Orbitofrontal sulcal and gyrus pattern in human: an anatomical study

The anatomical characterization of the orbitofrontal cortex in human is limited in literature instead of many functional and clinical studies involving it. Objective: Anatomically define the orbitofrontal region aiming to possible neurosurgical treatments and unify the scientific nomenclature as well. Method: We analyze eighty four human hemispheres using a surgical microscope. Then we chose four hemispheres and dissect them according to Klinger' technique. Results: We found five main sulcus: olfatory sulcus, orbital medial sulcus, orbital lateral sulcus, orbital transverse sulcus and orbital intermediate sulcus. These sulcus, excluding the intermediate sulcus, delimit five gyrus: rectus gurys, orbital medial gyrus, orbital anterior gyrus, orbital lateral gyrus and orbital posterior gyrus. the main sulcal configuration can be divided on four more frequently patterns. Conclusion: Orbitofrontal cortex is associated with many psychiatric disorders. Better anatomical and functional characterization of the orbitofrontal cortex and its connections will improve our knowledge about these diseases.Universidade Federal de São Paulo, Escola Paulista Med, Disciplina Neurocirurgia, São Paulo, SP, BrazilHosp Albert Einstein, Disciplina Radiol, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Disciplina Neurocirurgia, São Paulo, SP, BrazilWeb of Scienc

Alterações anatômicas da base do crânio nas mielomeningoceles tratadas intra-útero e após o nascimento

Objective: Analyze the skull base of patients that underwent to fetal myelomeningocele repair and compare them to patients submitted to postnatal correction surgery and to a normal control group. Methods: We retrospectively analyzed the records of patients from the Post Natal Group with individuals who underwent myelomeningocele correction surgery up to 48 hours after birth, and the Fetal Group consisting of patients undergoing myelomeningocele correction surgery in the period between 19 and 27 weeks and six days of gestation. We compared birth weight, gestational age at birth, ventriculo-peritoneal shunt placement rate, clivus supraocciput angle (an indirect measure of posterior fossa amplitude), Welcher angle, head circumference adjusted for gestational age at birth up to the age of 2 years. For analysis of the supraocciput clivus angle, we used T1-weighted or T2- weighted brain magnetic resonance in sagittal sections of the postnatal period and a Control Group of individuals which the brain magnetic resonance reveled normal under the age of 5. Results: We selected 70 individuals from the Fetal Group and 68 from the Post Natal Group. A statistically significant difference between the mean supraocciput clivus angle of 87.6o of the Fetal Group was found compared to the mean angle of the of 77.7o of the Post-Natal Group and 89,1o of the Control Group (p <0.0001 in the one-way ANOVA Test). Besides, the mean angle of Welcher in the Fetal Group was 136o , while in the Post Natal Group it was 135o , and 137o in the Control Group, with no statistical difference between the means. Gestational age at birth and sex-adjusted head circumference growth curves were generated and showed that both groups Fetal and Post-Natal had statistically distinct curves, which are within the range of -3 and + 3 score Z of the World Health Organization curves. The comparison of the head circumference growth curves adjusted for sex and gestational age at the birth of the subgroups that used or not acetazolamide in the Fetal Group revealed that patients of both sexes of the group who used the acetazolamide remained tangent to the +3 Score Z while the group that did not use acetazolamide remained between +2 and +3 Score Z. There was 8.5% indication of ventricular-peritoneal shunt or endoscopic third ventriculostomy in the Fetal Group and 76.4% in the Post Natal Group. It was also identified prematurity and low birth weight in the Fetal Group when compared to the Post Natal Group. Conclusion: The increase in the supraocciput clivus angle, which occurs in the intrauterine repaired patients when compared to patients operated after birth, may justify a decrease in the prevalence of hydrocephalus because it represents an increase in the amplitude of the posterior fossa.Objetivos: Analisar a base do crânio dos pacientes submetidos a cirurgia de correção de mielomeningocele intra-útero, compará-los aos pacientes submetidos a cirurgia de correção pós-natal e aos indivíduos normais do grupo controle. Métodos: Foram analisados retrospectivamente os registos de pacientes do Grupo Pós-Natal com indivíduos que foram submetidos a cirurgia de correção de mielomeningocele até 48 horas após o nascimento e do Grupo Fetal constituído de pacientes submetidos a cirurgia de correção de mielomeningocele no período entre 19 e 27 semanas e 6 dias de gestação. Foram comparados peso ao nascimento, idade gestacional ao nascimento, taxa de indicação de derivação ventrículo-peritoneal, ângulo clivus supraoccipital (medida indireta do volume da fossa posterior), ângulo de Welcher, perímetro cefálico ajustados para idade gestacional ao nascimento até a idade de 2 anos. Para análise do ângulo clivus supraoccipital utilizamos ressonâncias de crânio ponderadas em T1 ou T2 em cortes sagitais do período pósnatal dos Grupos Fetal e Pós-natal, bem como de um Grupo Controle composto por indivíduos menores de 5 anos com exames normais de ressonância magnética de crânio. Resultados: Foram selecionados 70 indivíduos do Grupo Fetal e 68 do Grupo Pós-Natal. Encontrou-se uma diferença estatisticamente significante do ângulo clivus supraoccipital médio de 87,6o do Grupo Fetal comparados ao ângulo médio do Grupo Pós-Natal de 77,7o e 89,1o do grupo Controle ( p<0,0001 no teste one-way ANOVA). Além disso o ângulo médio de Welcher no Grupo Fetal foi de 136o , no Grupo Pós-Natal foi de 135o e no Grupo Controle 137o , sem diferença estatística para as médias. Identificou-se nas curvas de crescimento do perímetro cefálico ajustadas para idade gestacional ao nascimento e sexo, que os grupos Fetal e Pós-Natal, embora pertençam a curvas estatisticamente distintas, estão dentro do intervalo dos Escore Z -3 e +3 das curvas da Organização Mundial de Saúde. Na comparação das curvas de crescimento do perímetro cefálico ajustada para sexo e idade gestacional ao nascimento dos subgrupos que fizeram ou não uso de acetazolamida, identificou-se que os pacientes de ambos os sexos que usaram acetazolamida se mantiveram tangentes ao Escore Z+3 enquanto o grupo que não fez uso de acetazolamida permaneceu entre os Escores Z +2 e +3. Encontrou-se 8,5% de indicação de derivação ventrículo-peritoneal ou terceiro ventriculostomia endoscópica no Grupo Fetal e 76,4% no Grupo Pós-Natal. Identificou-se ainda prematuridade e baixo peso ao nascimento no Grupo Fetal quando comparado ao Grupo Pós-Natal. Conclusão: O aumento do ângulo clivus supraoccipital, que ocorre nos casos operados intra-útero quando comparado com os pacientes operados após o nascimento, pode justificar a diminuição da prevalência de hidrocefalia por representar um aumento da amplitude da fossa posterior.Dados abertos - Sucupira - Teses e dissertações (2019

Antenatal management of fetal neurosurgical diseases

The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.Univ Fed Sao Paulo, Dept Neurosurg, Rua Botucatu 591,Conj 41, BR-04023062 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Gynecol & Obstet, Rua Botucatu 591,Conj 41, BR-04023062 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Neurosurg, Rua Botucatu 591,Conj 41, BR-04023062 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Gynecol & Obstet, Rua Botucatu 591,Conj 41, BR-04023062 Sao Paulo, SP, BrazilWeb of Scienc