胶质细胞瘤术中功能组织定位技术

大脑功能组织指与语言、运动和感觉功能密切相关的皮质和皮质下通路.胶质瘤术中功能组织定位术(techniques for functional brain mapping during glioma surgery)是脑皮质电刺激技术、电生理监测技术和功能磁共振技术在胶质瘤手术中综合应用而形成的专门技术.近年来,美国加州大学旧金山分校的Berger和华盛顿大学的Ojemann为代表的一批学者在该技术的发展和完善方面做了大量的基础研究工作和临床实践.该技术在最大程度切除胶质瘤的同时尽可能保留肿瘤附近的功能组织,避免术后失语、偏瘫和感觉异常,控制肿瘤性癫痫,延长胶质瘤患者术后生存时间,提高患者手术后生活质量等方面有重要作用.在欧美国家,该技术已成为胶质瘤手术中的必要步骤,国内尚少报道,本文作一简要介绍.     

Labio-glosso-pharyngo-laryngeal paralysis caused by two brain lesions: cortical and subcortical.

We report a case of labio-glosso-pharyngo-laryngeal paralysis with some peculiar features. CT and MRI yielded the diagnosis of acute pseudobulbar syndrome by demonstrating the existence of two lesions of the corticobulbar tract: one subcortical (recent) and the other opercular cortical (old) on the opposite side.     

Apomorphine-haloperidol interactions: Different types of antagonism in cortical and subcortical brain regions

Apomorphine, a dopamine (DA) receptor stimulant induced a dose-dependent decrease in the content of the dopamine metabolites 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in the olfactory tubercle and striatum of rats, but it was ineffective in the frontal cortex. Apomorphine also antagonized the haloperidol-induced accumulation of DOPAC and HVA in the olfactory tubercle and striatum, whereas in the frontal cortex it antagonized the effects of haloperidol on DOPAC but not on HVA. The total (free and conjugated) content of DA metabolites was measured in these experiments.     

Purely subcortical tumors in eloquent areas: Awake surgery and cortical and subcortical electrical stimulation (CSES) ensure safe and effective surgery

Objective

To analyze the efficacy and safety of cortical and subcortical electrical stimulation CSES and awake surgery to approach purely subcortical tumors in highly functional locations, particularly in guiding the choice of the best transcortical path.

Patients and methods

Prospective analysis of the surgical, neurological, and radiological outcome of patients harboring supratentorial, subcortically located brain tumors or vascular malformations who are operated on through awake surgery and CSES. Functional magnetic resonance (fMRI; either sensory-motor or language, based on the location) was performed in order to confirm the proximity to functional cortical areas. Major white matter tracts were investigated by MRI diffusion tensor fiber tracking (DTI-ft). The Rankin modified score was chosen to express the pre and postoperative functional neurological status. Immediate postoperative MRI was used to evaluate the extent of resection.

Results

Seventeen patients were selected. The main distance of the tumors from the cortical surface was 18.2 mm (range 9–48 mm). Neuronavigation was used to show the most direct route to the tumor (transsulcal or transgyral), but CSES was fundamental to adapt the surgical corridor to the functional topography both cortically and subcortically. If the transgyral route was chosen, CSES helped to detect a non-eloquent area. When a transsulcal route was preferred, CSES documented the presence or absence of function in the deep sulcus. The transient postoperative morbidity was 76.4%, but at last follow-up (range 4–20 months), all the patients regained preoperative status and 2 improved. Postoperative MRI demonstrated complete resection in all cases.

Conclusions

Approaching purely subcortical tumors requires microsurgical skills, but in eloquent areas, functional topography monitoring is mandatory to allow safe surgery. CSES in an awake patient is a method that produces very good results in terms of resection and neurological outcome.     

Anatomic correlation between several cortical and subcortical brain structures]

Investigation of frontal brain sections of 10 cats, 30 dogs and 20 people revealed a topographic correlation between certain cortical and subcortical structures: the beginning of fissura. Sylvii (the so-called "fossa Sylvii") and commissura alba cerebri anterior are located always in the same stereotaxic frontal plane. A method of practical application of the revealed topographic correlation is suggested for the stereotaxic operations on higher animals and human beings.     

Calbindin distribution in cortical and subcortical brain structures of normal and rabies-infected mice

Rabies has been an enigmatic disease of the nervous system because microscopic findings in the brain tissue are not paralleled by the severity of the clinical illness. The calcium binding protein calbindin (CB) is a neuronal marker of great interest in neuroanatomy and neuropathology. CB-ir neurons in the striatum and cerebral cortex are gabaergic cells. In the present work CB-immunoreactivity was evaluated in brains of normal and rabies-infected mice. Rabies infection caused loss of CB-immunostaining in the cortical supragranular layers as well as in the striatum. Loss of CB in the brains of mice infected with rabies virus can produce impairment in Ca++ homeostasis and in the gabaergic neurotransmission.     

