J Biomed Clin Res Volume 11 Number 2, 2018
DOI: 10.2478/jbcr-2018-0020 Original Articles
BASIC NEURONAVIGATION OPTIONS FOR CORTICAL AND SUBCORTICAL BRAIN LESIONS SURGERY
0LODQ10ODGHQRYVNL Summary Nikolay V. Vasilev, 0ODGHQ(2YFKDURY &UDQLRPHWULFSRLQWVDUHHVVHQWLDOIRURULHQWLQJQHXURVXUJHRQV Iliya V. Valkov LQ WKHLU SUDFWLFH 8QGHUVWDQGLQJ WKH FRUUHODWLRQV RI WKHVH points help to manage any pathological lesion located on WKH FRUWLFDO VXUIDFH DQG VXEFRUWLFDOO\ 7KH EUDLQ VXOFL DQG Department of Neurology and J\UL VKRXOG EH LGHQWL¿HG EHIRUH FUDQLRWRP\ ,W LV GLI¿FXOW Neurosurgery, WR LGHQWLI\ WKHVH DQDWRPLFDO VWUXFWXUHV LQWUDRSHUDWLYHO\ Medical University – Pleven, DIWHUFUDQLRWRP\ ZLWKSUHFLVLRQ7KHPDLQSXUSRVHRIWKLV Bulgaria VWXG\ZDVWRFROOHFWDVPXFKLQIRUPDWLRQDVSRVVLEOHIURP WKHOLWHUDWXUHDQGRXUFOLQLFDOSUDFWLFHLQRUGHUWRIDFLOLWDWH WKH SODFHPHQW RI FUDQLRWRPLHV ZLWKRXW XVLQJ PRGHUQ QHXURQDYLJDWLRQV\VWHPV2SHUDWLYHUHSRUWVIURPWKHODVW¿YH \HDUVRQFUDQLDORSHUDWLRQVIRUFRUWLFDODQGVXEFRUWLFDOOHVLRQV ZHUHUHYLHZHG$OOWKHFUDQLRWRPLHVKDGEHHQSODQQHGXVLQJ IRXU PHWKRGV GHWHFWLRQ RI FUDQLRPHWULF SRLQWV FRPSXWHG WRPRJUDSK\ &7 VFDQVWRSRJUDPV PDJQHWLF UHVRQDQFH LPDJLQJ 05, VFDQVWRSRJUDPV DQG LQWUDRSHUDWLYH UHDO WLPHXOWUDVRQRJUDSK\ 86* 5HWURVSHFWLYHO\ZHDQDO\]HG FUDQLDORSHUDWLRQV2XUDQDO\VLVVKRZHGWKDWRSHUDWLQJ RQIRUFRUWLFDOOHVLRQVZHKDGIUHTXHQWO\XVHGWKH¿UVWDQG the second method mentioned above (118 patients), while LQ FDVHV RI VXEFRUWLFDO OHVLRQV ZH KDG XVHG FUDQLRPHWULF SRLQWV 05, VFDQVWRSRJUDPV DQG LQWUDRSHUDWLYH UHDOWLPH 86*DVPHWKRGVRIQHXURQDYLJDWLRQ SDWLHQWV 7KHVH UHVXOWV VKRZ WKDW FUDQLRPHWULF SRLQWV DUH HVVHQWLDO LQ ERWK QHXURVXUJLFDOSURFHGXUHV Key ZRUGV QHXURQDYLJDWLRQ FUDQLRPHWULF SRLQWV PRGHUQ QHXURQDYLJDWLRQ V\VWHPV &705, WRSRJUDPV LQWUDRSHUDWLYHUHDOWLPHXOWUDVRQRJUDSK\ 86*
Introduction
