František Charvát

Cortical and subcortical atrophy in alzheimer disease: Parallel atrophy of thalamus and hippocampus

Brain atrophy is a key imaging hallmark of Alzheimer disease (AD). In this study, we carried out an integrative evaluation of AD-related atrophy. Twelve patients with AD and 13 healthy controls were enrolled. We conducted a cross-sectional analysis of total brain tissue volumes with SIENAX. Localized gray matter atrophy was identified with optimized voxel-wise morphometry (FSL-VBM), and subcortical atrophy was evaluated by active shape model implemented in FMRIB’s Integrated Registration Segmentation Toolkit. SIENAX analysis demonstrated total brain atrophy in AD patients; voxel-based morphometry analysis showed atrophy in the bilateral mediotemporal regions and in the posterior brain regions. In addition, regarding the diminished volumes of thalami and hippocampi in AD patients, subsequent vertex analysis of the segmented structures indicated shrinkage of the bilateral anterior thalami and the left medial hippocampus. Interestingly, the volume of the thalami and hippocampi were highly correlated with the volume of the thalami and amygdalae on both sides in AD patients, but not in healthy controls. This complex structural information proved useful in the detailed interpretation of AD-related neurodegenerative process, as the multilevel approach showed both global and local atrophy on cortical and subcortical levels. Most importantly, our results raise the possibility that subcortical structure atrophy is not independent in AD patients.

Treatment for brain arteriovenous malformation in the 1998–2011 period and review of the literature

PurposeThe results of the treatment of pial AVM provided at our neurosurgical centre are presented. Based on these results and on an overview of literary data on the efficacy and complications of each therapeutic modality, the algorithm of indications, as used at our institution, is presented.Cohort of patientsThe series comprises 195 patients, aged 9 to 87xa0years and treated in the years 1998–2011. The surgical group consists of 76 patients; of these, 49 patients solely received endovascular treatment, 25 were consulted and referred directly to the radiosurgical unit, and the remaining 45 were recommended to abide by the strategy of “watch and wait”.ResultsIn the surgical group, serious complications were 3.9xa0%, at a 96.1xa0% therapeutic efficacy. As for AVM treated with purely endovascular methods, serious procedural complications were seen in 4.1xa0% of patients, with efficacy totalling 32.7xa0%. One observed patient suffered bleeding, resulting in death. For comparison with literary data for each modality, a survival analysis without haemorrhage following monotherapy for AVM with each particular modality was carried out.ConclusionsBased on our analysis, we have devised the following algorithm of treatment:1.We regard surgical treatment as the treatment of choice for AVM of Spetzler-Martin (S-M) grades I and II, and only for those grade III cases that are surgically accessible.2.Endovascular intervention should mainly be used for preoperative embolisation, as a curative procedure for lower-grade AVM in patients with comorbidities, and as palliation only for higher-grade cases.3.Stereotactic irradiation with Leksell Gamma Knife (LGK) is advisable, mainly for poorly accessible, deep-seated grade-III AV malformations. In the case of lower grades, the final decision is left to the properly informed patient.4.Observation should be used as the method of choice in AVM of grades IV and V, where active therapy carries greater risk than the natural course of the disease.

Clip first policy in management of intracranial MCA aneurysms: Single-centre experience with a systematic review of literature

BackgroundThe results of microsurgical treatment for middle cerebral artery (MCA) aneurysms (ANs) have been highly satisfying for decades, notoriously posing a challenge for interventional neuroradiologists. Following the International Subarachnoid Aneurysm Trial (ISAT) study results, most centres across Europe and the USA switched to a coil first policy. The purpose of this study is to evaluate and critically review the substantiation of this change.MethodsThe authors conducted a single-institution retrospective study of MCA AN treatment between January 2000 and December 2013 maintaining a “clip first” policy. The results are supplied with a literature review.ResultsA total of 315 MCA ANs were treated in 288 consecutive patients (209 females, 79 males). Microsurgical treatment was performed for 238 AN patients (116 ruptured, 122 unruptured) and 77 AN patients (46 ruptured, 31 unruptured) who underwent a coiling procedure. Treatment-related morbidity and mortality (MM) for unruptured ANs was 2.8xa0% in the microsurgical group and 10.3xa0% in the endovascular group. The percentage of patients with no/minor permanent neurological deficits after SAH in a good initial clinical state (HH 1–2) was 93xa0% in the microsurgical and 76xa0% in the endovascular group. A literature review identified 21 studies concerning MCA AN treatment with a specified decision-making algorithm. Microsurgery seemed superior to endovascular management regarding both clinical and radiological outcomes, although several aspects of the analysed reports might appear questionable.ConclusionAlthough this study has its inherent limitations, the effect brought about by microsurgical clipping of MCA ANs remains superior to that of endovascular embolisation and it should be sustained as the first treatment choice. The decision about the treatment strategy should be made by a multi-disciplinary team consisting of specialists from both teams, bearing in mind the higher occlusion rate and longevity of the surgical treatment.

