Search Results (160)

Purpose: Our understanding of the influence of preterm birth and related perinatal exposures on early brain development is limited, hampering personalized optimization of neuroprotective strategies. This study assesses the effect of gestational age (GA) at birth on brain volumes at term-equivalent age (TEA) in infants without overt brain injury born across the GA spectrum. Methods: A cohort of infants born across the GA spectrum (25–40 weeks’ gestation) underwent 3T brain MRI around TEA (40–46 weeks postmenstrual age). Eight brain regions, intracranial and total tissue volumes were segmented using MANTiS (morphologically adaptive neonatal tissue segmentation toolbox). Segmentations were visually quality-checked and excluded if segmentation failed. Absolute TEA volume in relation to GA was assessed using univariate and multivariate (correction for postmenstrual age) linear regression analysis. Statistical significance was set at p < 0.05. Post hoc scatter plots of brain volumes relative to intracranial volumes were created. Results: Fifty infants were included (mean GA = 35.0 [SD = 3.3, range = 25.7–40.1] weeks). A higher GA at birth was significantly related to lower cerebrospinal fluid (p = 0.004) and amygdala (p = 0.02) volumes; no significant relation was found between GA and other volumes. Post hoc analyses showed positive trends between GA and several brain structures, including total brain tissue, cortical gray matter, deep gray matter, hippocampus, cerebellum and brainstem volumes. Conclusions: Our results suggest that GA has an effect on TEA brain volumes that is independent of brain lesions, with lower GA being associated with smaller brain tissue volumes and significantly larger cerebrospinal fluid volume. Preterm birth and related exposures may thus affect early brain growth and contribute to neurodevelopmental challenges encountered by preterm-born children. Full article

Background and Objectives: The objective of this research is to make a comparative evaluation of the correlation between the volumetric examination of subcortical cerebral regions and white matter hyperintensities classified according to the Fazekas scoring system. Materials and Methods: A total of 236 cases with cranial MRI studies were retrospectively analyzed. This study included patients aged over 45 years who had white matter hyperintensities and who did not have a prior stroke diagnosis. White matter hyperintensities were evaluated in axial FLAIR images according to Fazekas’s grading scale. Patients with Fazekas 0 and 1 were grouped in group 1 and the patients with Fazekas 2 and 3 were grouped in group 2. MRI data processing and subcortical volumetric analyses were performed using the volBrain MRI brain volumetry system. Results: There were statistically significant differences between groups 1 and 2 in terms of cerebrospinal fluid total brain white and gray matter (p < 0.001), total brain white and gray matter (p = 0.009), total cerebrum (p < 0.001), accumbens (p < 0.001), thalamus (p < 0.001), frontal lobe (p < 0.001), parietal lobe (p < 0.001), and lateral ventricle (p < 0.001) volumes. Conclusions: Our study finds a strong link between white matter hyperintensity burden and brain atrophy. This includes volume reductions in total brain white and gray matter, frontal and parietal lobe atrophy, increased cerebrospinal fluid (CSF), and atrophy in specific brain regions such as the accumbens and thalamus. Full article

Introduction: Obesity is a rapidly increasing condition that leads to serious health issues. The sense of smell, one of the oldest senses related to energy metabolism, has been increasingly studied in relation to obesity. Objective: This study investigates the impact of childhood obesity on the volumes of the olfactory bulb and pituitary gland, exploring the relationship between body mass index and these brain structures. Method: This study included 146 participants aged 6–18 years with different body mass indices between 2021 and 2024 at Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey. Participants were classified into normal weight, obese, and morbidly obese groups, and olfactory bulb and pituitary gland volumes were retrospectively analyzed. MRI scans were performed to exclude intracranial pathologies due to headache complaints, and patients with cranial pathologies were excluded from the study. Results: This study examined the olfactory bulb and pituitary gland volumes among normal weight, obese, and morbidly obese groups aged 6–18 years. In the morbidly obese group, right olfactory bulb area and right olfactory bulb volume were significantly higher compared to the other groups, while left olfactory bulb area was higher in both the obese and morbidly obese groups. Additionally, in the morbidly obese group, pituitary height was significantly lower than the other groups, and pituitary volume was also found to be reduced in morbid obesity. Conclusions: This study demonstrated that childhood obesity is linked to significant changes in the volumes of the olfactory bulb and pituitary gland. In morbidly obese children, an increase in pituitary volume and alterations in olfactory bulb volume suggest possible neuroanatomical adaptations. Full article