The articulatory loop: study of the subcortical connectivity by electrostimulation

Although a cortical network involving Broca's area and the supramarginal gyrus (SMG) was widely studied using neurofunctional imaging, the functional connectivity underlying this so-called articulatory loop remains poorly documented. We describe a patient operated on for a glioma invading the left parietal operculum, using intraoperative electrical functional mapping under local anesthesia. Following the identification of cortical language sites within Broca's area and SMG, the subcortical pathways connecting these regions were detected and preserved during the resection. Postoperatively, the patient presented a slight dysarthria, then recovered. This is the first report of direct tracking of the subcortical connectivity underlying the fronto-parietal articulatory loop, allowing to better understand the pathophysiology of this network and the consequences of its damage.     

Claustrum in the hedgehog (Erinaceus europaeus) brain: cytoarchitecture and connections with cortical and subcortical structures.

The cytoarchitecture of the claustrum in the hedgehog (Erinaceus europaeus) brain, the morphology of its neurons, and the efferent connections with cortical and subcortical structures were studied with the Nissl and Klüver-Barrera, the Golgi, and the horseradish peroxidase methods. It was found that the claustrum is a well developed nucleus in the hedgehog telencephalon and, as in other mammals, is divided into dorsal and ventral parts. In Golgi-stained sections, spiny multipolar cells are the predominant neurons of both the dorsal and the ventral claustrum and are projection neurons. Aspiny multipolar neurons with fewer, often beaded, dendrites constitute a minority in both divisions and are interneurons. Injections of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) in the prefrontal, motor, somatosensory, auditory and visual areas, and HRP or WGA-HRP injections in the thalamus showed that: (1) the claustroneocortical projections originate in the dorsal claustrum and are distributed to the entire neocortex; these projections are mainly ipsilateral but some also originate contralaterally; (2) the claustroneocortical projections show a rough topographic organization; there exists a substantial degree of overlap; and (3) the claustrothalamic projection, arising throughout the dorsal claustrum, is strictly ipsilateral. No evidence of a thalamoclaustral projection was found. The present results suggest that, although the hedgehog has been referred to as a "paleocortical mammal" owing to the great development of its rhinencephalic structures in comparison with its small neocortex, the dorsal claustrum is well developed and is connected with all neocortical areas as well as with the thalamus, establishing it as a key structure in the hedgehog forebrain.     

Development of cortical and subcortical brain structures in childhood and adolescence: a structural MRI study

The purpose of the present study was to describe in greater anatomical detail the changes in brain structure that occur during maturation between childhood and adolescence. High-resolution MRI, tissue classification, and anatomical segmentation of cortical and subcortical regions were used in a sample of 35 normally developing children and adolescents between 7 and 16 years of age (mean age 11 years; 20 males, 15 females). Each cortical and subcortical measure was examined for age and sex effects on raw volumes and on the measures as proportions of total supratentorial cranial volume. Results indicate age-related increases in total supratentorial cranial volume and raw and proportional increases in total cerebral white matter. Gray-matter volume reductions were only observed once variance in total brain size was proportionally controlled. The change in total cerebral white-matter proportion was significantly greater than the change in total cerebral gray-matter proportion over this age range, suggesting that the relative gray-matter reduction is probably due to significant increases in white matter. Total raw cerebral CSF volume increases were also observed. Within the cerebrum, regional patterns varied depending on the tissue (or CSF) assessed. Only frontal and parietal cortices showed changes in gray matter, white matter, and CSF measures. Once the approximately 7% larger brain volume in males was controlled, only mesial temporal cortex, caudate, thalamus, and basomesial diencephalic structures showed sex effects with the females having greater relative volumes in these regions than the males. Overall, these results are consistent with earlier reports and describe in greater detail the regional pattern of age-related differences in gray and white matter in normally developing children and adolescents.     

Analysis of cerebral microvascular architecture--application to cortical and subcortical vessels in rat brain

Cerebral vascular morphology, including vascular diameters, lengths and branch points, was measured using quantitative three-dimensional (3D) imaging software developed in our laboratory, where data were collected from cortical and subcortical regions of a rat brain. To compare multiple records of the vascular morphological differences between anatomical regions with unpaired data, a simple analysis of variance (ANOVA) model may not be applicable, or may not be valid without considering correlation and unpaired data. In this paper, we formulate a novel outcome to study vascular morphological differences, discuss proper paired test statistics on unpaired data and apply the proposed methods to study the cerebral vascular morphological differences between cortical and sub-cortical regions in rats (N=6). The total vessel surface was analyzed as a composite of diameter, length and branches of vessels. The extended Fisher permutation test provides the paired test on unpaired data, which is equivalent to a permutation test based on the average of multiple sections; however, the permutation test may not be exact. The repeated measure analysis of variance using Generalized Estimating Equations (GEE) can be used to conduct the paired test on unpaired data as an alternative, when the permutation test is not exact. These new approaches can be applied in the study of treatment effects on changes of vascular morphology under physiological and pathological conditions.     

