下丘脑火腿肠瘤激光消融术后丘脑大规模回路的术中变化

IF 3.4 2区 医学 Q2 NEUROIMAGING
Karim Mithani , Oliver L. Richards , Mark Ebden , Noor Malik , Ladina Greuter , Hrishikesh Suresh , Farbod Niazi , Flavia Venetucci Gouveia , Elysa Widjaja , Shelly Weiss , Elizabeth Donner , Hiroshi Otsubo , Ayako Ochi , Puneet Jain , Ivanna Yau , Elizabeth N. Kerr , James T. Rutka , James M. Drake , Alexander G. Weil , George M Ibrahim
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引用次数: 0

摘要

背景和目的下丘脑仓瘤(HH)引起的痉挛性发作治疗难度很大,部分原因是对发作传播途径的了解不全面。尽管磁共振成像引导下的激光间质热疗(MRgLITT)是一种很有前景的干预方法,可切断下丘脑仓瘤与癫痫发作传播网络的联系,但实现癫痫发作自由的最佳消融部位尚不清楚。在这项研究中,我们调查了术中消融后静息态功能连接的变化,以确定与成功断开HH连接相关的大规模网络。方法连续招募在两家机构接受MRgLITT治疗HH的儿童,并随访至少一年。最后一次随访时恩格尔评分达到 1A 即为无癫痫发作。在保持恒定的全身麻醉深度的情况下,采集消融前后的即时静息状态功能磁共振成像扫描。采用多变量广义线性模型确定术中与癫痫发作结果相关的大尺度连通性变化。涉及前扣带回皮层的丘脑皮层回路的术中变化与癫痫无发作有关。无癫痫发作的儿童与前扣带皮层和背侧前扣带皮层的连接分别增加和减少。讨论HH的成功断开与术中丘脑皮层连接的大规模变化有关。这些变化为了解凝胶痉挛发作的大规模基础提供了新的视角,并可能代表治疗成功的术中生物标志物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intraoperative changes in large-scale thalamic circuitry following laser ablation of hypothalamic hamartomas

Background and objectives

Gelastic seizures due to hypothalamic hamartomas (HH) are challenging to treat, in part due to an incomplete understanding of seizure propagation pathways. Although magnetic resonance imaging-guided laser interstitial thermal therapy (MRgLITT) is a promising intervention to disconnect HH from ictal propagation networks, the optimal site of ablation to achieve seizure freedom is not known. In this study, we investigated intraoperative post-ablation changes in resting-state functional connectivity to identify large-scale networks associated with successful disconnection of HH.

Methods

Children who underwent MRgLITT for HH at two institutions were consecutively recruited and followed for a minimum of one year. Seizure freedom was defined as Engel score of 1A at the last available follow-up. Immediate pre- and post- ablation resting-state functional MRI scans were acquired while maintaining a constant depth of general anesthetic. Multivariable generalized linear models were used to identify intraoperative changes in large-scale connectivity associated with seizure outcomes.

Results

Twelve patients underwent MRgLITT for HH, five of whom were seizure-free at their last follow-up. Intraprocedural changes in thalamocortical circuitry involving the anterior cingulate cortex were associated with seizure-freedom. Children who were seizure-free demonstrated an increase and decrease in connectivity to the pregenual and dorsal anterior cingulate cortices, respectively. In addition, children who became seizure-free demonstrated increased thalamic connectivity to the periaqueductal gray immediately following MRgLITT.

Discussion

Successful disconnection of HH is associated with intraoperative, large-scale changes in thalamocortical connectivity. These changes provide novel insights into the large-scale basis of gelastic seizures and may represent intraoperative biomarkers of treatment success.

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来源期刊
Neuroimage-Clinical
Neuroimage-Clinical NEUROIMAGING-
CiteScore
7.50
自引率
4.80%
发文量
368
审稿时长
52 days
期刊介绍: NeuroImage: Clinical, a journal of diseases, disorders and syndromes involving the Nervous System, provides a vehicle for communicating important advances in the study of abnormal structure-function relationships of the human nervous system based on imaging. The focus of NeuroImage: Clinical is on defining changes to the brain associated with primary neurologic and psychiatric diseases and disorders of the nervous system as well as behavioral syndromes and developmental conditions. The main criterion for judging papers is the extent of scientific advancement in the understanding of the pathophysiologic mechanisms of diseases and disorders, in identification of functional models that link clinical signs and symptoms with brain function and in the creation of image based tools applicable to a broad range of clinical needs including diagnosis, monitoring and tracking of illness, predicting therapeutic response and development of new treatments. Papers dealing with structure and function in animal models will also be considered if they reveal mechanisms that can be readily translated to human conditions.
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