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Craniopharyngioma
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Hermann L. Müller, Claire Alapetite, Jeffrey Wisoff
Since these tumors often extend diffusely throughout the suprasellar cisterns, displacing and distorting normal structures, identification of the vascular anatomy provides essential landmarks. Starting laterally, the Sylvian fissure is widely split and the distal branches of the middle cerebral artery are identified. The arachnoidal dissection proceeds medially to the main trunk of the middle cerebral artery, which is followed proximally to the ipsilateral carotid bifurcation, anterior cerebral artery, and internal carotid artery. As the carotid is followed proximally to the clinoid, the optic nerve, chiasm, and/or tracts are identified in relation to the tumor.
Normal Fetal Anatomy
Published in Asim Kurjak, CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
The hypoechoic area located posteriorly and laterally to the thalami represents the hypocampus. The strong echoes between the thalamus and the hypocampus are thought to represent ambient cisterns. The lateral border of the hypocampus is formed by the trigone of the lateral ventricle, where two lines can occasionally be seen, corresponding to the medial and lateral borders of the trigone. At the same level, the insula with the overlying Sylvian fissure is usually visible in the lateral aspect of the cerebral hemisphere. On real time it can be easily recognized by the vascular pulsations of the middle cerebral artery (Figure 12).
Perception of Sounds at the Auditory Cortex
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Frank E. Musiek, Jane A. Baran
The classic study of Geschwind and Levitsky8 alerted us to the concept of anatomical differences between the left and right sides of the planum temporale (see Figure 50.2). This study and many subsequent studies have shown that in normal brains the left planum temporale is significantly larger than its right-sided counterpart. There is also anatomical evidence that is definitely slanted towards the Sylvian fissure being longer and more horizontal on the left than the right side of the brain.2,9 In regard to Heschl’s gyrus there is also evidence supporting a left-sided size advantage, but this is not without some exceptions that point to both left and right Heschl’s being similar in size.1,2,10,11 The existence of asymmetries for the core–belt orientation is, at least for the present authors, difficult to glean from the literature and requires more investigation before a definitive determination of the existence of any asymmetries (or lack thereof) can be rendered. This lack of information regarding asymmetries in the core–belt areas is due in part to the lack of understanding of the borders of the core–belt designation as it applies to humans.
Clinical profile of primary progressive aphasias in a tertiary care centre from India
Published in International Journal of Speech-Language Pathology, 2019
Appaswamy Thirumal Prabhakar, Vivek Mathew, Ajith Sivadasan, Sanjith Aaron, Anirudh George, Mathew Alexander
Of the 23 patients with PPA, 16 (69.6%) were diagnosed with PPA-G. The mean age was 58.8 years and more males were affected. The mean duration of disease at the time of presentation was 3 years. Patients presented with agrammatism, anomia and non-fluent speech. Their speech was effortful and agrammatic, and single word comprehension was normal but complex comprehension was impaired. Phonemic paraphasias were noted in five patients. Two patients had severe apraxia of speech (AOS) at the time of presentation. Seven patients were bilingual, and 3 patients had relative preservation of the mother tongue. During the follow-up period, 3 patients developed features of cortico-basal syndrome and parkinsonism. MRIs of the brains of patients showed prominence of the left Sylvian fissure in 15 (93.7%) patients and left inferior frontal gyrus atrophy in 12(75%) patients.
Beyond descriptive neurology: Broca, cerebral hemodynamics, and cortical function
Published in Journal of the History of the Neurosciences, 2018
Broca’s understanding of the potential of the collateral circulation in cerebral ischemia was as sophisticated as ours is today. Contemporary neurologists, who can assemble arteriography, computed tomography, magnetic resonance imaging, and positron emission tomography as aids in the diagnosis and treatment of stroke, are sometimes surprised that the concepts on which they rely were known to their nineteenth-century predecessors. Chief among them is the ability of the ischemic area to recruit blood from unaffected arteries. Most strokes involve the distribution of the middle cerebral artery, which includes the frontal, parietal, and temporal lobes about the Sylvian fissure. The central core of a stroke is irrevocably destined for infarction, whether the occlusion is at the origin of the internal carotid artery or more distally within the main trunk of the middle cerebral artery. The periphery of a stroke, referred to as the penumbra (Hakim, 1987), may only be ischemic and may remain viable if it is revascularized. This can occur if anastomoses develop to supply the penumbra across a border zone region. Therefore, blood flow across the border zones is a major determinant in the extent and severity of a stroke. The capacity to form anastomoses to revascularize the penumbra depends on three factors: the integrity of the circle of Willis, through which the major cerebral arteries communicate at the base of the brain; the size of the anterior and posterior communicating arteries and extent to which they are free of arteriosclerosis; and the speed at which the occlusion of the affected artery occurs, that is, rapidly with embolization, slowly with thrombosis.
Successfully disposal of an acute MCA occlusion by Onyx during AVM embolism
Published in British Journal of Neurosurgery, 2020
Gang Peng, Chen Xing Yang, Hongwei Liu, Chenfu Shen
Still under general anesthesia, a large pterional cranioectomy was performed. The anterior and middle skull base was exposed. The fronto-temporal dura was opened. The superior sylvian veins were filled with bright red arterial blood. The Sylvian fissure was dissected. The MCA trunk and M2 and M3 branches were filled with Onyx. We performed arterotomy on the MCA trunk, removed the Onyx and suture the arterotomy, then from proximal to distal we repeated this procedure to remove the Onyx from M2 and M3 branches, after totally 10 arterotomies, all the Onyx gel were removed. 8 hours after occlusion, all arteries were then seen to pulsate. Finally, we removed the AVM. We feared a malignant MCA infarct to removed the bone flap.