Search Results (16)

Objectives: The aim of this study was to evaluate macular vessel area densities (superficial and deep) and foveal avascular zone (FAZ) measurements using OCT-A in the eyes of primary progressive multiple sclerosis (PPMS) patients receiving Ocrelizumab treatment with or without optic nerve involvement. Methods: The medical records of PPMS patients who received Ocrelizumab treatment at least once were reviewed. Retinal nerve fiber layer (RNFL) thickness measurements and OCT-A analysis were conducted on the PPMS patients and on age-matched healthy individuals. The patient group was divided into two subgroups: eyes with optic neuritis (PPMS+ON) and eyes without ON (PPMS-ON). Central and mean superficial vessel area (SVA) and deep vessel area (DVA) densities, as well as foveal avascular zone (FAZ) measurements, were analyzed. All parameters were statistically compared between groups and subgroups. Results: A total of 38 PPMS patients receiving Ocrelizumab treatment and 31 healthy individuals were included in this study. Statistically significant differences were observed between the groups in terms of best corrected visual acuity (BCVA), RNFL thickness, and the superficial vessel area densities for all parts except for the central part. In terms of deep vessel area densities, differences were found in the central and inferior parts. The mean FAZ area also showed a statistically significant difference between groups. Mean RNFL thickness differed significantly between the subgroups. Mean nasal, temporal, inferior part, and total superficial vessel area densities were statistically different between the subgroups. The central and inferior parts of the deep vessel area densities showed statistically significant differences. The mean FAZ area was also statistically different between the subgroups. Conclusions: The findings suggest that macular superficial and deep vascular densities are affected in PPMS patients receiving the same therapy modality and that previous optic neuritis may influence the results. Full article

Myofascial pain (MFP) is one of the most frequent temporomandibular disorders (TMDs), primarily affecting the masseter and temporalis muscles. Various treatment strategies have been developed, including trigger point injections (TrP) and nerve blocks. Among these, the twin block technique has recently emerged as a promising, minimally invasive approach for simultaneously anesthetizing the masseteric and anterior deep temporal nerves through a single extraoral injection. This review presents the anatomical considerations essential for the application of the twin block technique. The course, branching patterns, and relationships of the masseteric and deep temporal nerves with adjacent vascular structures are described based on the current anatomical literature. A comparison is also made of isolated nerve blocks and the twin block, highlighting procedural protocols, clinical advantages, and safety profiles. The anatomical proximity between the masseteric and deep temporal nerves supports the rationale for a single-puncture approach, which can effectively reduce muscle tone, inhibit nociceptive input, and silence multiple trigger points simultaneously. In addition to its therapeutic benefits, the twin block can serve as a diagnostic tool to differentiate muscular from joint or odontogenic pain. In conclusion, the twin block technique offers a precise and efficient method for managing masticatory myofascial pain, provided that detailed anatomical knowledge is applied to ensure procedural accuracy, a low incidence of adverse effects, and patient safety. Full article

Background Facial clefts are rare congenital malformations, occurring in approximately 1 in 700 live births for cleft lip and palate and fewer than 1 in 100,000 for atypical Tessier clefts. They pose significant diagnostic and surgical challenges. While genetic, vascular, and environmental factors are well documented, growing embryological evidence suggests that the trigeminal nerve may also contribute to craniofacial development. This narrative review explores the association between trigeminal nerve development and facial clefts, aiming to provide a neurodevelopmental perspective with clinical implications, particularly in the context of personalized medicine, where patient-specific neuroanatomical and developmental factors can guide tailored care. Methods A narrative review of embryological, anatomical, and clinical data was conducted. Histological analyses of malformed fetuses and normal human embryos were integrated with published studies. Clinical findings were compared with Paul Tessier’s facial cleft classification and mapped against trigeminal innervation territories. Results Two groups of facial clefts emerged according to the timing of trigeminal disruption. Early embryonic damage (before 10 weeks of gestation) produces superficial epidermal continuity with fibrotic tissue replacing normal deep structures. Later fetal damage results in complete clefts with full tissue discontinuity. The distribution of these clefts corresponds to trigeminal nerve terminal branch territories, supporting the hypothesis that trigeminal innervation exerts trophic effects on craniofacial morphogenesis through neurohormonal signaling. Conclusions Early impairment of trigeminal development may play a pivotal role in the pathogenesis of certain clefts. The spatial and temporal relationship between nerve development and morphogenesis should be considered in classification and surgical planning. However, limitations of this narrative approach include selective literature coverage and lack of quantitative synthesis. Future directions include single-cell transcriptomics, organoid models, and fetal MRI tractography to clarify trigeminal–mesenchyme interactions and inform therapeutic strategies. These advances may foster a personalized medicine approach, enabling more precise prenatal diagnosis, individualized surgical planning, and optimized long-term outcomes. Full article

