Cercul de NEUROCHIRURGIE SI

NEUROLOGIE
BUCURESTI

FASCICULUL LONGITUDINAL
SUPERIOR

AMIGDALOHIPOCAMPECTOMIA SELECTIVA

Caru Bogdan
Clin Edward

 Manunchi important de fibre de

asociatie
Situat dorsolateral de PUTAMEN si
superior de CLAUSTRUM
Conecteaza lobul
FRONTAL
TEMPORAL
PARIETAL

Fascicul
longitudinal
superior

Claustrum
Putamen

 Format din 3 segmente:

Orizontal : lob parietal lob frontal
SLF I
SLF II
SLF III

Vertical : lob parietal lob temporal

Fascicul arcuat : lob temporal lob
frontal

SLF I
Cortex parietal superior si medial
Ariile 6, 8, 9 si aria motorie suplimentara
II

Reglarea comportamentului motor in

functie de locatia partilor corpului in
spatiu

SLF II
Cortex parietal inferior
Cortex prefrontal dorsolateral (6, 8, 46)

Informatii referitoare la perceptia spatiului

vizual
Aria 46 sustinerea atentiei si memoria
de lucru

SLF III
Girul supramarginal
Cortex premotor ventral (6, 44, 46)

Transfera informatie
somatosenzoriale articularea
limbajului

Fasciculul arcuat
Partea dorsala a girului temporal superior
(22)
Cortexul prefrontal (8, 46) / partea
dorsala a girului frontal inferior

Rol in repetarea cuvintelor percepute si

trasmiterea informatiilor auditive

Metode de vizualizare
Diffusion tensor imaging (DTI)
Permite mapping-ul procesului de difuziune al
apei in tesuturi biologie
Arata anormalitati in structura substantei albe
Fractional anisotropy (FA) scara valorica
intre 0 si 1 care descrie gradul de anizotropie
al unui proces de difuziune
Tractografia reconstituirea 3D a tracturilor
nervoase

Fascicul arcuat -Afazia de

conducere
Este un SINDROM DE DECONECTARE
apare prin lezarea FASCICULULUI
ARCUAT
Afazie de conducere fara lezarea
fasciculului arcuat afectarea
cortexului temporal superior stang si
a girului supramarginal stang

Afazia motorie/Broca cortex

frontal posterior si structuri
subiacente

Afazia senzoriala/Wernicke
partea posterioara a cortexului
temporal superior si mijlociu

Fascicul arcuat Schizofrenie

Schizofrenie modificari de conectivitate la
nivelul materiei albe
Fascicule care unesc lobii frontal, temporal si
parietal : FA si FU
Modificari la nivelul acestor fascicule la
pacientii schizofrenici si la persoane
susceptibile
Biomarker in apreciera riscului de a dezvolta
schizofrenie
Severitatea simptomatologiei gradul de
modificare al fasciculelor

Evidence of slow maturation of the

SLF in early childhood

Scop: existenta unor modificari

macroscopice in anatomia
creierului, descifrate prin DTI

Procedura:

DTI a 44 subiecti pediatrici si 30 adulti

comparatie pixel cu pixel a orientarii
tisulare intre grupuri

 Rezultat:
schimbari statistice semnificative
intre neonatali si adulti la nivel SLF
corelare puternica intre varsta si SLF

Discutii:
maturizarea axonala incetinita a
tractului implicat in limbaj
reorganizare axonala si mielinizarea
contribuie la aparitia SLF

 Diverse studii au aratat ca

manunchiuri de fibre distincte
corespunzatoare SLF, exista doar
la specii dezvoltate( si maimuta
Macaque) si nu la soarece sau
specii inferioare.
Implicarea SLF in functii inalte ale
creierului asociate limbajului.

Childhood risk factors for

psychosis predict lower FA in SLF
Factori de risc: IQ scazut, status
socioeconomic scazut, traume in
copilarie, istoric de cannabis
Neurodezvoltare aberanta in 112
adulti sanatosi

 Rezultatele au evidentiat ca o
prezenta crescuta de factori de risc
se asociaza cu o anizotropie
fractionala scazuta in SLF stang
(densitate,diametru,mielinizare
scazuta)
Acesti factori de risc contribuie la
anormalitatile creierului asociate
cu boala psihotica

Right Arcuate Fasciculus abnormality in

Chronic Fatigue Syndrome

15 subiecti de control cu CFS supusi DTI

Scop: identificarea unor diferente in
structura microscopica care sa explice
simptomele
Rezultat: anizotropia fractionala crescuta in
fasciculul arcuat drept, proportional cu
gradul de severitate CFS
Utilizare: biomarker

Correlation between language function and

left AF after brain tumor surgery

Evaluarea schimbarii postoperatorii

in fasciculul arcuat( prin tractografie)
si a limbajului(Western Aphasia
Battery)
7 pacienti cu tumora in emisfera
stanga proximal de fasciculul arcuat

 Dupa rezectia tumorala, vizualizarea

FA a fost crescuta la 5 din 7 pacienti
si scorul WAB crescut la 6 din 7
Confirma legatura dintr FA si limbaj
Schimbarile postoperatorii detectate
prin DTI pot reprezenta un factor
predictiv al limbajului.

