RESUMO
BACKGROUND: Surgical planning for treating brain arteriovenous malformations (bAVMs) is challenging because it entails visualizing 3-dimensional (3D) relationships between the nidus, its feeding and en passage arteries, and draining veins. Surgical experience in developing the capacity to mentally visualize pathological bAVM angioarchitecture could be complemented by this software, and thus potentially lower the steep learning curve for understanding complex bAVM angioarchitecture. We evaluated the clinical application of freely available online 3D reconstruction software in facilitating visualization of AVM angioarchitecture for presurgical planning. METHODS: Preoperative Digital Imaging and Communications in Medicine magnetic resonance imaging/magnetic resonance angiography images of 56 superficial bAVMs from 2013 to 2018 were processed using open-source software Horos. 3D rendered images were compared with the surgical view to evaluate software accuracy and determine its value as a preoperative tool. 3D reconstructed images were compared with intraoperative recordings. RESULTS: A useful image identifying both the main feeding artery and draining vein was achieved in 35 of 56 cases (62.5%). Reconstructions of small AVMs (nidus ≤2 cm) and those located within the temporal or cerebellar cortex were less useful due to soft tissue artifacts. Frontal and parietal lobe lesions had significantly higher rates of identifying feeding arteries and draining veins (P < 0.05). CONCLUSION: Presurgical planning for resection of superficial bAVMs using Horos software allows for a comprehensive 3D analysis of the bAVM angioarchitecture. This technique is most useful for frontal and parietal lobe lesions, and aids the surgeon in formulating an optimal surgical strategy. The 3D reconstruction of the brain surface offers a surgical map not influenced by brain shift.
Assuntos
Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Planejamento de Assistência ao Paciente , Software , Adolescente , Adulto , Idoso , Angiografia Digital , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto JovemRESUMO
We investigated the relationship among nutritional reserves, previtellogenic ovary development and juvenile hormone (JH) synthesis in Aedes aegypti female mosquitoes. By raising larvae under different nutritional regimes, two adult phenotypes (large and small females) were generated, which differed significantly in size at eclosion (measured by wing length). We measured the total amount of protein, lipids and glycogen in newly emerged (teneral) large and small females. Teneral reserves were significantly lower in small females. Maximum previtellogenic ovary development occurred only if enough teneral nutrients were present. Maximum previtellogenic ovary development was stimulated in small females with low teneral nutrients by topically applying a JH analog. The biosynthetic activity of Ae. aegypti corpora allata (CA) was studied in vitro using a radiochemical method. JH synthesis was significantly reduced in females emerged with low teneral reserves and stimulated by sugar feeding. These results establish that the CA synthesizes enough JH to activate ovary maturation only in the presence of large nutrient reserves.