The quality of life (QoL) perception has been studied in neurological diseases; however, there is limited information linking brain morphological characteristics, QoL, and cognition. Human behavior and perception are associated with specific brain areas that interact through diffuse electrochemical networking. We used magnetic resonance imaging (MRI) to analyze the brain region volume (BRV) correlation with the scores of Rand’s 36-item Short Form Survey (SF-36) and cognitive domains (memory and dementia status). We analyzed data from 420 adult participants in the Maracaibo Aging Study (MAS). Principal component analysis with oblimin axis rotation was used to gather redundant information from brain parcels and SF-36 domains. Canonical correlation was used to analyze the relationships between SF-36 domains and BRV (adjusted for intracranial cavity), as well as sex, age, education, obesity, and hypertension. The average age (±SD) of subjects was 56 ± 11.5 years; 71% were female; 39% were obese; 12% had diabetes, 52% hypertension, and 7% dementia. No sex-related differences were found in memory and orientation scores, but women had lower QoL scores. The 1st and 2nd canonical correlation roots support the association of SF-36 domains (except social functioning and role emotional) and total brain volume, frontal lobe volume, frontal pole, lateral orbital lobe, cerebellar, and entorhinal areas. Other variables, including age, dementia, memory score, and systolic blood pressure, had a significant influence. The results of this study demonstrate significant correlations between BRV and SF-36 components, adjusted for covariates. The frontal lobe and insula were associated with the mental health component; the lateral-orbital frontal lobe and entorhinal area were correlated with the physical component. Full article

Objectives: Methamphetamine (MA) abuse during adolescence can have a significant impact on brain development. On the other hand, regular exercise is known to promote brain health and may have neuroprotective effects. The purpose of this study is to compare brain volumes in three different adolescent groups: those with active methamphetamine use disorder (MUD), adolescent athletes who regularly exercise, and healthy control adolescents. Methods: This MRI study involved three groups of adolescents: 10 with active MUD (9 males, 1 female), nine licensed runner adolescents (three males, six females), and 10 healthy adolescents (5 males, 5 females). Brain volumes were analyzed using T1-weighted images from a 3.0 Tesla MRI scanner, and then segmented automatically with vol2Brain. Statistical analyses included ANCOVA with sex as a covariate and LSD post hoc tests performed using SPSS Statistics 23. Results: Adolescents with MUD showed a 10% increase in total white matter volume compared to the athlete group. Conversely, cortical gray matter volume was reduced by 4% compared to the healthy control group and by 7% compared to the athlete group. The frontal and insular cortices in the MUD group had significantly diminished volumes compared to the athlete group. Overall, individuals with MUD had decreased gray matter volumes and increased white matter volumes in their brains. The brain volumetric differences between the MUD group and the athlete group were statistically significant. Conclusions: The brains of those with MUD displayed a reduction in gray matter volume and an increase in white matter volume, indicating damage from MA on the developing adolescent brain. The volumetric disparities between the MUD and athlete groups were found to be significantly different, suggesting a possible neuroprotective factor of exercise. Further studies are required to explore the potential of exercise-based interventions in alleviating the harmful effects of MA abuse. Full article

Objective: Traditional imaging modalities for the planning of Gamma Knife radiosurgery (GKRS) are non-specific and do not accurately delineate intracranial neoplasms. This study aimed to evaluate the utility of positron emission tomography (PET) for the planning of GKRS for intracranial neoplasms (ICNs) and the post-GKRS applications of PET for patient care. Methods: PubMed, Scopus, and ScienceDirect were searched in order to assemble relevant studies regarding the uses of PET in conjunction with GKRS for ICN treatment. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to identify relevant studies on the use of PET in conjunction with GKRS. Particular emphasis was placed on review articles and medical research investigating tumor delineation and post-operative care. Relevant studies were selected and assessed based on quality measures, including study design, sample size, and significance. Inclusion and exclusion criteria were used to examine the yield of the initial search (n = 105). After a secondary review, the included results were identified (n = 50). Results: This study revealed that PET imaging is highly accurate for the planning of GKRS. In fact, many cases indicate that it is more specific than traditional imaging modalities. PET is also capable of complementing traditional imaging techniques through combination imaging. This showed significant efficacy for the planning of GKRS for ICNs. Conclusions: While PET shows a multitude of applications for the treatment of ICNs with GKRS, further research is necessary to assemble a complete set of clinical guidelines for treatment specifications. Importantly, future studies need a greater standardization of methods and expanded trials with a multitude of radiotracers. Full article

