6000 msec, TE 140 msec, section thickness 5 mm; and 3) postcontrast T1-weighted images using gadopentetate dimeglumine injection (0.1 mmol/kg, Beilu Pharma), TR 450 msec, TE 15 msec, section thickness 5 mm, matrix size 256 × 256. The radiological parameters of the postoperative MR images were maintained in accordance with the preoperative scans. Tumor Classification We proposed a new classification of insular gliomas, the “putamen classification,” to describe the anatomical features of the tumors. In this classification, insular gliomas were divided into 2 cohorts
Yongheng Wang, Yinyan Wang, Xing Fan, Shaowu Li, Xing Liu, Jiangfei Wang and Tao Jiang
Paul F. Morrison, Russell R. Lonser and Edward H. Oldfield
subsequently, no clinical benefit was observed and this delivery route was abandoned. To overcome these limitations, GDNF, or a viral vector expressing GDNF, was distributed in the striatum using CED and was found to reverse parkinsonian symptoms in animal models of PD, 13 , 17 which led to clinical trials in which GDNF was distributed in the putamen via CED. Unlike intraventricular delivery and other methods that rely on diffusion for distribution, CED is not limited by an agent's molecular weight, concentration, or restricted diffusive properties. 7 , 25 Convection
John T. Slevin, Don M. Gash, Charles D. Smith, Greg A. Gerhardt, Richard Kryscio, Himachandra Chebrolu, Ashley Walton, Renee Wagner and A. Byron Young
and two women (age 47–70 years) with moderate to advanced idiopathic PD (Hoehn and Yahr Stage III or IV) comprised the study population ( Table 1 ). During stereotactic surgery, a catheter was implanted in the putamen and then connected to a SynchroMed pump (Medtronic, Inc.) subcutaneously implanted in the abdominal wall. The 40-port catheters (model 10532, Medtronic) were unilaterally implanted into the posterior to midputamen, contralateral to the most affected side. Details on the surgery, the drug delivery system, and the response of the patients to the first 6
Vivek Sudhakar, Jerusha Naidoo, Lluis Samaranch, John R. Bringas, Russell R. Lonser, Massimo S. Fiandaca and Krystof S. Bankiewicz
Consequently, effective perfusion of elongated nuclear structures is essential to potentiate clinical trial outcomes, including gene therapy for Parkinson’s disease (PD), other neurodegenerative disorders, and deficiency syndromes. 8 , 10 , 23 , 24 , 36 To overcome this limitation using current CED techniques, we investigated the effectiveness and efficiency of a dynamic “infuse-as-you-go” approach where a single cannula is advanced stepwise during active CED within the longitudinal (anteroposterior) axis of the putamen. We compared these findings to those obtained using
Comparative study based on serial CT and time-course analysis
Kazuhiko Fujitsu, Masato Muramoto, Yoshihiro Ikeda, Yoshinori Inada, Iru Kim and Takeo Kuwabara
✓ Serial computerized tomography (CT) scans were correlated with a precise time-course analysis of the neurological condition of 180 patients with hypertensive putaminal hemorrhage. All patients entered the study within 3 hours of the ictus. In this series, 111 patients were treated conservatively and 69 surgically. The neurological condition of each patient was measured by means of a newly proposed grading system for intracerebral hemorrhage-intracranial hemorrhage (ICH grade) which is a modification of the Glasgow Coma Scale. Serial CT scans revealed that most hemorrhages were completed within 6 hours after ictus. Based on the ICH grade at 6 hours postictus, a clinical classification of the severity of putaminal hemorrhage was defined: fulminant, rapidly progressive, slowly progressive, and nonprogressive. According to this classification, precise time courses of the ICH grade were compared between the conservative and surgical treatment groups in a 7-day postictal period. Activities of daily living at 6 months after ictus were also compared.
Surgical treatment for a rapidly progressive hemorrhage appears to be beneficial if undertaken in patients under 65 years of age. Surgery in a slowly progressive hemorrhage should be considered only in a small number of patients who deteriorate neurologically with conservative treatment. In this series of patients, surgical treatment of fulminant and nonprogressive hemorrhage was not likely to improve the quality of life or functional recovery. Regardless of treatment modality, CT provided evidence that patients with anterior capsular hemorrhage (16% in this series) showed good recovery of motor and speech function.