Background and Clinical Significance: Meningiomas are among the most common primary intracranial tumors, usually benign and slow-growing. Extracranial extension is exceptionally rare, particularly when arising from convexity meningiomas extending into the temporal fossa. Such cases pose unique diagnostic and therapeutic challenges due to their atypical growth patterns and anatomical complexity. Case Presentation: A 63-year-old woman previously treated for a right temporal convexity meningioma with subtotal resection and Gamma Knife radiosurgery demonstrated progressive extracranial tumor growth over five years, while the intracranial component remained stable. MRI revealed infiltration of the temporalis and lateral pterygoid muscles and erosion of the temporal bone. Due to extensive extracranial involvement and limited neurosurgical accessibility, resection was performed by a maxillofacial surgical team through a preauricular approach. Intraoperatively, the tumor was encapsulated but adherent to the deep temporal fascia and zygomatic arch. The temporal branch of the facial nerve was identified and preserved. Histopathology confirmed a meningothelial meningioma, WHO Grade I, with low proliferative activity (Ki-67 < 1%). Postoperative recovery was uneventful, with transient facial nerve weakness that resolved within weeks. Conclusions: This report adds to the limited literature describing temporal fossa involvement by convexity meningiomas and illustrates the value of collaboration between neurosurgical and maxillofacial teams. Regular MRI surveillance every 6–12 months is advised for early detection of recurrence. Full article

Objectives: To evaluate the long-term effects of coronavirus disease (COVID-19) on optic disc and macular microvasculature. Methods: 40 post-COVID-19 and 40 healthy subjects were included. Optical coherence tomography angiography (OCTA) was performed for all subjects at the first visit and repeated in the fourth and twelfth months. Radial peripapillary capillary (RPC) vessel density (VD), retinal nerve fiber layer (RNFL) thickness, foveal avascular zone (FAZ) area, FAZ perimeter, VDs of the fovea, parafovea, and perifovea at superficial capillary plexus (SCP) and deep capillary plexus (DCP), and central macular thickness (CMT) were evaluated. The OCTA measurements of the COVID-19 group were compared with the control group. Results: The COVID-19 group showed lower VD values than the control group in the nasal parafoveal quadrant of the SCP at all visits (p = 0.009, p = 0.47, p = 0.042) and in the superior perifoveal quadrant of the DCP in the twelfth-month visit (p = 0.014). At all visits, FAZ area and FAZ perimeter were higher (p = 0.02, p = 0.02, p = 0.002; p = 0.002, p = 0.003, p = 0.005), foveal VD values of both SCP and DCP were lower (p < 0.001, p < 0.001, p < 0.001; p = 0.005, p = 0.001, p = 0.001), and CMT was lower (p < 0.001, p = 0.001, p = 0.001) in the COVID-19 group. The COVID-19 group had higher temporal quadrant RPC at all visits (p = 0.003, p = 0.003, p < 0.001) and higher average, superior and inferior RNFL at first and fourth-month visits (p = 0.014, p = 0.020; p = 0.001, p = 0.003; p = 0.021, p = 0.024). Conclusions: There are long-term changes that mainly point to the ischemia in the COVID-19 patients. We emphasize the need for long-term ophthalmologic and systemic follow-up of COVID-19 patients regarding potential complications. Full article