Meningiomas are the most common primary intracranial tumors in adults. For most cases, surgical resection is effective in mitigating recurrence risk. Accurate visualization of meningiomas helps radiologists assess the distribution and volume of the tumor within the brain while assisting neurosurgeons in preoperative planning. This paper introduces an innovative realistic 3D medical visualization system, namely SegR3D. It incorporates a 3D medical image segmentation pipeline, which preprocesses the data via semi-supervised learning-based multi-target segmentation to generate masks of the lesion areas. Subsequently, both the original medical images and segmentation masks are utilized as non-scalar volume data inputs into the realistic rendering pipeline. We propose a novel importance transfer function, assigning varying degrees of importance to different mask values to emphasize the areas of interest. Our rendering pipeline integrates physically based rendering with advanced illumination techniques to enhance the depiction of the structural characteristics and shapes of lesion areas. We conducted a user study involving medical practitioners to evaluate the effectiveness of SegR3D. Our experimental results indicate that SegR3D demonstrates superior efficacy in the visual analysis of meningiomas compared to conventional visualization methods. Full article

(1) Background: Lymphedema is a common but underrecognized sequela of cancer treatment. Supermicrosurgical procedures such as lymphaticovenular anastomosis (LVA) and, more recently, lymph node-to-vein anastomosis (LNVA) have emerged as effective options for fluid-predominant disease. In 2024, we began performing robot-assisted LNVA using a next-generation microsurgical robot. This study describes our initial experience, technical insights, and the potential for robotics to extend the boundaries of supermicrosurgery. (2) Methods: Twenty-two consecutive robotic LNVAs were performed by a high-volume supermicrosurgeon at a tertiary center. Preoperative imaging with standard and ultra-high frequency ultrasound was used to identify optimal lymph nodes and veins. Robotic LNVA was performed using the Symani Surgical System, with adaptations for motion scaling, ergonomics, and console control. Intraoperative patency was confirmed by direct washout and/or indocyanine green (ICG) transit. (3) Results: All 22 procedures were technically successful, with 100% intraoperative patency. Anastomosis time improved from 37 to 18 min. Robotic assistance enhanced precision, eliminated tremors, and reduced the technical burden of operating at extreme submillimeter scales. (4) Conclusions: Robotic LNVA is safe, feasible, and efficient. It optimizes current techniques, offering the potential to extend surgical access below the 0.1 mm threshold, with implications for future treatment of lymphatic and possibly intracranial disease. Full article

Intracranial pressure (ICP) pulse wave morphology, including the ratios of the three characteristic peaks (P1, P2, and P3), offers valuable insights into intracranial dynamics and brain compliance. Traditional invasive methods for ICP pulse wave monitoring pose significant risks, highlighting the need for non-invasive alternatives. This pilot study investigates a novel non-invasive method for monitoring ICP pulse waves through closed eyelids, using a specially designed, liquid-filled, fully passive sensor system named ‘Archimedes 02’. To our knowledge, this is the first technological approach that enables the non-invasive monitoring of ICP pulse waveforms via closed eyelids. This study involved 10 healthy volunteers, aged 26–39 years, who underwent resting-state non-invasive ICP pulse wave monitoring sessions using the ‘Archimedes 02’ device while in the supine position. The recorded signals were processed to extract pulse waves and evaluate their morphological characteristics. The results indicated successful detection of pressure pulse waves, showing the expected three peaks (P1, P2, and P3) in all subjects. The calculated P2/P1 ratios were 0.762 (SD = ±0.229) for the left eye and 0.808 (SD = ±0.310) for the right eye, suggesting normal intracranial compliance across the cohort, despite variations observed in some individuals. Physiological tests—the Valsalva maneuver and the Queckenstedt test, both performed in the supine position—induced statistically significant increases in the P2/P1 and P3/P1 ratios, supporting the notion that non-invasively recorded pressure pulse waves, measured through closed eyelids, reflect intracranial volume and pressure dynamics. Additionally, a transient hypoemic/hyperemic response test performed in the upright position induced signal changes in pressure recordings from the ‘Archimedes 02’ sensor that were consistent with intact cerebral blood flow autoregulation, aligning with established physiological principles. These findings indicate that ICP pulse waves and their dynamic changes can be monitored non-invasively through closed eyelids, offering a potential method for brain monitoring in patients for whom invasive procedures are not feasible. Full article