Motor-induced brain activation in cortical, subcortical and cerebellar regions in schizophrenic inpatients. A whole brain fMRI fingertapping study

Motor symptoms including neurological soft signs have been found to be more prevalent in schizophrenic patients. In addition, catatonic symptoms and neuroleptic treatment as well may influence cortical and subcortical motor organization in schizophrenia. The results of previous neuroimaging studies exploring motor function in patients with schizophrenia are inhomogenous reporting on a decreased activity in cortical motor regions in some studies and normal activity in others. Using fMRI, we studied 40 subjects performing a unilateral self-paced fingertapping task. Analyzing a general linear model of four groups, we compared patients with schizophrenia according to DSM-IV treated with olanzapine (OL; 10) or haloperidol (HA; 10) to healthy controls (HC; 10) and untreated patients (UN; 10). Brainvoyager software was used for data analyzing. In all groups, the contralateral motor cortex was significantly activated. Significant activation of the ipsilateral cerebellum was found in the UN group, the control group and the OL group. The contralateral basal ganglia were activated in UN and in controls. Motor-induced cortical and subcortical brain activation in HC was significantly higher than in patients with schizophrenia. UN with schizophrenia showed a significant overactivation than the other groups. In conclusion, we revealed a diminished activation in the patient group treated with neuroleptic drugs. This study outlines the importance of further fMRI studies to investigate interindividual activation differences under different conditions especially focusing on basal ganglia.     

Iron-induced experimental cortical seizures: Electroencephalographic mapping of seizure spread in the subcortical brain areas

The iron-induced model of post-traumatic chronic focal epilepsy in rats was studied by depth-electrode mapping to investigate the spread of epileptiform activity into subcortical brain structures after its onset in the cortical epileptic focus. Electrical seizure activity was recorded in the hippocampal CA1 and CA3 areas, amygdala and caudate-putamen, in rats with iron-induced chronic cortical focal epilepsy. These experiments showed that the epileptiform activity with its onset in the cortical focus synchronously propagated into the studied subcortical brain areas. Seizure behaviours seemed to increase in correspondence with the spread of the epileptic electrographic activity in subcortical areas. Comparison of the cortical focus electroencephalographic and associated multiple-unit action potential recordings with those from the subcortical structures showed that the occurrence and evolution of the epileptiform activity in the subcortical structures were in parallel with that in the cortical focus. The intracerebral anatomic progression and delineation of seizure spread (mapped by field potential (EEG) and multiple-unit action potentials (MUA) recordings) indicated participation of these regions in the generalization of seizure activity in this model of epilepsy. The seizure-induced activation of the hippocampus appeared to evolve into an epileptic focus independent of the cortical focus. The present study demonstrates the propagation of epileptic activity from the cortical focus into the limbic and basal ganglia regions. Treatment of iron-induced epileptic rats with ethosuximide, an anti-absence drug, resulted in suppression of the epileptiform activity in the cortical focus as well as in the subcortical brain areas.     

Hand somatosensory subcortical and cortical sources assessed by functional source separation: an EEG study

We propose a novel electroencephalographic application of a recently developed cerebral source extraction method (Functional Source Separation, FSS), which starts from extracranial signals and adds a functional constraint to the cost function of a basic independent component analysis model without requiring solutions to be independent. Five ad-hoc functional constraints were used to extract the activity reflecting the temporal sequence of sensory information processing along the somatosensory pathway in response to the separate left and right median nerve galvanic stimulation. Constraints required only the maximization of the responsiveness at specific latencies following sensory stimulation, without taking into account that any frequency or spatial information. After source extraction, the reliability of identified FS was assessed based on the position of single dipoles fitted on its retroprojected signals and on a discrepancy measure. The FS positions were consistent with previously reported data (two early subcortical sources localized in the brain stem and thalamus, the three later sources in cortical areas), leaving negligible residual activity at the corresponding latencies. The high-frequency component of the oscillatory activity (HFO) of the extracted component was analyzed. The integrity of the low amplitude HFOs was preserved for each FS. On the basis of our data, we suggest that FSS can be an effective tool to investigate the HFO behavior of the different neuronal pools, recruited at successive times after median nerve galvanic stimulation. As FSs are reconstructed along the entire experimental session, directional and dynamic HFO synchronization phenomena can be studied.     