Background: Meckel’s cave is a challenging surgical target due to its deep location and proximity to vital neurovascular structures. Surgeons have developed various microsurgical transcranial approaches (MTAs) to access it, but there is no consensus on the best method. Newer endoscopic approaches have also emerged. This study seeks to quantitatively compare these surgical approaches to Meckel’s cave, offering insights into surgical volumes and exposure areas. Methods: Fifteen surgical approaches were performed bilaterally in six specimens, including the pterional approach (PTA), fronto-temporal-orbito-zygomatic approach (FTOZA), subtemporal approach (STA), Kawase approach (KWA), retrosigmoid approach (RSA), retrosigmoid approach with suprameatal extension (RSAS), endoscopic endonasal transpterygoid approach (EETPA), inferolateral transorbital approach (ILTEA) and superior eyelid approach (SEYA). All the MTAs were performed both with 10 mm and 15 mm of brain retraction, to consider different percentages of surface exposure. A dedicated navigation system was used to quantify the surgical working volumes and exposure of different areas of Meckel’s cave (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada). Microsurgical transcranial approaches were quantified with two different degrees of brain retraction (10 mm and 15 mm). Statistical analysis was performed using a mixed linear model with bootstrap resampling. Results: The RSAS with 15 mm of retraction offered the maximum exposure of the trigeminal stem (TS). If compared to the KWA, the RSA exposed more of the TS (69% vs. 46%; p = 0.01). The EETPA and ILTEA exposed the Gasserian ganglion (GG) mainly in the anteromedial portion, but with a significant 20% gain in exposure provided by the EETPA compared to ILTEA (42% vs. 22%; p = 0.06). The STA with 15 mm of retraction offered the maximum exposure of the GG, with a significant gain in exposure compared to the STA with 10 mm of retraction (50% vs. 35%; p = 0.03). The medial part of the three trigeminal branches was mainly exposed by the EETPA, particularly for the ophthalmic (66%) and maxillary (83%) nerves. The EETPA offered the maximum exposure of the medial part of the mandibular nerve, with a significant gain in exposure compared to the ILTEA (42% vs. 11%; p = 0.01) and the SEY (42% vs. 2%; p = 0.01). The FTOZA offered the maximum exposure of the lateral part of the ophthalmic nerve, with a significant gain of 67% (p = 0.03) and 48% (p = 0.04) in exposure compared to the PTA and STA, respectively. The STA with 15 mm of retraction offered the maximum exposure of the lateral part of the maxillary nerve, with a significant gain in exposure compared to the STA with 10 mm of retraction (58% vs. 45%; p = 0.04). The STA with 15 mm of retraction provided a significant exposure gain of 23% for the lateral part of the mandibular nerve compared to FTOZA with 15 mm of retraction (p = 0.03). Conclusions: The endoscopic approaches, through the endonasal and transorbital routes, can provide adequate exposure of Meckel’s cave, especially for its more medial portions, bypassing the impediment of major neurovascular structures and significant brain retraction. As far as the most lateral portion of Meckel’s cave, MTA approaches still seem to be the gold standard in obtaining optimal exposure and adequate surgical volumes. Full article

Purpose: To investigate the relationship between the apolipoprotein E (APOE) ε4 allele and retinal structural and vascular characteristics in older adult participants from several research studies. We also studied the relationship between these structural and vascular characteristics with multifocal visual evoked potential (mfVEP) indices, neuropsychological parameters and MRI brain volumes in these participants. Methods: In this study, 109 participants with a mean (SD) age of 67.1 (9.0) years were recruited. Participants were classified as APOE ε4 carriers or non-carriers based on the presence or absence of the ε4 allele. Baseline measurements included peripapillary retinal nerve fibre layer optical coherence tomography (RNFL OCT), and OCT–angiography (OCT-A) for evaluation of the retinal layer thickness and vessel density (VD) parameters. A multifocal visual evoked potential (mfVEP) test, including amplitude and latency, was used to assess the visual pathway function. Finally, cognitive function was evaluated using a battery of neuropsychological tests. OCT-A images were analysed in ImageJ to quantify VD in the superficial and deep vascular plexus and the size of the foveal avascular zone (FAZ). The relationship between carriers of APOE ε4 allele and these ocular parameters was analysed using generalised estimating equation (GEE) models and data adjusted for age, sex and inter-eye differences as within-subject variables (p < 0.05). Results: Twenty-four participants were APOE ε4 carriers. Temporal RNFL thickness was decreased in APOE ε4 carriers (p < 0.01). Vessel density between carriers and non-carriers was not significantly different at either the superficial or deep level. The FAZ area was significantly smaller in ε4 carriers in both superficial (p < 0.01) and deep layers (p < 0.003). Conclusions: Retinal abnormalities were present in participants with increased genetic risk of dementia due to presence of the ε4 allele. These findings provide preliminary evidence for their potential role in the diagnosis of dementia. Full article

