Impact of DTI tractography on surgical planning for resection of a pediatric pre-pontine neurenteric cyst: a case discussion and literature review

Birinyi, Paul V.; Bieser, Sarah; Reis, Martin; Guzmán, Miguel A.; Agarwal, Alpana; AbdelBaki, Mohamed S.; Elbabaa, Samer K.

doi:10.1007/s00381-014-2587-0

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…In fetal life, the neurenteric canal establishes a temporary communication between the yolk sac and the amniotic cavity, and possibly maintains equal pressures in the 2 cavities. 27 CM-3.5 may be due to the persistence of the neurenteric canal with resultant abnormal communication between the yolk sac and the amniotic cavity. 15…”

Section: Pathophysiology Of Cmsmentioning

confidence: 99%

The Perplexity Surrounding Chiari Malformations – Are We Any Wiser Now?

Hiremath

Fitsiori²,

Boto³

et al. 2020

AJNR Am J Neuroradiol

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Chiari malformations are a diverse group of abnormalities of the brain, craniovertebral junction, and the spine. Chiari 0, I, and 1.5 malformations, likely a spectrum of the same malformation with increasing severity, are due to the inadequacy of the para-axial mesoderm, which leads to insufficient development of occipital somites. Chiari II malformation is possibly due to nonclosure of the caudal end of the neuropore, with similar pathogenesis in the rostral end, which causes a Chiari III malformation. There have been significant developments in the understanding of this complex entity owing to insights into the pathogenesis and advancements in imaging modalities and neurosurgical techniques. This article aims to review the different types and pathophysiology of the Chiari malformations, along with a description of the various associated abnormalities. We also highlight the role of ante-and postnatal imaging, with a focus on the newer techniques in the presurgical evaluation, with a brief mention of the surgical procedures and the associated postsurgical complications. ABBREVIATION: CM ¼ Chiari malformation C hiari malformations (CMs) are a group of rhombencephalic abnormalities, initially described by Hans Chiari, traditionally classified into 4 types. 1-3 Types I to III are associated with a varying degree of caudal displacement of the contents of the posterior fossa, along with cerebellar tonsillar herniation through the foramen magnum. Type IV is characterized by cerebellar hypoplasia or aplasia and an occipital encephalocele. 1-3 Because of the complex nature of the associated abnormalities, CMs can present with diverse clinical manifestations, secondary to the involvement of the cerebellum, brain stem, spinal cord, lower cranial nerves, and altered CSF flow dynamics. Recent advances in imaging techniques, such as phase-contrast imaging, cine MR imaging, and DTI, with frequent imaging and surgical management of these

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Section: Pathophysiology Of Cmsmentioning

confidence: 99%

The Perplexity Surrounding Chiari Malformations – Are We Any Wiser Now?

Hiremath

Fitsiori²,

Boto³

et al. 2020

AJNR Am J Neuroradiol

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show abstract

“…During normal vertebral development, the proximal part of the axial canal of the notochord persists for a short time, allowing for a temporary communication between amniotic and yolk sacs. This canal could contribute to equalizing the pressures between the two sacs until the canal seals shut (Birinyi et al, ). Failure of this canal to close is probably involved in the anomalous neurenteric fistula seen in CM3.5.…”

Section: Chiari Malformation 35mentioning

confidence: 99%

The newer classifications of the chiari malformations with clarifications: An anatomical review

et al. 2018

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In 1891, Hans Chiari described a group of congenital hindbrain anomalies, which were eventually named after him. He classified these malformations into three types (Chiari malformations I, II, and III), and four years later added the Chiari IV malformation. However, numerous reports across the literature do not seem to fit Chiari's original descriptions of these malformations, so researchers have been encouraged to propose new classifications to encompass these variants (e.g., Chiari 0, Chiari1.5, and Chiari 3.5 malformations). Moreover, there is a continued misunderstanding and misuse of the term "Chiari IV malformation." Therefore, the current review intended to describe anatomical, pathophysiological, and clinical aspects of the newer classifications with clarifications of the Chiari malformations. We reviewed available literature about Chiari malformations and their variants using "PubMed" and "Google Scholar." We also looked into the term Chiari IV, clarifying its original description and citing examples where the term has been used erroneously. References in the reviewed articles were searched manually. Variants of the originally described Chiari malformations are termed Chiari 0, Chiari 1.5, and Chiari 3.5. Each has distinct anatomical characteristics and some of these are extremely rare and incompatible with life (e.g. Chiari 3.5). Chiari IV malformation has been further clarified. Some physicians might be unfamiliar with the newer classifications of Chiari malformations because these conditions are rare or even unique. Furthermore, care is needed in using the term "Chiari IV malformation", which must be consistent with Chiari's original description, i.e. an occipital encephalocele containing supratentorial contents. Clin. Anat. 31:314-322, 2018. © 2018 Wiley Periodicals, Inc.