&RUUHVSRQGLQJ$XWKRU Craniometric points DUHFUDQLDOODQGPDUNVIURPZKLFK Milan N. Mladenovski FUDQLRPHWULFPHDVXUHPHQWVFDQEHWDNHQ 'HSDUWPHQWRI1HXURORJ\DQG Neurosurgery, /DQGPDUNVDUHDQDWRPLFDOVWUXFWXUHVXVHGDVSRLQWV Medical University – Pleven RI RULJLQ LQ ORFDWLQJ RWKHU DQDWRPLFDO VWUXFWXUHV Bulgaria Craniometric points are essential cranial points that 1, St. Kl. Ochridski Str. RULHQWDWH QHXURVXUJHRQV LQ SUDFWLFH 7KH EUDLQ VXOFL Pleven, 5800 DQGJ\ULFRXOGEHLGHQWL¿HGEHIRUHFUDQLRWRP\DQGWKLV Bulgaria PDNHVLWSRVVLEOHWRapproach any pathological lesion e-mail: [email protected] ORFDWHG RQ WKH FRUWLFDO VXUIDFH RU GHHS LQ WKH EUDLQ 3UHFLVH LGHQWL¿FDWLRQ RI WKHVH DQDWRPLFDO VWUXFWXUHV 5HFHLYHG October 04, 2018 LQWUDRSHUDWLYHO\ DIWHU FUDQLRWRP\ LV GLI¿FXOW VR WKH 5HYLVLRQUHFHLYHG November 07, 2018 PDLQREMHFWLYHRIWKLVVWXG\ZDVWRFROOHFWDVPXFK $FFHSWHG January 17, 2019 © Medical University Pleven J Biomed Clin Res Volume 11 Number 2, 2018
LQIRUPDWLRQDVSRVVLEOHIURPWKHOLWHUDWXUHDQG Basic anthropological (craniometric) RXUFOLQLFDOSUDFWLFHWRIDFLOLWDWHWKHSODFHPHQW points RI FUDQLRWRPLHV ZLWKRXW XVLQJ PRGHUQ 6RPHRIWKHHVVHQWLDODQWKURSRORJLFDOSRLQWVDUH QHXURQDYLJDWLRQV\VWHPV YHU\ XVHIXO UHIHUHQFHV IRU SUHFLVH GHVFULSWLRQ ,Q WKH VWXG\ WKH WHUP ³QHXURQDYLJDWLRQ´ LV RI WKH DSSURDFK SODQQHG 7DEOH 7KH PDMRU QRWDV\QRQ\PIRULPDJHJXLGHGVXUJHU\ ,*6 DGYDQWDJHFRPHVIURPWKHLUIHDWXUH±WKH\FDQ DQG FRPSXWHUDVVLVWHGFRPSXWHUDLGHG VXUJHU\ EHVHHQERWKRQWKHKHDGDQGWKHLPDJLQJVWXGLHV &$6 WKHODWWHUWZREHLQJV\QRQ\PVIRUPRGHUQ VKRZLQJWKHLQWUDFUDQLDOSDWKRORJ\IRXQG>@ QHXURQDYLJDWLRQ V\VWHPV 1HXURQDYLJDWLRQ LV D WHFKQLTXH GHVLJQHG WR KHOS QHXURVXUJHRQV Topography of the main cerebral SUHFLVHO\ GHWHUPLQH WKH ORFDWLRQ RI YDULRXV sulci FRUWLFDO DQG VXEFRUWLFDO OHVLRQV E\ XVLQJ 7KH ODWHUDO DQG FHQWUDO ¿VVXUHV DUH WKH WZR PHWKRGVVXFKDVFUDQLRPHWULFSRLQWVFRPSXWHG PRVW LPSRUWDQW VXOFL RQ WKH FRQYH[ VXUIDFH RI tomography (CT), magnetic resonance imaging WKH FHUHEUDO KHPLVSKHUH VHUYLQJ DV UHIHUHQFHV 05, XOWUDVRQRJUDSK\ 86* LPDJHVHWF IRU ORFDOL]LQJ WKH RWKHU VXOFL DQG FRQYROXWLRQV RI