SLF subserves vestibular network in human

Corelatii intre imagistica

postoperatorie si manevre
intraoperatorii(stimulare) sugereaza
implicarea SLF in raspandirea
simptomelor vestibulare.
Fasciculul poate juca un rol in
conectivitatea ariilor implicate in
functia vestibulara

Increased FA of SLF associated with poor

visuospatial abilities in Williams syndrome

S-a examinat integritatea substantei

albe la pacienti cu sindrom Williams
Integritatea microstructurala era
crescuta in SLF drept
Rol specific al anormalitatii SLF drept in
deficitul de constructie spatiala din
Williams.

 http://youtu.be/1aplTvEQ6ew?
t=36s
https://www.youtube.com/watch?
v=Zi1yQhYpfFM
http://youtu.be/XbJUmVIES7k?t=9s
http://www.hhmi.org/biointeractive/
patient-conduction-aphasia

BADEA IONUT
MOHOREA ALEXANDRA

Hipocamp

Amigdala

Memory outcome after selective amygdalohippocampectomy: a

study in 140 patients with temporal lobe epilepsy.
PURPOSE:
The technique of selective amygdalohippocampectomy (SAH) was originally
developed in epilepsy surgery to spare unaffected brain tissue from surgery,
thus minimizing the cognitive consequences of temporal lobe surgery. The
results of previous studies, however, are equivocal in this regard. This study
evaluated memory after SAH in a large sample of patients with mesial
temporal lobe epilepsy.
METHODS:
The 140 patients received material-specific memory tests before and 3
months after unilateral SAH.
RESULTS:
Significant declines in all aspects of verbal learning and memory were found
particularly for the left resected group. With reliability-of-change indices, a
high number of patients showed postoperative verbal memory declines, < or
= 51% in left SAH and < or = 32% in right SAH. For left SAH, a higher
preoperative verbal memory performance, a lower preoperative nonverbal
memory score, an older age at surgery, and a later onset of epilepsy
predicted a stronger decline in verbal memory. After right SAH, the risk for a
verbal memory decline was slightly increased when patients had surgical
complications or a presurgical evaluation with bilateral intrahippocampal
depth electrodes. Results concerning nonverbal memory were less clear.
CONCLUSIONS:
The results clearly indicate, that particularly left SAH can lead to a significant
decline in memory functions. Predictors of postoperative verbal memory
were similar to those reported for temporal lobectomy. Postoperative
deteriorations were broader and stronger in our study than in previous
studies. We discuss methodologic differences (sample size, retest interval,
extent of resection) and other factors as possible reasons.

BNST neurocircuitry in humans.

Abstract
Anxiety and addiction disorders are two of the most common mental
disorders in the United States, and are typically chronic, disabling, and
comorbid. Emerging evidence suggests the bed nucleus of the stria
terminalis (BNST) mediates both anxiety and addiction through
connections with other brain regions, including the amygdala and
nucleus accumbens. Although BNST structural connections have been
identified in rodents and a limited number of structural connections have
been verified in non-human primates, BNST connections have yet to be
described in humans. Neuroimaging is a powerful tool for identifying
structural and functional circuits in vivo. In this study, we examined BNST
structural and functional connectivity in a large sample of humans. The
BNST showed structural and functional connections with multiple
subcortical regions, including limbic, thalamic, and basal ganglia
structures, confirming structural findings in rodents. We describe two
novel connections in the human brain that have not been previously
reported in rodents or non-human primates, including a structural
connection with the temporal pole, and a functional connection with the
paracingulate gyrus. The findings of this study provide a map of the
BNST's structural and functional connectivity across the brain in healthy
humans. In large part, the BNST neurocircuitry in humans is similar to the
findings from rodents and non-human primates; however, several
connections are unique to humans. Future explorations of BNST
neurocircuitry in anxiety and addiction disorders have the potential to
reveal novel mechanisms underlying these disabling psychiatric illnesses.

 The amygdala and basal forebrain as a pathway for

motivationally guided attention.
Visual stimuli associated with rewards attract spatial attention.
Neurophysiological mechanisms that mediate this process must
register both the motivational significance and location of visual
stimuli. Recent neurophysiological evidence indicates that the
amygdala encodes information about both of these parameters.
Furthermore, the firing rate of amygdala neurons predicts the
allocation of spatial attention. One neural pathway through which
the amygdala might influence attention involves the intimate
and bidirectional connections between the amygdala and basal
forebrain (BF), a brain area long implicated in attention. Neurons
in the rhesus monkey amygdala and BF were therefore recorded
simultaneously while subjects performed a detection task in
which the stimulus-reward associations of visual stimuli
modulated spatial attention. Neurons in BF were spatially
selective for reward-predictive stimuli, much like the amygdala.
The onset of reward-predictive signals in each brain area
suggested different routes of processing for reward-predictive
stimuli appearing in the ipsilateral and contralateral fields.
Moreover, neurons in the amygdala, but not BF, tracked trial-totrial fluctuations in spatial attention. These results suggest that
the amygdala and BF could play distinct yet inter-related roles in
influencing attention elicited by reward-predictive stimuli.