Objective: The aim of this investigation was to compare the thickness of the deep local muscles in the neck region, as well as local and widespread sensitivity and functionality, between individuals with migraine and healthy control subjects. Methods: An observational study was carried out in accordance with the STROBE statements. The flexor longus colli and multifidus, two neck-stabilizing muscles, were measured using B-mode ultrasound imaging. The upper trapezius, masseter, temporalis, anterior tibialis, and median nerve all underwent bilateral pressure-pain threshold (PPT) assessments. The statistical program SPSS 29.0 was used to implement the Mann–Whitney U test and Chi-squared test. Spearman Rho was utilized to establish the correlations between the variables. Results: Sixty participants were enrolled in the study. The subjects, who were matched in terms of age, gender, and body mass index (BMI), were equally divided into migraine and control groups. No significant differences between the groups were found in the multifidus CSA regarding both sides at rest (right: p = 0.625; left: p = 0.203). However, in contraction, the multifidus CSA showed a significant decrease on the left side in the patients with migraine compared to the controls (p = 0.032), but no significant differences were found in the right multifidus CSA in contraction between the two groups (p = 0.270). In comparison to the healthy volunteers, the migraine sufferers showed a substantial reduction in CSA in the longus colli muscle on both the left side (p = 0.001) and the right side at rest (p = 0.003), as well as in the CSA of the left longus colli in contraction (p < 0.001). Furthermore, the migraine patients showed significantly lower PPT compared to the healthy subjects in local and widespread areas bilaterally. All the parameters revealed higher sensitization in the migraine group in the following areas: the right and left temporal regions (p < 0.001), the right and left upper trapezius (p < 0.001 and p < 0.01, respectively), the right and left masseter muscles (p < 0.01), the right and left median nerves (p < 0.001 and p < 0.01, respectively), and the right and left anterior tibialis muscles (p < 0.001). In terms of the craniocervical flexion test (CCFT), the migraine patients demonstrated significantly lower values than the healthy subjects (p < 0.001). A moderate positive correlation was noted between the PPT in the right temporalis muscle and that in the left longus colli and the right multifidus in contraction. The PPT in the right temporalis muscle also exhibited a positive correlation with the CCFT, although this correlation was low. Between the PPT values, the upper trapezius on both sides showed a moderate positive correlation with the median nerve bilaterally. Conclusions: This research suggests that individuals with migraine may experience local and widespread pain sensitization. A decrease in functionality due to the low muscle endurance of the deep cervical muscles is also accompanied by low values of muscle thickness in contraction. These findings may help to select more accurate treatment approaches for patients with migraine. Full article

Temporal interference stimulation (TIS) aims at targeting deep brain areas during transcranial electrical alternating current stimulation (tACS) by generating interference fields at depth. Although its modulatory effects have been demonstrated in animal and human models and stimulation studies, direct experimental evidence is lacking for its utility in humans (in vivo). Herein, we directly test and compare three different structures: firstly, we perform peripheral nerve and muscle stimulation quantifying muscle twitches as readout, secondly, we stimulate peri-orbitally with phosphene perception as a surrogate marker, and thirdly, we attempt to modulate the mean power of alpha oscillations in the occipital area as measured with electroencephalography (EEG). We found strong evidence for stimulation efficacy on the modulated frequency in the PNS, but we found no evidence for its utility in the CNS. Possible reasons for failing to activate CNS targets could be comparatively higher activation thresholds here or inhibitory stimulation components to the carrier frequency interfering with the effects of the modulated signal. Full article

