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Blood–Brain Barrier and Cerebrospinal Fluid (CSF)
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
CSF circulates through the ventricular system and the subarachnoid space from the formation sites to the absorption sites and has a hydrostatic pressure of 6.5–20 cmH2O (or 5–15 mmHg). Ciliary movements of the ependymal cells propel the CSF towards the fourth ventricle and the foramina of Luschka and Magendie into the cisterna magna. From the cisterna magna, CSF passes superiorly into the subarachnoid space around the cerebellar hemispheres, caudally into the spinal subarachnoid space, and cephalad to the basilar cisterns (around the premedullary pontine and interpeduncular cisterns). From the basilar cisterns, CSF flows through the pre-chiasmatic cistern and Sylvian fissure to the lateral and frontal cortical regions, and by a second route to the medial and posterior part of the cerebral cortex (Figure 5.2). Respiratory oscillations and arterial pulsations of the cerebral arteries and choroid plexus provide additional momentum for the movement of CSF.
Oil contrast lymphangiography: New role for the surgical candidate?
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Francesco Boccardo, Sara Dessalvi, Corrado Cesare Campisi, Corradino Campisi
Chyloperitoneum and PLE may often be combined. Also, it should not be forgotten that, apart from intestinal lymphatics, lumbar lymphatics—collecting the lymph from the lower limbs, external genitalia, intra-abdominal organs, kidneys, adrenal gland, and abdominal wall—flow into the cisterna chyli. Furthermore, considering the thoracic-mediastinal catchment basin of the thoracic duct and that lymphatic dysplasias can affect even one or more extra-abdominal sites, due to bizarre malformation combinations, chyloperitoneum can also be associated with a whole range of different pathological pictures: chylothorax; chylous cyst, mediastinal chyloma, or chylomediastinum; chylopericardium; chyluria; chylo-colpometrorrhea; chyloedema of external genitalia and/or of one or both lower limbs, with chylo-lymphostatic verrucosis and subsequent chylo-lymphorrhea; and chylous joint effusion.
Microdeletion Syndromes
Published in Merlin G. Butler, F. John Meaney, Genetics of Developmental Disabilities, 2019
Gopalrao V. N. Velagaleti, Nancy J. Carpenter
With increasing age, the phenotype changes and becomes less distinctive (21). The cry disappears during the first two years. The face lengthens and the eyes may become deep set. The hypertelorism and epicanthal folds disappear and the palpebral fissures are normally placed (Fig. 4). In adult patients, the mouth is large with a high-arched palate and there is severe dental malocclusion and decay. They may have a wide-based or ataxic-like gait. Sometimes hypertonia replaces the hypotonia seen in childhood. Premature graying of the hair and scoliosis are commonly seen in adults. A CT scan of the brain in one adult with this syndrome showed dilatation of the lateral ventricles and widened basal cisternae (21). Additional studies of malformations of the cranial base in patients with this syndrome suggested the presence of a developmental field between the brainstem and the laryngeal region (22).
Investigation of apoptotic and antiproliferative effects of Turkish natural tetraploids Trifolium pratense L. extract on C6 glioblastoma cells via light and electron microscopy
Published in Ultrastructural Pathology, 2023
Gamze Tanrıverdi, Aynur Abdulova, Hatice Çölgeçen, Havva Atar, Belisa Kaleci, Tuğba Ekiz-Yılmaz
It was determined that the control groups consisted of spindle-shaped elongated cells with intact cell membrane, euchromatic nuclei, mitochondria with normal morphology and ordinary crista, well-developed Golgi, many free ribosomes in the cytoplasm and prominent GER and SER (Figure 10A and B). In the 12.5 µg/mL and 25 µg/mL Trifolium pratense L. applied (also called as effective dose) groups, the cells had lost their elongated form and exhibited round or polygonal shapes and also were evaluated as vacuolated and hypertrophic (Figure 10E–L). Furthermore, mitochondria were damaged, and the cristae structures were degenerated (Figure G, H). The GER and SER cisternae were highly enlarged and with irregular shape. The cells had abnormal morphology and cytoplasmic appearance, and the number of vesicular structures in their cytoplasm had increased markedly (Figure 10E–L). In parallel with the increasing doses of Trifolium pratense extract, the number of autophagic vacuoles increased in the cells. In addition, it was observed that there were many extra-vesicles closely related to the cells (Figure 10E–L). Microscopic evaluations revealed numerous cells with cytoplasmic membrane blebs and numerous apoptotic cell bodies (Figure 10I–K).
Pure endoscopic resection of pineal region tumors through supracerebellar infratentorial approach with ‘head-up’ park-bench position
Published in Neurological Research, 2023
Wei Hua, Hao Xu, Xin Zhang, Guo Yu, Xiaowen Wang, Jinsen Zhang, Zhiguang Pan, Wei Zhu
Patients were placed in the modified left ‘head-up’ park-bench position, with the upper body elevated and the head slightly extended instead of anteflexion. The head was then secured in place with a Mayfield three-pin head clamp and slightly flexed. Neuronavigation was registered in the Stryker Navigation System (Stryker, Kalamazoo, Michigan) and used to determine the optimal ‘head-up’ angle. An occipital midline skin incision and craniotomy approximately 3 × 3 cm in size were made (Figure 1 d and e). A U-shaped dural incision was made, and the cerebrospinal fluid of the cisterna magna was slowly released to further decrease the intracranial pressure. Through the combination of gravity assistance and reduced pressure, the corridor between the cerebellum and the tentorium could be easily opened.
Prenatal diagnosis of Emanuel syndrome – case series and review of the literature
Published in Journal of Obstetrics and Gynaecology, 2022
Patrycja Piwowarczyk, Diana Massalska, Izabela Obodzińska, Sylwia Gawlik Zawiślak, Julia Bijok, Anna Kucińska-Chahwan, Tomasz Roszkowski
The third unrelated patient at the age of 36 years (gravida 2 para 1) was referred to our department at 13 gestational weeks due to foetal cerebral malformations visualised during routine first-trimester scan and increased nuchal translucency (3.9 mm). Her medical history was unremarkable and there was no family history of genetic disorders. The ultrasound examination performed in our department revealed an enlarged cisterna magna, parallel cerebral peduncles and dilated cerebral aqueduct (Figure 3). Additionally, hypoplastic right ventricle was diagnosed. Chorionic villus sampling was performed due to foetal abnormalities and a pathogenic genomic imbalance, consistent with ES, was diagnosed by CMA – 11q23.3q25x3, 22q11.1q11.21x3. After genetic counselling, the patient decided to terminate the pregnancy. Parental karyotyping is pending.