A comparative study of 305 nonsurgical and 154 surgical cases
Tetsuo Kanno, Hirotoshi Sano, Youichi Shinomiya, Kazuhiro Katada, Junji Nagata, Masaaki Hoshino and Fuyuki Mitsuyama
✓ The indications for surgery in hypertensive intracerebral hematoma are still controversial. The reason for this may be: 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution; 2) lack of adequate close follow-up monitoring over an extended period of time; or 3) lack of proper classification of hematomas for comparison of results from different institutions. The authors have treated 459 cases of hypertensive intracerebral hematoma between October, 1975, and July, 1983. The hematomas have been classified according to their mode of extension on computerized tomography. The long-term outcome was assessed on the basis of activity of daily living.
Putaminal hematomas were classified as mild, moderate, severe, and very severe. In general, there was no significant difference in outcome between the surgical and nonsurgical cases; however, the outcome in the moderate and severe hematomas was found to be a little better for the surgical cases in some restricted areas. Thalamic and pontine hemorrhages were classified as mild, moderate, or severe. If the hematoma is localized to the thalamus or pons, and if it extends to the midbrain, there is no indication for surgery; however, in patients with moderate hematomas, the prognosis showed a variable outcome, and the indications for surgery were questionable. In cerebellar hematomas, the authors propose that even a hematoma with a diameter greater than 3 cm might show a good outcome with nonsurgical therapy.
Taro Nimura, Keiichiro Yamaguchi, Tadashi Ando, Satoshi Shibuya, Takanori Oikawa, Atsuhiro Nakagawa, Reizo Shirane, Masatoshi Itoh and Teiji Tominaga
demonstrated that fluctuation of synaptic dopamine concentrations in the putamen precedes the clinically apparent wearing-off phenomenon and suggested that an increased dopamine turnover might be involved in levodopa-related motor complications. In the present study, we estimated the effects of DBS of the STN on the concentration of dopamine in the putamen and caudate nucleus of patients with advanced PD. Recently, [ 11 C]raclopride PET has been used to assess levels of dopamine D 2 receptor occupancies by different doses of levodopa or typical and atypical antipsychotics
Satoshi Okada, Yoshio Nakagawa and Kimiyoshi Hirakawa
tactile sensation were disturbed mainly in the right C-4 to T-2 areas, and the right side of the face. Vibration and position sensation were intact. There were no cerebellar signs and, with the exception of the fifth nerve, the cranial nerves were not impaired. Magnetic resonance imaging of an area from the lower spine to the brain showed the presence of syringomyelia from T-1 to C-1, and a lowering of the tonsil to the C-1 level in the sagittal section. The syrinx was revealed to extend through the brain stem to the right putamen along the pyramidal tract ( Fig. 1
Xiaotong Fan, Brian D. Nelson, Yi Ai, David K. Stiles, Don M. Gash, Peter A. Hardy and Zhiming Zhang
was to analyze targeted compound delivery into the primate putamen using a catheter designed to promote CED. The MRI contrast agent Gd-DTPA was used so that the infused compound could be tracked by noninvasive neuroimaging. 13 The parameters evaluated were 1) neurological effects from continuous infusion into the putamen, 2) catheter placement, 3) catheter patency, 4) volume of distribution of 2 concentrations of test material, and 5) kinetics of compound distribution and clearance. Each animal underwent 4 sequential catheter implantations into the putamen. The
Takeshi Nakajima, Taro Nimura, Keiichiro Yamaguchi, Tadashi Ando, Masatoshi Itoh, Takashi Yoshimoto and Reizo Shirane
agitation nor body movement was observed during the scanning period. Evaluation of the Binding Potential of Dopamine Receptors Seven hemispheres that underwent surgical intervention, five unilaterally and one bilaterally, and five hemispheres without intervention were subjected to the binding potential analysis. An ROI analysis was conducted using average 11 C-nemonapride—enhanced images obtained 70 to 90 minutes after injection of the tracer. As shown in Fig. 2 , in each hemisphere, ROIs were defined in the putamen, thalamus, dorsolateral prefrontal cortex