Anatomía microquirúrgica e irrigación arterial de la región uncal / Microsurgical anatomy and arterial irrigation of the uncal region

El objetivo de este trabajo fue realizar una revisión microquirúrgica de los principales ramos arteriales que otorgan irrigación a la región uncal, identificando sus principales variantes y sus relaciones anatómicas mas relevantes con las estructuras circundantes. Se estudiaron 20 hemisferios cerebrales con el sistema arterial perfundido con latex y colorante mediante disección microquirúrgica y bajo aumento con un rango de 3X a 40X. Se realizaron registros morfométricos de las principales estructuras. La irrigación de la región uncal del lóbulo temporal se establece principalmente por tres grupos de ramas uncales: las ramas uncales anteriores provenientes de la arteria temporopolar que es uno de las ramas colaterales que inicialmente se derivan de la arteria cerebral media en su segmento M1. Ramas uncales mediales provenientes de la arteria coroidea anterior en su trayecto cisternal. Ramas uncales posteriores provenientes de los segmentos P2A y P2P de la arteria cerebral posterior. La relevancia de la descripción vascular arterial de la región uncal radica en la aplicación del conocimiento de estas relaciones y variantes durante los diversos procedimientos diagnósticos y quirúrgicos del lóbulo temporal.

The objective of this work was realizing a microsurgical review of the main arterial ramus that distribute irrigation to the uncal region, identifying the most common variations and more relevant relationships with surrounding structures. Twenty (20) fixed human brain hemispheres were studied, with the arterial latex and red colorant perfusion technique for dissection under microscope magnification (3X-40X). Morphometric characterization and data were obtained of the structures studied. Arterial irrigation of the uncal region of the temporal lobe is established by three groups of uncal ramus: the anterior uncal rami, deriving from the temporopolar artery, which is one of the first branches of the middle cerebral artery in segment M1. The medial uncal rami, branches of the cisternal portion of the anterior choroidal artery. The posterior uncal rami, branches of the P2A and P2P segments of the posterior cerebral artery. The relevance of arterial vascular description of the uncus, results in the application of knowledge of the variations and relationships during the diagnostic and surgical procedures of the temporal lobe.

Anatomia microcirúrgica do hipocampo na Amígdalo-hipocampectomia seletiva sob a perspectiva da técnica de Niemeyer e método pré-operatório para maximizar a corticotomia / Hippocampal microsurgical anatomy regarding the selective amygdalohippocampectomy in the Niemeyer’s technique perspective and preoperative method to maximize the corticotomy

O conhecimento da anatomia microcirúrgica do hipocampo tem importância fundamental na cirurgia da epilepsia do lobo temporal. Uma das técnicas mais utilizadas na cirurgia da epilepsia é a técnica de Niemeyer. OBJETIVO: Descrever em detalhes a anatomia do hipocampo e mostrar uma técnica na qual pontos de referências anatômicos pré-operatórios visualizados na RNM são usados para guiar a corticotomia. MÉTODO: Foram utilizados 20 hemisférios cerebrais e 8 cadáveres para dissecções anatômicas microcirúrgicas do lobo temporal e hipocampo para identificação e descrição das principais estruturas do hipocampo. Foram estudados prospectivamente 32 pacientes com epilepsia do lobo temporal refratários ao tratamento clínico submetidos a amígdalo-hipocampectomia seletiva pela técnica de Niemeyer três parâmetros anatômicos foram mensurados na RNM pré operatória e transferidos para o ato cirúrgico. RESULTADOS: O hipocampo foi dividido em cabeça, corpo e cauda e sua anatomia microcirúrgica descrita em detalhes. As medidas adquiridas são apresentadas e discutidas. CONCLUSÃO: A complexa anatomia do hipocampo pode ser entendida de uma forma tridimensional durante dissecções microcirúrgicas. As medidas pré-operatórias mostraram-se guias anatômicos úteis para corticotomia na técnica de Niemeyer.

The deep knowledge of hippocampal microsurgical anatomy is paramount in epilepsy surgery. One of the most used techniques is those proposed by Niemeyer. PURPOSE: To describe the hippocampal anatomy in details and to present a technique which preoperative anatomical points in MRI are identified to guide the corticotomy. METHOD: Microsurgical dissections were performed in twenty brain hemispheres and eight cadaveric heads to identify temporal lobe and hippocampus structures. Thirty two patients with drug-resistent temporal lobe epilepsy underwent a selective amygdalohippocampectomy with Niemeyer’s technique being measured three preoperative MRI preoperative distances to guide the corticotomy. RESULTS: The hippocampus was divided in head, body and tail and its microsurgical anatomy described in details. The MRI measurements are presented and discussed. CONCLUSION: The knowledge of the complex anatomy of the hippocampus can be achieved in a three-dimensional way during microsurgical dissections not. The preoperative MRI measurement is a reasonable guide to perform temporal corticotomy in Niemeyer’s techinique.