Purpose: We present our single-institution experience of sarcomatous brain metastasis patients who underwent stereotactic radiosurgery (SRS) over the past 35 years. Methods: In total, 31 patients (16 males) who underwent SRS for sarcoma brain metastases were identified. Median age at presentation to SRS was 47 (range: 4–78) months. Common histopathologies included leiomyosarcoma (eight patients), osteosarcoma (six patients), alveolar sarcoma (three patients), Ewing sarcoma (three patients), and undifferentiated/unclassified sarcoma (three patients). The median Karnofsky Performance Score (KPS) was 90. Nine patients underwent pre-SRS craniotomy. The median dose prescribed was 18 Gy. The median cumulative tumor volume was 1.4 cc. Results: Median patient overall survival (OS) after SRS was 7 (range: 0–155) months. Local tumor control (LTC) was achieved in 105 out of 113 tumors, at a median time of 3 (range: 0–17) months between SRS and progression. LTC rates per patient and per tumor were 74.2% and 92.9%, respectively. Following SRS, 10 patients (32.3%) developed new tumors at a median time of 6 (range: 1–25) months. Four patients experienced adverse radiation effects (AREs). At the last follow-up, all patients died, one patient from intracranial progression, 27 from systemic disease progression, and the remaining from unrelated medical conditions. Conclusions: Given high LTC and low ARE rates, this suggests SRS as a strong candidate for the non-invasive management of sarcomatous brain metastases, which typically present late following initial presentation of the primary disease. Full article

Background/Objective: The Trail Making Test (TMT) is a widely used neuropsychological tool to assess processing speed (Part A) and executive function (Part B). However, the neuroanatomical substrates underlying its Black & White variant (TMT-B&W) and the influence of demographic factors remain poorly understood. This study aimed to identify gray matter (GM) correlates of TMT-B&W performance across unadjusted and covariate-adjusted models in cognitively healthy adults. Methods: In this cross-sectional study, 87 participants (40–80 years) underwent structural magnetic resonance imaging (MRI) and completed TMT-B&W. Whole-brain voxel-based morphometry (VBM) was conducted using FreeSurfer for preprocessing and Computational Anatomy Toolbox (CAT12)/Statistical Parametric Mapping (SPM12) for analysis. Two voxel-wise regression models (unadjusted and adjusted for age, education, gender, and total intracranial volume (TICV)) assessed GM associations with TMT-B&W-A-B performance. Statistical thresholds were voxel-level p < 0.001 (uncorrected) and cluster-level Family-Wise Error (FWE) correction (p < 0.001). Results: In unadjusted models, TMT-B&W-A performance correlated with GM reductions in the right orbitofrontal cortex (T = 42.64, equivk = 515.60, representing peak voxel level T-statistic and cluster size in voxels), while TMT-B&W-B linked to the right insular cortex (T = 50.65, equivk = 515.50). After adjustment, both tasks converged on the left thalamus (TMT-A: T = 8.05, equivk = 594; TMT-B: T = 8.11, equivk = 621), with TMT-B&W-B showing a denser thalamic cluster. Demographic covariates attenuated cortical associations, revealing thalamic integration as a shared mechanism. Conclusions: The thalamus emerges as a critical hub for TMT-B&W performance when accounting for demographic variation, while distinct cortical regions mediate task-specific demands in unadjusted models. These findings support the TMT-B&W as a practical, low-cost neurobehavioral marker of brain integrity in older populations. Full article

Background/Objectives: Aging is one of the greatest risk factors for neurodegenerative diseases such as Alzheimer’s disease (AD). As the disease progresses, neural loss in brain regions, such as the olfactory cortex (OC), i.e., a set of areas including the mediotemporal and orbitofrontal regions, may lead to dysfunction in the sense of smell and affect other brain regions that relate to the olfactory cortex by either afferent or efferent projections. Methods: The objective of this study was to assess sex-related differences in olfactory cortex volume using magnetic resonance imaging in individuals with mild cognitive impairment, probable dementia of the AD type and in healthy older adults, using the Mini-Mental Statement Examination score, years of education, and total intracranial volume as correction factors. Results: Atrophy of the olfactory cortex was observed in patients of both sexes with probable AD dementia. However, at the MCI stage, significant volumetric loss in the OC was detected in females only but not in males. Conclusions: This finding indicates greater pathological effects in this region in females at an earlier disease stage than in males. This study suggests that OC volume loss occurs differently between the sexes in older adults, with volumetric loss being greater in females. Full article

