Clin Neuroradiol (2015) 25:65–67 DOI 10.1007/s00062-013-0269-z
Correspondence
Cingulum Injury by External Ventricular Drainage Procedure: Diffusion Tensor Tractography Study H. G. Kwon · S. H. Jang
Received: 20 July 2013 / Accepted: 21 October 2013 / Published online: 13 November 2013 © Springer-Verlag Berlin Heidelberg 2013
Introduction Placement of an external ventricular drain (EVD), a common neurosurgical procedure for monitoring and treatment of hydrocephalus and/or intraventricular and subarachnoid hemorrhage, respectively, is routinely performed freehand [1, 2]. Many previous studies have reported on the accuracy of EVD [3, 4]. However, only a few studies have reported on neural injury caused by invasive procedures, including EVD [5, 6]. The cingulum is the neural fiber bundle connecting the basal forebrain and the medial temporal lobe [7]. Diffusion tensor tractography (DTT), derived from diffusion tensor imaging (DTI), has enabled three-dimensional visualization and localization of the cingulum [8, 9]. In a recent study using DTT, injury of the cingulum caused by ventriculoperitoneal shunt was reported in a patient with hydrocephalus [6]. However, cingulum injury caused by invasive procedures such as EVD or ventriculoperitoneal shunt has not been clearly elucidated so far [6]. In the current study, using DTT, we report on a patient who showed injury of the cingulum after EVD. Case Report A 44-year-old female patient and a 47-year-old female control subject with no history of neurologic disease were recruited
S. H. Jang, MD () · H. G. Kwon, MS Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea e-mail: [email protected]
for this study. The patient underwent suboccipital craniectomy for subarachnoid and intraventricular hemorrhage, and clipping for a ruptured aneurysm in the distal portion of the posterior inferior cerebellar artery at the neurosurgery department of a hospital (Fig. 1a). She also underwent the EVD procedure two times, on the day of onset (right side) and at 10 days after onset (left side). At 6 weeks after onset, she was transferred to the rehabilitation department of a university hospital to undergo rehabilitation. No specific lesions were observed on brain magnetic resonance imaging (MRI) [T1-weighted, T2-weighted, and fluid-attenuated inversion recovery images] taken at 6 weeks after onset (Fig. 1c). The insertion sites for EVDs were located 4.0 cm (right) and 3.5 cm (left) laterally from the midline, and 4.0 cm above from the nasion in the forehead. The patient showed severe cognitive impairment at 6 weeks after onset: Wechsler adult intelligence scale: 81, and the Memory Assessment Scale— global memory: 53 (
Correspondence
Cingulum Injury by External Ventricular Drainage Procedure: Diffusion Tensor Tractography Study H. G. Kwon · S. H. Jang
Received: 20 July 2013 / Accepted: 21 October 2013 / Published online: 13 November 2013 © Springer-Verlag Berlin Heidelberg 2013
Introduction Placement of an external ventricular drain (EVD), a common neurosurgical procedure for monitoring and treatment of hydrocephalus and/or intraventricular and subarachnoid hemorrhage, respectively, is routinely performed freehand [1, 2]. Many previous studies have reported on the accuracy of EVD [3, 4]. However, only a few studies have reported on neural injury caused by invasive procedures, including EVD [5, 6]. The cingulum is the neural fiber bundle connecting the basal forebrain and the medial temporal lobe [7]. Diffusion tensor tractography (DTT), derived from diffusion tensor imaging (DTI), has enabled three-dimensional visualization and localization of the cingulum [8, 9]. In a recent study using DTT, injury of the cingulum caused by ventriculoperitoneal shunt was reported in a patient with hydrocephalus [6]. However, cingulum injury caused by invasive procedures such as EVD or ventriculoperitoneal shunt has not been clearly elucidated so far [6]. In the current study, using DTT, we report on a patient who showed injury of the cingulum after EVD. Case Report A 44-year-old female patient and a 47-year-old female control subject with no history of neurologic disease were recruited
S. H. Jang, MD () · H. G. Kwon, MS Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea e-mail: [email protected]
for this study. The patient underwent suboccipital craniectomy for subarachnoid and intraventricular hemorrhage, and clipping for a ruptured aneurysm in the distal portion of the posterior inferior cerebellar artery at the neurosurgery department of a hospital (Fig. 1a). She also underwent the EVD procedure two times, on the day of onset (right side) and at 10 days after onset (left side). At 6 weeks after onset, she was transferred to the rehabilitation department of a university hospital to undergo rehabilitation. No specific lesions were observed on brain magnetic resonance imaging (MRI) [T1-weighted, T2-weighted, and fluid-attenuated inversion recovery images] taken at 6 weeks after onset (Fig. 1c). The insertion sites for EVDs were located 4.0 cm (right) and 3.5 cm (left) laterally from the midline, and 4.0 cm above from the nasion in the forehead. The patient showed severe cognitive impairment at 6 weeks after onset: Wechsler adult intelligence scale: 81, and the Memory Assessment Scale— global memory: 53 (