Ischemic preconditioning in the rat hippocampus increases antioxidant activities but does not affect the level of hydroxyl radicals during subsequent severe ischemia

Several studies have demonstrated that ischemic preconditioning increases superoxide dismutase activity, but it is unclear how ischemic preconditioning affects events downstream of hydrogen peroxide production during subsequent severe ischemia and reperfusion in the hippocampus. To answer this question, we investigated whether ischemic preconditioning in the hippocampal CA1 region increases the activities of antioxidant enzymes glutathione peroxidase and catalase, resulting in a decrease in the level of hydroxyl radicals during subsequent severe ischemia-reperfusion. Transient forebrain ischemia was induced by four-vessel occlusion in rats. Ischemic preconditioning for 3 min or a sham operation was performed and a 15-min severe ischemia was induced three days later. Ischemic preconditioning preserved the CA1 hippocampal neurons following severe ischemia. The concentration of 2,3-dihydroxybenzoic acid, an indicator of hydroxyl radical, was measured using in vivo microdialysis technique combined with HPLC. The ischemia-induced increase in the ratio of 2,3-dihydroxybenzoic acid concentration relative to baseline did not differ significantly between preconditioned and control groups. On the other hand, activities of the antioxidant enzymes glutathione peroxidase-1 and catalase were significantly increased at 3 days after ischemic preconditioning in the hippocampus. Our results suggest that, in preconditioned rats, while hydrogen peroxide is generated from severe ischemia, the activity of catalase and glutathione peroxidase-1 is correspondingly increased to eliminate the excessive hydrogen peroxide. However, our results show that the enhanced activity of these antioxidant enzymes in preconditioned rats is not sufficient to decrease hydroxyl radical levels during subsequent severe ischemia-reperfusion.

Progesterone: Protective effects on the cat hippocampal neuronal damage due to acute global cerebral ischemia

Background. Barbiturates, benzodiazepines, and synthetic steroids having anesthetic properties, by enchacing the inhibitory GABAergic neurotransmission to the neruronal circuits of cerebral structures vulnerable to ischemia, reduce the damage induced by this condition. Some endogenous steroids resulting from progesterone (P4) biotransformation in the brain exert GABAaergic effects, thus inhibiting neuronal excitability. Hence, P4 administration both before and after an experimentally induced ischemic episode may prevent or decrease the ischemic cerebral damage. Methods. Ovariectomized adult cats were treated sc with either P4 (10 mg/kg/day) or corn oil during 7 days before and 7 days after being subjected to a period of acute global cerebral ischemia by 15 min of cardiorespiratory arrest followed by 4 min of reanimation. After 14 days of survival, animals were sacrificed and the brains perfused in situ and formalin-fixed for histological examination. Results. Acute global cerebral ischemia resulted in a severe loss of neurons (54-85 percent), mainly in CA1 and CA2 subfields of oil-treated cats. Progesterone significantly reduced the neuronal loss in those areas (21-49 percent). Conclusions. Overall results suggest that progesterone exerts protective effects against the neuronal cerebral damage induced by acute global cerebral ischemia

Cambios en la excitibilidad neuronal y alteraciones en la densidad neuronal del hipocampo inducidos por isquemia focal / Changes in neuronal excitability and modifications in neural population of the hippocampus induce y focal ischemia

Despúes de un periodo de isquemia cerebral se observa aumento en la frecuencia de descarga neuronal de hipocampo y signos electroencefalográficos de actividad paroxística espontánea. Es probable que estos cambios en la excitabilidad se deban a mecanismos de excitotoxicidad que inducen muerte neuronal. En el presente estudio se evaluaron los cambios en la inhibición recurrente así como en la densidad neuronal del hipocampo de ratas sometidas a 5 y 20 min de isquemia focal con un periodo de recuperación de 7 días. El grado de inhibición recurrente se cuantificó mediante el índice de máxima inibición (IMI). La cuantificación neuronal se realizó a través de un sistema de procesamiento digital de imágenes (Imagenia 2000). Se observó aumento en la amplitud del segundo componente del segundo potencial provocado. Al calcular el IMI resultó mayor que 1. La mayor pérdida neuronal se observó en CA1 y CA2, mientras que la mayor vulnerabilidad se observó en el GD, CA3 y CA4. En conclusión, la isquemia focal con recuperación de 7 días provocó disminución en la densidad neuronal así como la aparición de un mecanismo de desinhibición, que condiciona cambios en la excitabilidad neuronal del hipocampo probablemente debido a lesión de interneuronas