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“…25 For these reasons, DTI remains, to date, the most used technique for investigating white matter bundles, also for the pre-surgical planning of brain neoplasms. [26][27][28] In reality, as recently highlighted by Mormina and colleagues, 29 CSD-based tractography is feasible in clinical settings and it is able to provide very useful information during the pre-surgical evaluation of eloquent bundles in patients with high-grade gliomas. It was shown that DTI-based reconstructions can be affected also by neoplasm's effects on white matter bundles.…”

mentioning

confidence: 99%

The Pre-Surgical Planning of Brain Neoplasms: From Diffusion Tensor Imaging to More Advanced Approaches

Arrigo¹,

Mormina²,

Calamuneri³

2016

Radiol Open J

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The pre-surgical planning of brain neoplasms is strongly contributing to change the prognosis of neoplastic patients. Indeed, it supplies more and more detailed and reliable functional and morphological information before as well as during surgery. Both invasive and noninvasive approaches are available to achieve this goal. A powerful technique for the pre-surgical planning of brain neoplasms is Diffusion Weighted Imaging (DWI) based tractography. Differently from other approaches, tractography is able to provide, non-invasively, morphological information regarding brain pathways relationship with the neoplasm, by analyzing water diffusion within white matter. This is important especially for eloquent bundles, such as Cortico-Spinal Tract (CST) and Arcuate Fasciculus (AF), whose damages have a bad impact on the patient's Quality of Life (QoL). Tractography can be performed through several diffusion signal modeling techniques, among which Diffusion Tensor Imaging (DTI) is the most known. DTI has been widely used for neurosurgery both in pre-operative and intra-operative contexts, also in combination with other functional approaches such as functional MRI (fMRI) and cortical stimulation.1-8 This useful technique was able to reduce post-surgical deficits as well as to improve the survival of neoplastic patients, through a better delineation of maximal safe resection.9 Moreover, its use provided great benefits in patients with high-grade gliomas in terms of risk of death.9 Several studies have demonstrated that DTI suffers from many limitations regarding its reliability to correctly model diffusion signal in different conditions. 10,11 Furthermore, tensorial models are not able to resolve different fibers geometries (i.e. crossing fibers) within the same voxel; these complex configurations have been demonstrated to characterize more than 90% of white matter voxels, 12 thus making DTI an unreliable diffusion modeling technique. In order to overcome these limitations, several other approaches were developed; in particular, High Angular Resolution Diffusion-weighted Imaging (HARDI), 13 Q-Ball Imaging (QBI) 14 and Diffusion Spectrum Imaging (DSI) 15 were found to be promising techniques for resolving voxels with multiple fibers orientations. Nevertheless, tractography was further improved by an HARDI modified approach called Constrained Spherical Deconvolution (CSD); this technique does not require very long acquisition time with respect to DSI 16 and it is able to improve angular resolution if compared to QBI.17 CSD-based tractography was widely used in physiological contexts as well as in pathological ones, showing high sensitivity for the detection of white matter pathways. [18][19][20][21][22] Although tensorial approaches were proved to be inadequate for reliably reconstructing brain pathways 23 and histological validation of CSD-based tractography has been recently provided, 24 more advanced diffusion techniques are still considered not usable in clinical settings due to their too high technical requirements. 25 F...

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Impact of DTI tractography on surgical planning for resection of a pediatric pre-pontine neurenteric cyst: a case discussion and literature review

Cited by 7 publications

References 18 publications

The Perplexity Surrounding Chiari Malformations – Are We Any Wiser Now?

The Perplexity Surrounding Chiari Malformations – Are We Any Wiser Now?

The newer classifications of the chiari malformations with clarifications: An anatomical review

The Pre-Surgical Planning of Brain Neoplasms: From Diffusion Tensor Imaging to More Advanced Approaches

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