Postoperative Transient Reduced Diffusion in the Ipsilateral Striatum and Thalamus

Kamiya, Kazutaka; Sato, Nobuya; Nakata, Yasuhiro; Ito, Kenji; Kimura, Yasuyuki; Ota, Miho; Takahashi, Akio; Mori, Hiromu; Kunimatsu, Akira; Ohtomo, Kazuyoshi

doi:10.3174/ajnr.a3242

Cited by 11 publications

(5 citation statements)

References 40 publications

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“…Such late occurrence of restricted diffusion in the striatum suggests secondary neurodegeneration (i.e., Wallerian degeneration) due to the widespread frontostriatal disconnection and has been reported to occur in a proportion of patients with resective-type frontal surgery. 9 The restricted diffusion was transient, reaching their peaks around 2 to 3 weeks after the surgery 9 as in our patients. However, similar findings have not yet been reported in patients who underwent frontal disconnection surgery.…”

Section: Discussionsupporting

confidence: 67%

“…The striatal signal abnormalizes should not be confused with perioperative ischemic stroke. 9 They may pass unnoticed due to the lack of obvious neurological symptoms likely because the procedure is performed in patients with a vast frontal lesion or hypometabolism. The benign postoperative course despite the striatal degeneration supports the use of this surgical procedure in otherwise inoperable patients with broad frontal epileptogenicity.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative striatal degeneration: a hitherto unrecognized impact of frontal disconnection surgery for drug-resistant epilepsy. Illustrative cases

Hagiwara

Tanaka²,

Miyoshi

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Frontal disconnection surgery is a useful surgical option for patients with frontal epilepsy whose seizure onset zones are exceedingly large and thus are not amenable to conventional resective surgery. While it has the advantage of avoiding sequelae stemming from a large resection cavity, the impact of radical anatomofunctional disconnection of such a vast frontal region is not fully understood. OBSERVATIONS The authors have identified secondary degeneration in the striatum ipsilateral to the frontal disconnection surgery in two adult patients who had otherwise favorable postoperative outcomes following the surgery. On serial postoperative magnetic resonance imaging, the striatum showed transient restricted diffusion in the caudate head and rostral putamen around several weeks postoperatively and subsequent atrophy in the caudate head. The affected striatal regions (i.e., the anterior portion of the striatum) were congruent with the known fronto-striatal connectivity corresponding to the disconnected frontal regions anterior to the primary and supplementary motor areas. Both patients achieved 1-year seizure freedom without apparent disability related to the surgery. LESSONS The benign postoperative course despite the marked degenerative changes in the ipsilateral striatum supports the feasibility of the frontal disconnection surgery in otherwise inoperable patients with broad frontal epileptogenicity.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Postoperative striatal degeneration: a hitherto unrecognized impact of frontal disconnection surgery for drug-resistant epilepsy. Illustrative cases

Hagiwara

Tanaka²,

Miyoshi

et al. 2022

Journal of Neurosurgery: Case Lessons

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“…Brodtmann et al [ 9 ] suggested that thalamic atrophy could be observed as early as 3 h after the onset of symptoms. In a population of 125 patients who had surgery for resection of a cortical lesion, Kamiya et al [ 28 ] observed transient diffusion restriction of the ipsilateral striatum and thalamus as early as 7 days after the intervention followed by atrophy of these structures; the extension of the anomalies being correlated with the extension of the resection. This indicates the presence of early morphological alterations of the interconnected structures within the striato-thalamo-cortical network ipsilateral to MCA stroke.…”

Section: Discussionmentioning

confidence: 99%

Automated MRI-based volumetry of basal ganglia and thalamus at the chronic phase of cortical stroke

et al. 2020

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Purpose We aimed at assessing the potential of automated MR morphometry to assess individual basal ganglia and thalamus volumetric changes at the chronic phase after cortical stroke. Methods Ninety-six patients (mean age: 65 ± 18 years, male 55) with cortical stroke at the chronic phase were retrospectively included. Patients were scanned at 1.5 T or 3 T using a T1-MPRAGE sequence. Resulting 3D images were processed with the MorphoBox prototype software to automatically segment basal ganglia and thalamus structures, and to obtain Z scores considering the confounding effects of age and sex. Stroke volume was estimated by manual delineation on T2-SE imaging. Z scores were compared between ipsi- and contralateral stroke side and according to the vascular territory. Potential relationship between Z scores and stroke volume was assessed using the Spearman correlation coefficient. Results Basal ganglia and thalamus volume Z scores were lower ipsilaterally to MCA territory stroke (p values < 0.034) while they were not different between ipsi- and contralateral stroke sides in non-MCA territory stroke (p values > 0.37). In MCA territory stroke, ipsilateral caudate nucleus (rho = − 0.34, p = 0.007), putamen (rho = − 0.50, p < 0.001), pallidum (rho = − 0.44, p < 0.001), and thalamus (rho = − 0.48, p < 0.001) volume Z scores negatively correlated with the cortical stroke volume. This relation was not influenced by cardiovascular risk factors or time since stroke. Conclusion Automated MR morphometry demonstrated atrophy of ipsilateral basal ganglia and thalamus at the chronic phase after cortical stroke in the MCA territory. The atrophy was related to stroke volume. These results confirm the potential role for automated MRI morphometry to assess remote changes after stroke.

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“…Injuries to the corticostriatal pathways caused by hemorrhage or surgery involving the external capsule may induce transneuronal degeneration of the striatum [ 1 ]. It is convenient to know this uncommon entity because it mimics an acute ischemic lesion from another cause and should not be mistaken [ 2 ].…”

mentioning

confidence: 99%

“…Las lesiones de las vías corticoestriadas producidas por hemorragias o cirugías que afectan a la cápsula externa pueden inducir una degeneración transneuronal del cuerpo estriado [ 1 ]. Es conveniente conocer esta entidad infrecuente, porque simula una lesión isquémica aguda por otra causa y no debe confundirse [ 2 ].…”

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Restricción transitoria de la difusión en resonancia magnética debido a degeneración transneuronal del cuerpo estriado

Belloch-Ripollés¹,

Carreres-Polo²

2022

RevNeurol

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Postoperative Transient Reduced Diffusion in the Ipsilateral Striatum and Thalamus

Cited by 11 publications

References 40 publications

Postoperative striatal degeneration: a hitherto unrecognized impact of frontal disconnection surgery for drug-resistant epilepsy. Illustrative cases

Postoperative striatal degeneration: a hitherto unrecognized impact of frontal disconnection surgery for drug-resistant epilepsy. Illustrative cases

Automated MRI-based volumetry of basal ganglia and thalamus at the chronic phase of cortical stroke

Restricción transitoria de la difusión en resonancia magnética debido a degeneración transneuronal del cuerpo estriado

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