WKH KHPLVSKHUHV +RZHYHU ZKHQ SODQQLQJ 0DWHULDOVDQG0HWKRGV FUDQLRWRPLHV GLVSODFHPHQW SURGXFHG E\ PDVV OHVLRQV VKRXOG EH DOVR FRQVLGHUHG VLQFH DIWHU 2SHUDWLYH UHSRUWV IURP WR ZHUH WKH SODQQHG FRUWLFDO H[SRVXUH J\UL DQG VXOFL UHYLHZHG RQ VXUJHULHV SHUIRUPHG DW WKH FDQEHIRXQGWREHQRWH[DFWO\DWWKHLUH[SHFWHG 1HXURVXUJHU\ &OLQLF 8QLYHUVLW\ 0XOWLSUR¿OH locations. +RVSLWDOIRU$FWLYH7UHDWPHQW³'U*6WUDQVNL´ $FFRUGLQJWRWKHVLPSOL¿HG.URQOHLQPHWKRG LQ 3OHYHQ 7ZR KXQGUHG QLQHW\¿YH FUDQLDO DKRUL]RQWDOOLQHLVGUDZQDWWKHOHYHORIWKHXSSHU RSHUDWLRQV IRU FRUWLFDO DQG VXEFRUWLFDO WXPRU RUELWDOHGJH )LJXUH lesions were reviewed. All craniotomies 7KHQWZRYHUWLFDOOLQHVDUHVXSHULPSRVHG WKH KDG EHHQ SODQQHG E\ XVLQJ IRXU PHWKRGV ¿UVWRQHWKURXJKWKHPLGSRLQWRIWKH]\JRPDWLF FUDQLRPHWULFSRLQWV&7VFDQVWRSRJUDPV05, DUFK DQG WKH VHFRQG WKURXJK WKH SRVWHULRU VFDQVWRSRJUDPV DQG LQWUDRSHUDWLYH UHDOWLPH ERUGHU RI WKH DXULFOH 7KH OLQH FRQQHFWLQJ WKH XOWUDVRQRJUDSK\ LQWHUVHFWLRQSRLQWEHWZHHQWKHKRUL]RQWDODQGWKH $OOLPDJHVZHUHSUHYLHZHGE\XVLQJ5DGL$QW ¿UVWYHUWLFDOOLQHZLWKWKHSRLQWZKHUHWKHVHFRQG ',&20 9LHZHU GHVLJQHG WR XVH UHVRXUFHV vertical line crosses the midline, corresponds to DV HI¿FLHQWO\ DV SRVVLEOH LQ YLHZLQJ PHGLFDO WKHSURMHFWLRQRIWKHFHQWUDOVXOFXV,IWKHDQJOH images. IRUPHG E\ WKH SURMHFWLRQ RI WKH FHQWUDO VXOFXV
Table 1. Basic anthropological (craniometric) points and their characteristics
Craniometric Characteristics points 1DVLRQ $SRLQWVLWXDWHGRIWKHEDVHRIWKHQRVHLQWKHPLGGOHRIWKHQDVRIURQWDOVXWXUH Bregma $SRLQWZKHUHWKHFRURQDODQGVDJLWWDOVXWXUHVMRLQ RQWKHLQWDFWVNLQLWFDQEHGHWHUPLQHG DVWKHLQWHUVHFWLRQRIWKHWZRSHUSHQGLFXODUOLQHVGUDZQXSIURPWKHPLGSRLQWVRIERWK ]\JRPDWLFDUFKHV Lambda 7KHSRLQWZKHUHWKHODPEGRLGDQGVDJLWWDOVXWXUHVMRLQ ,QLRQ 7KLVSRLQWFRUUHVSRQGVWRWKHH[WHUQDORFFLSLWDOSURWXEHUDQFH Estephanon 6\PPHWULFDOSRLQWVRQERWKVLGHVRIWKHVNXOODWWKHSODFHZKHUHWKHFRURQDOVXWXUHFURVVHV WKHVXSHULRUWHPSRUDOOLQH Pterion $SSUR[LPDWHO\V\PPHWULFDOSRLQWVRQERWKVLGHVRIWKHVNXOOORFDWHGZKHUHWKHIURQWDO