised and used for prediction of neurological outcome. Myelography and CT-Myelography (CTM) are still of diagnostic value since they might demonstrate the communication between the subarachnoid space and the cyst, which is important for surgical planning. The aim of surgical treatment is neural decompression and prevention of refilling of the cyst which is best accomplished by complete resection of the cyst and closure of the communication between cyst and subarachnoid space.
Collapse
Affiliation(s)
- T Krings
- Department of Neuroradiology, University Hospital of the University of Technology, Medical School, Aachen, Germany
| | | | | | | | | | | | | |
Collapse
|
48
|
Krings T, Schreckenberger M, Rohde V, Foltys H, Spetzger U, Sabri O, Reinges MH, Kemeny S, Meyer PT, Möller-Hartmann W, Korinth M, Gilsbach JM, Buell U, Thron A. Metabolic and electrophysiological validation of functional MRI. J Neurol Neurosurg Psychiatry 2001; 71:762-71. [PMID: 11723198 PMCID: PMC1737624 DOI: 10.1136/jnnp.71.6.762] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Although functional MRI is widely used for preoperative planning and intraoperative neuronavigation, its accuracy to depict the site of neuronal activity is not exactly known. Experience with methods that may validate fMRI data and the results obtained when coregistering fMRI with different preoperative and intraoperative mapping modalities including metabolically based (18)F-fluorodeoxyglucose PET, electrophysiologcally based transcranial magnetic stimulation (TMS), and direct electrical cortical stimulation (DECS) are described. METHODS Fifty patients were included. PET was performed in 30, TMS in 10, and DECS in 41 patients. After coregistration using a frameless stereotactic system, results were grouped into overlapping (<1 cm distance), neighbouring (<2 cm), or contradictory (>2 cm). RESULTS Comparing fMRI with PET, 18 overlapping, seven neighbouring, and one contradictory result were obtained. In four patients no comparison was possible (because of motion artefacts, low signal to noise ratio, and unusual high tumour metabolism in PET). The comparison of TMS and fMRI showed seven overlapping and three neighbouring results. In three patients no DECS results could be obtained. Of the remaining 38 patients, fMRI hand motor tasks were compared with DECS results of the upper limb muscles in 36 patients, and fMRI foot motor tasks were compared with DECS results of the lower limb on 13 occasions. Of those 49 studies, overlapping results were obtained in 31 patients, and neighbouring in 14. On four occasions fMRI did not show functional information (because of motion artefacts and low signal to noise). CONCLUSIONS All validation techniques have intrinsic limitations that restrict their spatial resolution. However, of 50 investigated patients, there was only one in whom results contradictory to fMRI were obtained. Although it is not thought that fMRI can replace the intraoperatively updated functional information (DECS), it is concluded that fMRI is an important adjunct in the preoperative assessment of patients with tumours in the vicinity of the central region.
Collapse
Affiliation(s)
- T Krings
- Department of Neuroradiology, University Hospital of the Technical University, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Krings T, Foltys H, Reinges MH, Kemeny S, Rohde V, Spetzger U, Gilsbach JM, Thron A. Navigated transcranial magnetic stimulation for presurgical planning--correlation with functional MRI. Minim Invasive Neurosurg 2001; 44:234-9. [PMID: 11830785 DOI: 10.1055/s-2001-19935] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE This paper describes the potential of navigated transcranial magnetic stimulation to map the motor cortex in patients with mass lesions near the primary motor cortex by comparing the results of this technique to those of functional MRI. MATERIAL AND METHODS Ten patients with mass lesions near the central sulcus were studied preoperatively using a figure-of-eight transcranial magnetic stimulator attached to a neuronavigation system to allow for direct visualization of the stimulated brain region. Subsequently, in all patients a blood oxygenation level dependent 2D multislice multishot T2*-weighted gradient echo EPI sequence on a 1.5 T Philips Gyroscan during motor activation was performed. Results of both methods were coregistered and compared. RESULTS The distances between the peak parenchymal fMRI activation and the cortical area where TMS elicited the maximum MEPs ranged between 0 and 1.2 cm (mean 0.6 cm, SD 0.4 cm). CONCLUSION We conclude that navigated TMS is a reliable alternative for localizing the motor-related areas in the human brain preoperatively and therefore may be a useful adjunct or, in selected patients, even a helpful alternative to functional MRI.
Collapse
Affiliation(s)
- T Krings
- Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Krings T, Chiappa KH, Foltys H, Reinges MH, Cosgrove GR, Thron A. Introducing navigated transcranial magnetic stimulation as a refined brain mapping methodology. Neurosurg Rev 2001; 24:171-9. [PMID: 11778822 DOI: 10.1007/s101430100151] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A major intrinsic limitation of transcranial magnetic stimulation (TMS) to map the human brain lies in the unclear relationship between the position of the stimulating coil on the scalp and the underlying stimulated cortex. The relationship between structure and function as the major feature constituting a brain mapping modality can therefore not be established. Recent advances in image processing allowed us to refine TMS by combining magnetic resonance imaging (MRI) modalities with TMS using a neuronavigation system to measure the position of the stimulating coil and map this position onto a MRI data set. This technique has several advantages over recent TMS mapping strategies. The position of the coil on the scalp can be held constant as verified by real time visual guidance. When evaluating higher cortical functions, the relationship between underlying cortical anatomy and the scalp stimulation site can be accurately assessed. Cortical motor output maps can be easily obtained for preoperative planning and decision making for mass lesions near rolandic cortex in patients. In conclusion, navigated TMS is a reliable alternative for localizing cortical functions and therefore may be a useful adjunct or in selected patients even a helpful alternative to other functional neuroimaging methods.
Collapse
Affiliation(s)
- T Krings
- University Hospital of the Technical University of Aachen, Interdisciplinary Center of Clinical Research, Central Nervous System, Germany.
| | | | | | | | | | | |
Collapse
|