The aim of the study was to evaluate changes in the retinal thickness and microvasculature based on optical coherence tomography (OCT) depending on baseline oxygen saturation (SpO2) in patients hospitalized due to COVID-19 bilateral pneumonia. The prospective study was carried out among 62 patients with COVID-19 pneumonia who underwent ophthalmic examination after hospital discharge. They were divided into three groups depending on the oxygen saturation (SpO2) on admission: ≤90% (group 1), >90% and ≤95% (group 2), and >95% (group 3). The following parameters were assessed in the ophthalmological examination and correlated with the baseline SpO2: ganglion cell layer (GCL), the retinal nerve fiber layer (RNFL) in the macular area, RNFL in the peripapillary area, the foveal avascular zone (FAZ) in superficial capillary plexus (SCP) and deep capillary plexus (DCP), vessel density (VD) in SCP, in DCP, and in the choriocapillaris plexus (CC). Baseline saturation ≤90% in COVID-19 patients caused a decrease of VD in some areas of SCP and DCP and an increase in FAZ area in SCP and DCP. In the group of patients with SpO2 ≤ 90% statistically significant thinning of the retina in the inner superior ring (ISR) (p = 0.029), the inner temporal ring (ITR) (p = 0.34), the outer superior ring (OSR) (p = 0.012), and the outer temporal ring (OTR) (p= 0.004)] was observed. The statistically significant thickening of RNFL optic disc and thinning of RNFL retina in some macular areas in patients with SpO2 ≤ 90% were reported. The size of FAZ area in SCP and vessel density were significantly greater in some areas of SCP, DCP, and CC in patients with SpO2 ≤ 90% (p = 0.025). Baseline oxygen saturation ≤90% has been found to influence the ocular parameters of OCT in COVID-19 patients. We noticed a widened FAZ zone in SCP and increased VD in some regions of the retina and choroid as a response to systemic hypoxia. Full article

In this paper, we designed a methodology to classify facial nerve function after head and neck surgery. It is important to be able to observe the rehabilitation process objectively after a specific brain surgery, when patients are often affected by face palsy. The dataset that is used for classification problems in this study only contains 236 measurements of 127 patients of complex observations using the most commonly used House–Brackmann (HB) scale, which is based on the subjective opinion of the physician. Although there are several traditional evaluation methods for measuring facial paralysis, they still suffer from ignoring facial movement information. This plays an important role in the analysis of facial paralysis and limits the selection of useful facial features for the evaluation of facial paralysis. In this paper, we present a triple-path convolutional neural network (TPCNN) to evaluate the problem of mimetic muscle rehabilitation, which is observed by a Kinect stereovision camera. A system consisting of three modules for facial landmark measure computation and facial paralysis classification based on a parallel convolutional neural network structure is used to quantitatively assess the classification of facial nerve paralysis by considering facial features based on the region and the temporal variation of facial landmark sequences. The proposed deep network analyzes both the global and local facial movement features of a patient’s face. These extracted high-level representations are then fused for the final evaluation of facial paralysis. The experimental results have verified the better performance of TPCNN compared to state-of-the-art deep learning networks. Full article

To explore retinal abnormalities using spectral domain optical coherence tomography (SD-OCT) and OCT-angiography (OCT-A) in a highly selective cohort of patients with type I hereditary angioedema (HAE). This prospective case-control study included 40 type I HAE patients and 40 age-/sex-matched healthy subjects (HC). All participants underwent SD-OCT-scanning of retinal posterior pole (PP), peripapillary retinal nerve fiber layer (pRNFL), and optic nerve head (ONH). Superficial/deep capillary density was analyzed by OCT-A. A total of 80 eyes from 40 HAE and 40 eyes from HC were evaluated. The pRNFL was thicker in HAE than in HC in nasal superior (p < 0.0001) and temporal quadrants (p = 0.0005 left, p = 0.003 right). The ONH thickness in HAE patients was greater than in HC in the nasal (p = 0.008 left, p = 0.01 right), temporal (p = 0.0005 left, p = 0.003 right), temporal inferior (p = 0.007 left, p = 0.0008 right), and global (p = 0.005 left, p = 0.007 right) scans. Compared to HC, HAE showed a lower capillary density in both superficial (p = 0.001 left, p = 0.006 right) and deep (p = 0.008 left, p = 0.004 right) whole images, and superficial (p = 0.03 left) and deep parafoveal (p = 0.007 left, p = 0.005 right) areas. Our findings documented subclinical retinal abnormalities in type I HAE, supporting a potential role of the retinal assessment by SD-OCT/OCT-A as a useful tool in the comprehensive care of HAE patients. Full article