Introduction: The purpose of this study is to provide foundational data for nursing care in patients with external ventricular drainage (EVD) by comparatively analyzing drainage volume in relation to intracranial pressure (ICP) and drainage catheter size. Methods: In this study, we conducted a volumetric analysis using the continuity and Bernoulli equations, considering friction forces under predefined conditions. In adults in the supine position with 37 °C CSF, the ventricular drainage volume was assessed based on the height of the EVD system, ICP levels, and EVD catheter sizes. Results: The results indicated that the CSF flow rate increased with larger catheter diameters and when the EVD system was positioned lower than the reference point (foramen of Monro). Across all catheter sizes, the minimum CSF flow occurred when the EVD system was 15 cm above the reference point, while the maximum flow was observed when it was 15 cm below the reference point. This multidisciplinary study, utilizing fluid dynamics, quantitatively estimates the drainage volume in EVD systems based on ICP and catheter size, contributing to the nursing care of EVD systems. The findings underscore the importance of developing specific nursing guidelines to improve patient safety in external ventricular drainage management and incorporating them into clinical education. Conclusions: A limitation of this study is that it does not compare with patients in clinical settings for clinical empirical validity. Therefore, a stepwise validation process is necessary. So, future studies will need to compare medical record data with the results of this study to confirm the validity of the equations presented. Full article

Introduction: Advanced magnetic resonance imaging (MRI) techniques in neuroplasticity evaluations provide important information on stroke disease and the underlying mechanisms of neuronal recovery. It has been observed that gray matter density or volume in brain regions closely related to motor function can be a valuable indicator of the response to treatment. Objective: To compare structural MRI-evaluated gray matter volume changes in patients with post-stroke upper limb spasticity for >1 year between those undergoing surgery and those treated with botulinum toxin A (BoNT-A) and to relate these findings to upper limb function and quality of life outcomes. Materials and Methods: Design. A two-arm controlled and randomized clinical trial in patients with post-stroke upper limb spasticity. Participants. Thirty post-stroke patients with spastic upper limbs. Intervention. Participants were randomly assigned (1:1 allocation ratio) for surgery (experimental group) or treatment with BoNT-A (control group). Main outcome measures. The functional parameters were analyzed with Fugl-Meyer, Zancolli, Keenan, House, Ashworth, pain visual analogue, and hospital anxiety and depression scales. Quality of life was evaluated using SF-36 and Newcastle stroke-specific quality of life scales. The carer burden questionnaire was also applied. Clinical examinations and MRI scans were performed at baseline and at six months post-intervention. Correlations between brain volume/thickness and predictors of interest were examined across evaluations and groups. Results: Five patients were excluded due to the presence of intracranial implants. Eleven patients were excluded from analyses since they were late dropouts. Changes were observed in the experimental group but not in the control group. Between baseline and six months, gray matter volume was augmented at the hippocampus and gyrus rectus and cortical thickness was increased at the frontal pole, occipital gyrus, and insular cortex, indicating anatomical changes in key areas related to motor and behavioral adaptation These changes were significantly related to subjective pain, Ashworth spasticity scale, and Newcastle quality of life scores, and marginally related to the carer burden score. Conclusions: The structural analysis of gray matter by MRI revealed differences in patients with post-stroke sequelae undergoing different therapies. Gray matter volume and cortical thickness measurements showed significant improvements in the surgery group but not in the BoNT-A group. Volume was increased in areas associated with motor and sensory functions, suggesting a neuroprotective or regenerative effect of upper limb surgery. Full article

Background/Objectives: Intracranial arteriovenous malformations (AVMs) exhibit a complex vasculature characterized by a locally occurring tangled nidus connecting the arterial and venous system bypassing the capillary network. Clinically available imaging modalities may not give sufficient spatial or temporal resolution. Adequate 3D models of large vascular areas and a detailed blood flow analysis of the nidus including the surrounding vessels are not available yet. Methods: Three representative AVM cases containing multimodal image data (3D rotational angiography, magnetic resonance angiography, magnetic resonance venography, and phase-contrast quantitative magnetic resonance imaging) are investigated. Image segmentation results in partial 3D models of the different vascular segments, which are merged into large-scale neurovascular models. Subsequently, image-based blood flow simulations are conducted based on the segmented models using patient-specific flow measurements as boundary conditions. Results: The segmentation results provide comprehensive 3D models of the overall arteriovenous morphology including realistic nidus vessels. The qualitative results of the hemodynamic simulations show realistic flow behavior in the complex vasculature. Feeding arteries exhibit increased wall shear stress (WSS) and higher flow velocities in two cases compared to contralateral vessels. In addition, feeding arteries are exposed to higher overall WSS with increased value variation between individual vessels (20.1 Pa ± 17.3 Pa) compared to the draining veins having a 62% lower WSS (8.9 Pa ± 5.9 Pa). Blood flow distribution is dragged towards the dominating circulation side feeding the nidus for all the cases quantified by the volume flow direction changes in the posterior communicating arteries. Conclusions: This multimodal study demonstrates the feasibility of the presented workflow to acquire detailed blood flow predictions in large-scale AVM models based on complex image data. The hemodynamic models serve as a base for endovascular treatment modeling influencing flow patterns in distally located vasculatures. Full article