Evaluation of white matter alterations in Alzheimer's disease and normal pressure hydrocephalus as measured by diffusion weighted MRI

IN ALZHEIMER’S DISEASE AND NORMAL PRESSURE HYDROCEPHALUS AS MEASURED BY DIFFUSION WEIGHTED MRI Daniel Horinek, Irena Buksakowska, Nikoletta Szab o, Eszter T oth, Vlastimil Sulc, Luka s Martinkovi c, Ji r ı Vr ana, Martin Vyhnalek, Franti sek Charv at, Miloslav Ro cek, L aszl o V ecsei, Jakub Hort, Tam as Kinsces, Charles Universit, 1st Medical Faculty, and University Central Military Hospital, Prague, Czech Republic; Charles University in Prague and University Hospital Motol, Prague, Czech Republic; Albert Szent-Gy€orgyi Clinical Center, University of Szeged, Szeged, Hungary; International Research Center, St. Anne’s University Hospital, Brno, Czech Republic; Charles University, 2nd Medical Faculty and University Hospital Motol,, Czech Republic; 6 University Central Military Hospital, Prague, Czech Republic; 7 Department of Neurology, Motol University Hospital, Prague, Czech Republic; International Research Center, Brno, Czech Republic.

Coil mainly policy in management of intracranial ACoA aneurysms: single-centre experience with the systematic review of literature and meta-analysis.

Endovascular techniques are still expanding in their capability by introducing novel technologies. Nevertheless, anterior communicating artery (ACoA) remains the region with high propensity for aneurysm (AN) re-growth after endovascular intervention. The purpose of this study is to highlight the ongoing importance for microsurgical treatment. The authors conducted a single-institution retrospective study of ACoA AN treatment between January 2000 and December 2016 maintaining “coil mainly” policy. The results are supplied with a systematic review of the literature. A total of nu2009=xa0398 ACoA ANs were treated in nu2009=xa0398 consecutive patients (207 females, 191 males). Microsurgical treatment was performed for 79 AN patients (54 ruptured, 25 unruptured), and 319 AN patients (250 ruptured, 69 unruptured) underwent coiling procedure. Treatment-related morbidity and mortality (MM) for unruptured ANs was 0% in the microsurgical and 1.5% in the endovascular group (pu2009=u20091.000). The percentage of patients with none or minor permanent deficits after subarachnoid hemorrhage was 74% in the microsurgical and 70% in the endovascular group (pu2009=u20090.693). The re-treatment rate was 3.8% in microsurgical group and 9.2% in endovascular group (pu2009=u20090.883). A literature review identified 39 studies concerning ACoA AN treatment. Clinical results of both modalities were comparable, with microsurgery being superior regarding radiological outcomes. This study demonstrates that both treatment techniques bring comparable clinical benefit to the patient. Microsurgery seemed superior regarding radiological outcomes. The decision about the treatment strategy should be made by a multi-disciplinary team consisting of specialists from both teams, bearing in mind the higher occlusion rate and longevity of the surgical treatment.

Integrative assessment of brain atrophy in Alzheimer's disease: Parallel hippocampal and thalamic atrophy

try(VBM) using statistical parametric mapping (SPM). Results: AD showed poorer performance of CDP, such as swaying distances, velocities and numbers of falling in unilateral stance, and medio-lateral swaying distance and velocity in sensory organization test than controls. Motor latency and antero-posterior swayingwere not different between groups. Therewere significant correlations of the performance in the unilateral stancewith frontal function tests, verbal memory and BNT. Although the cognitive status between AI+ and AIwas not different, there were gray matter atrophy in the bilateral SMA, right inferior frontal and right rectus gyrus when AI+ were compared to controls, and in left inferior frontal area when to AI(P<0.001). Conclusions: Postural instability was more prominent in AD and it was associated with gray matter atrophy in frontal and prefrontal regions responsible for attention and motor controls. We can speculate that postural instability might be an epiphenomenon of AD or be affected by the atrophy of the localized frontal areas.