Summary:Purpose: To test the sensitivity of extracranial magnetoencephalography (MEG) for epileptic spikes in different cerebral sites.Methods: We simultaneously recorded MEG and electrocorticography (ECoG) by using subdural electrodes with 1-cm interelectrode distances for one patient with lateral frontal epilepsy and one patient with basal temporal epilepsy. We analyzed MEG spikes associated with ECoG spikes and compared the maximal amplitude and number of electrodes involved. We estimated and evaluated the locations and moments of the equivalent current dipoles (ECDs) of MEG spikes.Results: In patient 1, MEG detected 100 (53%) of 188 ECoG lateral frontal spikes, including 31 (46%) of 67 spikes that activated three subdural electrodes. MEG spike amplitudes correlated with ECoG spike amplitudes and the number of electrodes activated (p < 0.01). ECDs were perpendicular to the superior frontal sulcus. In patient 2, MEG detected 31 (26%) of 121 ECoG basal temporal spikes, but none that activated only three subdural electrodes. ECDs were localized in the entorhinal and parahippocampal gyri, oriented perpendicular to those basal temporal cortical surfaces. The ECD strength was 136.6 ± 71.5 nAm in the frontal region, but 274.5 ± 150.6 nAm in the temporal region (p < 0.01).Conclusions: When lateral frontal ECoG spikes extend >3 cm 2 across the fissure, MEG can detect >50%, correlating with spatial activation and voltage. In the basal temporal region, MEG requires higher-amplitude discharges over a more extensive area. MEG shows a significantly higher sensitivity to lateral convexity epileptic discharges than to discharges in isolated deep basal temporal regions. Key Words: Magnetoencephalography-Electrocorticography-Epilepsy-Extent of epileptic spikes-Sensitivity.Magnetoencephalography (MEG) measures the extracranial magnetic fields generated by intraneuronal electric currents with superconducting quantum interference devices (1). Extracranial magnetic fields result from intracranial tangential currents, such as neuronal activity, in the fissural cortex, which makes up two thirds of the surface of the human brain (2). During MEG analysis, magnetic field recordings are fitted to an equivalent current dipole (ECD) model to localize sources of intracranial activity, such as epileptic spikes; the spike source locations are then overlaid onto magnetic resonance (MR) images of corresponding areas of the brain. Because magnetic fields are relatively unaffected by the different electrical conductivities of the brain, cerebral spinal fluid, skull, and skin, MEG can accurately localize the source of intraneuronal electric currents that contribute to extracranial magnetic fields (3).Electroencephalography (EEG) dipole recordings delineate both radial and tangential currents (4). However, the electrical fields, as measured by EEG, are affected by the conductivities of different tissues.MEG has clinical application for patients with partial epilepsy. Neurosurgeons use advanced multisensor helmet-shaped, whole-head neuromagnetomete...
Longstanding hydrocephalus and raised intracranial pressure can lead to unusual anatomical variants in the floor of the third ventricle, which may be important when performing endoscopic third ventriculostomy. Two middle aged patients with symptomatic longstanding hydrocephalus had scans that showed ventricular hydrocephalus, an empty sella, and a dilated infundibular recess which herniated into the sella turcica. Endoscopic third ventriculostomy confirmed that instead of the tuber cinerum and infundibular recess, the anterior inferior floor of the third ventricle was hanging down ventral to the pons into the sellar floor. Third ventriculostomy to the prepontine cistern was made on the dorsal wall of the dilated infundibular recess to the area surrounded by the dorsum sellae, the basilar artery trunk, and the left superior cerebellar artery, with good symptomatic control. Association of the empty sella and persistence of the infundibular recess must be carefully evaluated by MRI before attempting endoscopic third ventriculostomy. Herniation of the anterior inferior floor of the third ventricle into the empty sella can lead to loss of anatomical landmarks that require special attention during third ventriculostomy. (J Neurol Neurosurg Psychiatry 2000;69:531-534) Keywords: hydrocephalus; endoscopy; third ventriculostomy Endoscopic third ventriculostomy plays an important part in the treatment of hydrocephalus.1 Anatomical landmarks are well established and the procedure is safe in well experienced hands. Recently we have encountered two adult patients who were diagnosed as "long standing overt hydrocephalus in the adult (LOVA)" 2 and in whom the floor of the third ventricule was seen to be completely diVerent from the normal anatomy. We report the cases and surgical techniques, and discuss the relation between hydrocephalus, empty sella, and persistence of infundibular recess which were associated with the patients. CASE 1 A 31 year old woman had had chronic headaches, which increased in frequency and were accompanied by dizziness. Brain CT showed marked ventriculogmegaly with flat- Case report
For the last 25 years, it has been proven that the occurrence or recurrence of neural tube defects can be prevented with the administration of folic acid before and early pregnancy. At present, over 80 countries in the world, except Japan, have mandated the fortification of wheat flour and/or rice with folic acid, which has resulted in a significant reduction in the prevalence of neural tube defects. In 2000, the Japanese government recommended folic acid 400 μg daily for young women of childbearing age and women who are planning to conceive. In 2002, the government started to present information about the importance of folic acid in the development of fetuses in the Mother-Child Health Booklet annually. Despite these endeavors, the prevalence of neural tube defects has remained unchanged. We discuss the risk factors of neural tube defects and propose preventive measures to decrease the number of neonates with neural tube defects. We believe that the government should implement the fortification of staple food with folic acid very soon, which will eventually decrease not only the neonatal mortality and morbidity, but also the economic burden on our health care system.
The role of diffusion weighted imaging and apparent diffusion coefficient in intracranial germ cell tumors has not been fully elucidated. The aim of this study was to evaluate whether the ADC correlates with the histologic subtypes of germ cell tumors. We also aimed to investigate whether the ADC values can predict treatment response. The authors retrospectively analyzed the ADC values of the enhancing and solid regions of germ cell tumors. The absolute ADC values and the normalized ADC values were compared among different histologic diagnoses. The ADC values before and after the first course of chemotherapy were also compared between the different prognostic groups. Ten patients were included in the study. The median age at diagnosis was 9.3 years (range 5.3-13.8 years). There were four patients with germinoma and six patients with nongerminomatous germ cell tumor (NGGCT) including five mixed germ cell tumors and one immature teratoma. The mean absolute and normalized ADC values (×10(-3) mm(2)/s) were significantly lower in germinomas [0.835 ± 0.065 (standard deviation) and 1.11 ± 0.096, respectively] than in NGGCTs (1.271 ± 0.145 and 1.703 ± 0.223, respectively) (p = 0.01). The ADC values before and after the first course of chemotherapy were available in four patients. The ADC value after the first chemotherapy had a tendency to increase more in patients who eventually demonstrated complete response with chemotherapy than in patients who required second-look surgery. Assessment of the ADC values of germ cell tumors is considered to facilitate differentiation of histological subtypes of germ cell tumors. Evaluation of the ADC may also be useful for predicting treatment response.
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