| 제목 |
Changes of the prefronto-thalamic tract following cranioplasty: Case series |
| 소속 |
College of medicine, Yeungnam University, Department fo Rehabilitation Medicine1 |
| 저자 |
Sung Ho Jang 1†, Eun Bi Choi1†, Jung Hae Yun1*† |
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We report on three stroke patients who showed changes of the prefronto-thalamic tract (PTT) with improvement of cognitive impairment following cranioplasty (C/P), which was demonstrated on follow up diffusion tensor tractographies (DTTs). Three patients underwent decompressive craniectomy and hematoma removal. C/P was performed at 7 (patient 1 and patient 3) and 13 (patient 2) weeks after onset using auto-bone. Three stroke patients showed improvement of cognitive impairment after C/P. Mini-Mental State Examination score (MMSE) was increased as much as seven, eight, and five points in three patients on post-C/P compared with pre-C/P MMSE, respectively. On change of DTT configuration, the non-reconstructed DLPFC (patient 2 and 3) in contra-OP side and OFC (patient 3) in both sides on pre-C/P DTT were reconstructed on post-C/P DTT. Majority of the FA value were decreased on post-C/P DTT compared with pre-C/P DTT except for the OFC in contra-OP side of patient 2. The MD value of the PTT was increased in general, except the VLPFC in contra-OP side of patient 1 and OFC in contra-OP side of patient 2. The VN value was generally increased except the VLPFC in contra-OP side of patient 1. On post-C/P DTT, the reconstruction of the non-reconstructed DLPFC and OFC indicates the restoration of the injured or compressed PTT. As a result, C/P mitigate some of the conditions within the PFC in contra-op side as well as OP-side that were affecting the PTT, thereby inducing a relatively rapid decreased in the directionality and the increase in water diffusion and fiber number of the PTT. Our results suggest that C/P could affect the PTT state contra-OP side as well as OP-side. |
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(A) T2-weighted brain MR images of three stroke patients before (pre-C/P) and after cranioplasty (post-C/P) (yellow arrows: OP side). (B) Diffusion tensor tractography (DTT) for the dorsolateral prefrontal cortex, the ventrolateral prefrontal cortex and the orbitofrontal cortex of the prefronto-thalamic tract. The non-reconstructed dorsolateral prefrontal cortex of patient 2 and patient 3 in contra-OP side and the orbitofrontal cortex of patient 3 in both sides on pre-C/P DTT were reconstructed on post-C/P DTT (red arrows).
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