基于功能磁共振的Broca区脑动静脉畸形术后皮质和皮质下重塑模式研究

目的 探讨Broca区脑动静脉畸形患者语言皮层和语言相关白质纤维的可塑性。方法 前瞻性选取2016年9月至2019年5月在北京天坛医院接受显微手术切除的5例Broca区脑动静脉畸形患者为研究对象。在手术前1周内和术后6个月对患者进行血氧水平依赖性功能磁共振（BOLDfMRI）和弥散张量成像（DTI）检查，评估语言相关的脑白质功能区纤维束及其对侧的同源纤维走形，计算病变和对侧半球中激活的语言皮层体素之间的偏侧化指数（LI）。结果 术后6个月，5例患者术后左半球弓状束纤维数量为67(20,217)，低于术前的781(285,1 191)；术后左半球钩束的纤维数量为386(190,852)，高于术前的220(114,422)，差异有统计学意义（P<0.05）。5例患者术前、术后6个月两个半球的弓状束前段、弓状束后段、下纵束和下额枕束的纤维数量比较，差异无统计学意义（P>0.05）。5例患者术前Broca区LI为1.000(0.753,1.000)，高于术后的0.070(-0.890,0.537)，差异有统计学意义（Z=-0.023,P=0.043）。结论 手术切除Broca区脑动...     

Expanding the neurological examination using functional neurologic assessment part I: methodological considerations

Manual assessment of muscular function, in particular a method known as applied kinesiology (AK), is a clinical measure of neurologic function. A review of the literature reveals methodological problems with previous studies of AK as a form of neurologic assessment. Research designs that do not reflect clinical practice and principles of AK are common in the literature. Additional study is warranted to explore the potential of AK manual muscle testing as a diagnostic tool. We outline principles of AK and recommend that future research reflect more accurately the clinical practice of functional neurologic assessment and applied kinesiology.     

Pregnancies alters spine number in cortical and subcortical limbic brain regions of old rats

Pregnancy is a complex process, involving a number of hormones and trophic factors, many of which are formed in the placenta. Several of these trophic factors have an effect at the neuronal level, such as BDNF. Consequently, recent reports have shown that exposure to these hormones (estrogen and progesterone) and trophic factors such as BDNF exert a neuroprotective effect. Here, we study the effect of the number of pregnancies on dendritic morphology of aged female rats (18 months of age). Rats of the 18‐month‐old Sprague Dawley strain with zero, one, two, and three gestations were evaluated for locomotor activity, and Golgi–Cox stain was performed to evaluate the dendritic morphology parameters, the number of dendritic spines, total dendritic length, and branching order number. Adult nulliparous rats (3 months of age) were used as another control group. Adult nulliparous and aging rats with two pregnancies showed an increase in locomotor activity. Adult nulliparous showed an increase in the dendritic spine number compared to old nulliparous rats in both layers of the PFC, the DG, and NAcc. Old rats with two and three pregnancies also showed an increase in the number of dendritic spines compared to old nulliparous rats in layers 3 and 5 of the PFC and in the CA1. Aging animals with one pregnancy also showed an increase in dendritic length compared to old nulliparous rats in the CA1. Our results clearly suggest that two and three pregnancies increase the dendritic spines number in the PFC and CA1 of aged female rats.     

Acute social defeat reduces neurotrophin expression in brain cortical and subcortical areas in mice

Acute social defeat in mice activates the hypothalamic-pituitary-adrenal axis (HPA) and induces long-term behavioral changes, including exaggerated fear responses and inhibition of territorial behavior. Stress-induced hormonal and neurotransmitter release may contribute to disruption of expression of genes important for cell survival, neuronal plasticity, and neuronal remodeling. Brain-derived neurotrophic factor (BDNF) is a neurotrophic factor associated with structural cellular changes that occur during nervous system development and contributes to neural plasticity in the adult brain. In rats, acute (1-2 h) restraint stress transiently reduces BDNF mRNA expression in the hippocampus, a region important in the memory and in HPA regulation; restraint stress also decreases BDNF expression in the basolateral amygdala (BLA), a region important for fear consolidation and emotional memory. We hypothesized that a brief (10 min) exposure to intense social stress, a more naturalistic stressor than restraint stress, would also reduce BDNF mRNA in the hippocampus and BLA of mice. In the present study, we examined the time course of expression of BDNF mRNA expression in the hippocampus and amygdala, as well as other subcortical and cortical brain regions, following acute social stress. In situ hybridization analysis for BDNF mRNA expression showed that there was a significant decrease in BDNF mRNA expression in all regions studied in mice 24 h after social defeat when compared to control (naive) mice (P<0.05). These findings support our hypothesis that BDNF mRNA levels are reduced by social stress, and may have implications for brain plasticity and behavioral changes following social stress.