 Top-down control of visual responses to fear by the

amygdala.
Abstract
The visual cortex is sensitive to emotional stimuli. This
sensitivity is typically assumed to arise when amygdala
modulates visual cortex via backwards connections. Using
human fMRI, we compared dynamic causal connectivity
models of sensitivity with fearful faces. This model
comparison tested whether amygdala modulates distinct
cortical areas, depending on dynamic or static face
presentation. The ventral temporal fusiform face area
showed sensitivity to fearful expressions in static faces.
However, for dynamic faces, we found fear sensitivity in
dorsal motion-sensitive areas within hMT+/V5 and superior
temporal sulcus. The model with the greatest evidence
included connections modulated by dynamic and static fear
from amygdala to dorsal and ventral temporal areas,
respectively. According to this functional architecture,
amygdala could enhance encoding of fearful expression
movements from video and the form of fearful expressions
from static images. The amygdala may therefore optimize
visual encoding of socially charged and salient information.

PURPOSE:
The purpose of this study was to assess axis-I DSM-IV psychiatric disorders in
patients at baseline and 3 months after surgery for medically refractory temporal
lobe epilepsy.
METHOD:
The Mini International Neuropsychiatric Interview (MINI) and Quality of Life in
Epilepsy Inventory-10 (QOLIE-10) were evaluated before and 3 months after
surgery in 50 consecutive patients (21 females, 29 males) with medically
refractory temporal lobe epilepsy (persistent seizures>2/month, despite treatment
with 2 appropriate drugs in adequate doses for 2 years) who underwent
surgery [anterior temporal lobectomy with amygdalo-hippocampectomy (for
mesial temporal sclerosis in 40), electrocorticography-guided lesionectomy (for
other lesions in 10)].
RESULTS:
Twenty-six patients (52%) had an axis-I psychiatric disorder [26% depressive
disorder, 28% anxiety disorder] at baseline, while 30 (60%) patients had an axis-I
psychiatric disorder [28% depressive disorder, 28% anxiety disorder] at 3 months
after surgery. Twenty percent developed a new psychiatric disorder, while 12%
showed improvement postsurgery. Mean QOLIE-10 scores improved from 23.78 to
17.80 [24 (48%) patients showed 5-point improvement]. Thirty-four (68%)
patients had no seizure, 6 (12%) had non-disabling seizures, while 2 (4%) had
disabling seizures after surgery. High frequency of seizures prior to surgery
(p<0.038) and seizure occurrence after surgery (p<0.055) predicted the presence
of psychiatric disorders after surgery. No clinical characteristic could predict
development of new psychiatric disorder after surgery.
CONCLUSION:
Psychiatric dysfunction in the early postsurgery period is seen in nearly half of
patients undergoing surgery for temporal lobe epilepsy, is mild in nature, and
does not adversely affect quality of life but may cause significant clinical problems
when it arises de novo postsurgery
http://www.ncbi.nlm.nih.gov/pubmed/24463306

OBJECTIVE:
In temporal lobe epilepsy surgery, there is a trend towards becoming more
selective in order to achieve seizure control with an optimal neuropsychological
outcome. The present study evaluated whether mesial resection length matters
for memory outcome after selective amygdalo-hippocampectomy (SAH).
Therefore, a sub-analysis of the larger SFB/TR3/A1 multicentre randomised trial
on seizure outcome and mesial resection length in temporal lobe surgery was
performed.
METHODS:
A homogeneous group of 67 selectively operated patients with hippocampal
sclerosis as the sole pathology were allocated to a short (2.5 cm, n=34) or a
long (3.5 cm, n=33) mesial resection. Repeated memory assessment and
three-dimensional MRI data sets served as dependent within group variables,
and intraoperatively determined resection lengths (short/long), resected
hippocampal volumes (small/large) and side of surgery were independent
between group variables.
RESULTS:
Resection length did not have a significant effect on seizure or on memory
outcome. The resected hippocampal volume also did not affect seizure
outcome but it did make a difference with regard to memory outcome.
Outcome in verbal learning and memory was poorer after resection of larger
left hippocampal volumes. Figural memory outcome was poorer with larger
resected volumes on either side.
INTERPRETATION:
The data indicate that in SAH, mesial resection length and resected volumes
have no differential effect on seizure outcome. The findings on memory
outcome are best explained by suggesting that hippocampal volumes take the
degree of preoperative pathology into account whereas resection length does
not. This suggests resection of non-pathological functional tissues as the basis
for memory outcome after SAH.
http://www.ncbi.nlm.nih.gov/pubmed/21653207