Cognitive impairment risk in Parkinson’s disease increases with disease progression and poses a significant burden to the patients, their families and society. There are no disease-modifying therapies or preventative measures for Parkinson’s disease mild cognitive impairment (PD-MCI), or Parkinson’s disease dementia (PDD). This article reviews current and previously investigated treatments and those under investigation, including pharmacologic, non-pharmacologic and surgical procedures. There are currently no effective pharmacologic or non-pharmacologic treatments for PD-MCI. The only recommended treatment for PDD currently is rivastigmine, a cholinesterase inhibitor. Donepezil and galantamine—other cholinesterase inhibitors—are possibly useful. Memantine, a N-methyl-D-aspartate (NMDA) receptor antagonist, is considered investigational in PDD. Drug repurposing (atomoxetine, levodopa, insulin, atomoxetine for PD-MCI; ambroxol and ceftriaxone for PDD) and novel medications (SYN120, GRF6021, NYX-458 for PD-MCI; ANAVEX2-73, LY3154207, ENT-01, DAAOI-P for PDD) currently have insufficient evidence. There is growing research supporting exercise in the treatment of PD-MCI, but most non-pharmacological approaches have insufficient evidence for use in PD-MCI (cognitive rehabilitation, deep brain stimulation, transcranial direct current stimulation, transcranial ultrasound, vestibular nerve stimulation) and PDD (cognitive intervention, deep brain stimulation, transcranial alternating current stimulation, transcranial ultrasound, temporal blood brain barrier disruption). Research is needed for both disease-modifying and symptomatic treatments in PD cognitive impairment. Full article

The Genomics of Malignant Peripheral Nerve Sheath Tumor (GeM) Consortium is an international collaboration focusing on multi-omic analysis of malignant peripheral nerve sheath tumors (MPNSTs), the most aggressive tumor associated with neurofibromatosis type 1 (NF1). Here we present a summary of current knowledge gaps, a description of our consortium and the cohort we have assembled, and an overview of our plans for multi-omic analysis of these tumors. We propose that our analysis will lead to a better understanding of the order and timing of genetic events related to MPNST initiation and progression. Our ten institutions have assembled 96 fresh frozen NF1-related (63%) and sporadic MPNST specimens from 86 subjects with corresponding clinical and pathological data. Clinical data have been collected as part of the International MPNST Registry. We will characterize these tumors with bulk whole genome sequencing, RNAseq, and DNA methylation profiling. In addition, we will perform multiregional analysis and temporal sampling, with the same methodologies, on a subset of nine subjects with NF1-related MPNSTs to assess tumor heterogeneity and cancer evolution. Subsequent multi-omic analyses of additional archival specimens will include deep exome sequencing (500×) and high density copy number arrays for both validation of results based on fresh frozen tumors, and to assess further tumor heterogeneity and evolution. Digital pathology images are being collected in a cloud-based platform for consensus review. The result of these efforts will be the largest MPNST multi-omic dataset with correlated clinical and pathological information ever assembled. Full article

Glaucoma is a group of eye diseases which can cause vision loss by damaging the optic nerve. Early glaucoma detection is key to preventing vision loss yet there is a lack of noticeable early symptoms. Colour fundus photography allows the optic disc (OD) to be examined to diagnose glaucoma. Typically, this is done by measuring the vertical cup-to-disc ratio (CDR); however, glaucoma is characterised by thinning of the rim asymmetrically in the inferior-superior-temporal-nasal regions in increasing order. Automatic delineation of the OD features has potential to improve glaucoma management by allowing for this asymmetry to be considered in the measurements. Here, we propose a new deep-learning-based method to segment the OD and optic cup (OC). The core of the proposed method is DenseNet with a fully-convolutional network, whose symmetric U-shaped architecture allows pixel-wise classification. The predicted OD and OC boundaries are then used to estimate the CDR on two axes for glaucoma diagnosis. We assess the proposed method’s performance using a large retinal colour fundus dataset, outperforming state-of-the-art segmentation methods. Furthermore, we generalise our method to segment four fundus datasets from different devices without further training, outperforming the state-of-the-art on two and achieving comparable results on the remaining two. Full article