SDULHWDODQGWHPSRUDOERQHVMRLQWKHODUJHZLQJRIWKHVSKHQRLGERQH Asterion 6LPLODUWRWKHSUHYLRXVELODWHUDOSRLQWVDWWKHSODFHZKHUHWKHRFFLSLWDODQGSDULHWDOERQHV MRLQZLWKWKHPDVWRLGSDUWRIWKHWHPSRUDOERQH Glabella (g) ,WLVDFHSKDORPHWULFODQGPDUNWKDWLVMXVWVXSHULRUWRWKHQDVLRQ © Medical University Pleven Mladenovski M, et al. %DVLFQHXURQDYLJDWLRQRSWLRQVIRUFRUWLFDODQGVXEFRUWLFDOEUDLQ
FRQQHFWLQJWKH]\JRPDWLFSURFHVVRIWKHIURQWDO ERQH ZLWK D SRLQW DW RI WKH OHQJWK RI WKH QDVLRQLQLRQGLVWDQFHVWDUWLQJIURPWKHQDVLRQ 7KHFHQWUDOVXOFXVFRUUHVSRQGVWRWKHXSSHUKDOI RIWKHOLQHFRQQHFWLQJWKHPLGOLQH FPEHKLQG it is the nasion-inion midpoint) and reaches the PLGGOHRIWKH]\JRPDWLFDUFK>@ Correlations between anthropological FUDQLRPHWULF SRLQWVDUHNQRZQDVFUDQLRPHWULF NH\ SRLQWV >@ 7KHVH DUH SRLQWV RI FUXFLDO LPSRUWDQFHWKDWKHOSWRLGHQWLI\WKHFRUWLFDOEUDLQ VXOFLDQGJ\UL 7DEOH
CT brain scans/topograms Figure 1. Kronlein method CT head (brain) scan is the most common cranial $%KRUL]RQWDOOLQHDWWKHOHYHORIVXSHULRURUELWDOHGJH &' ¿UVW YHUWLFDO OLQH () VHFRQG YHUWLFDO OLQH +( LQYHVWLJDWLRQLQQHXURVXUJHU\$KHDG&7LVDV SURMHFWLRQ RI WKH FHQWUDO VXOFXV +* SURMHFWLRQ RI WKH important as a chest x-ray is in internal medicine. ODWHUDOFHUHEUDOVXOFXV VXOFXVRI6\OYLL $ V\VWHPDWLF UHYLHZ RI &7 VFDQV FDQ SUHYHQW FRPPRQ HUURUV HJ VHHLQJ DQ REYLRXV ODUJH parietal metastasis, and missing a smaller one at DQGWKHKRUL]RQWDOOLQHLVELVHFWHGWKLVODWWHUOLQH WKHSRVWHULRUFUDQLDOIRVVDLQWKHFHUHEHOOXP ZLOOFRUUHVSRQGWRWKHODWHUDOVXOFXV>@ :H VKRXOG SRLQW RXW WKDW LW LV HVVHQWLDO $FFRUGLQJ WR (JRURY¶PHWKRG IRU to approach this cranial investigation in a LGHQWL¿FDWLRQ WKH FHQWUDO VXOFXV SURMHFWLRQ V\VWHPDWLFIDVKLRQLQRUGHUWRE\SDVVDQ\PLVVWHS corresponds to the line, which begins 2 cm LQGLDJQRVLVDQGQHXURQDYLJDWLRQ EHKLQGWKHPLGSRLQWRIWKHQDVLRQLQLRQGLVWDQFH &7VFDQWRSRJUDPLVRQHRIWKHRSWLRQVIRU RQWKHVDJLWWDOOLQHDQGIRUPVGHJUHHVRIWKH QHXURQDYLJDWLRQ ,W LV DEVROXWHO\ QHFHVVDU\ IRU angle with it, open in an anterobasal direction. FUDQLRWRPLHV1HXURUDGLRORJLVWVVKRXOGLQFOXGH 7KXV WRSRJUDSK\ RI WKH WZR EDVLF ¿VVXUHV RI CT topograms in every CT head scan )LJXUHV the cerebral hemisphere (the lateral and central DEDE VXOFL FDQEHGHWHUPLQHGLQWKHIROORZLQJVLPSOH ZD\ WKH ODWHUDO VXOFXV OLHV DOO DORQJ WKH OLQH
Figure 2. CT topogram 7KHWXPRU PHQLQJLRPD LVORFDWHGLQWKHOHIWSDULHWRWHPSRUDOUHJLRQ-XVWDQWHULRUWR,53 © Medical University Pleven J Biomed Clin Res Volume 11 Number 2, 2018
Table 2.&UDQLRPHWULFNH\SRLQWV
Craniometric key points Abbreviation AQWHULRUV\OYLDQSRLQW H[WHUQDOFUDQLDOVXUIDFHDWWKHDQWHULRUVTXDPRVXV ASP 6\OYLDQ)LVVXUH SyF ,QIHULRU5RODQGLFSRLQW DSSUR[LPDWHO\FPDERYHWKHWUDJXV ,53 'LVWDQFHEHWZHHQWKH$63DQGWKH,53DORQJWKH6\)LVRIDURXQGFP FP $63,53GLVWDQFH ,QIHULRUIURQWDOVXOFXVDQGSUHFHQWUDOVXOFXVPHHWLQJSRLQW OLHVDURXQGFPSRVWHULRUWR ,)63UH&6 the estephanion (VWHSKDQLRQSRLQWLVDFUDQLRPHWULFSRLQWDWWKHOHYHORIWKHLQWHUVHFWLRQEHWZHHQWKH Es FRURQDOVXWXUHDQGWKHVXSHULRUWHPSRUDOOLQH $QHDV\ZD\WRGHWHUPLQH%URFDDUHDRQWKHGRPLQDQWKHPLVSKHUHLVE\ORFDOL]LQJWKHIRXU Broca area FUDQLRPHWULFDOSRLQWV WKH(VWHSKDQLRQ FPSRVWHULRUWRWKH(VWHSKDQLRQ WKHDQWHULRU 6\OYLDQSRLQW DQGWKH,53 SXSHULRUIURQWDOVXOFXVDQGSUHFHQWUDOVXOFXVPHHWLQJSRLQW 6)63&6 PRVWHULRUFRURQDOSRLQW±is aFUDQLRPHWULFDOSRLQWORFDWHGFPODWHUDOWRWKHVDJLWWDOVXWXUH PCop DQGFPSRVWHULRUWRWKHFRURQDOVXWXUH this PCop locates the hand motor cortex SXSHULRUURODQGLFSRLQW FPSRVWHULRUWRWKH%UHJPD 653 ,QWUDSDULHWDODQGSRVWFHQWUDOVXOFXVPHHWLQJSRLQW,33±LQWUDSDULHWDOSRLQW FRUUHVSRQGV ,363&6 ,363&6 /RFDWHGFPDQWHULRUWR/DPEGDDQGFPODWHUDOO\WRWKHVDJLWWDOVXWXUH E[WHUQDORFFLSLWDO¿VVXUH (2) E[WHUQDORFFLSLWDO¿VVXUHDQGSDULHWRRFFLSLWDOVXOFXVPHHWLQJSRLQW FPVXSHULRUWRWKH (2)326 2SLVWKRFUDQLRQ QRWWREHFRQIXVHGZLWKWKH,QLRQ (XULRQ MXQFWLRQRIWKHVXSHULRUWHPSRUDOOLQH 67/ DQGDYHUWLFDOOLQHGUDZQRYHUWKH (X PRVWSRVWHULRUSDUWRIWKHPDVWRLG 7KH(XU\RQZDVIRXQGWREHRYHUWKHVXSHULRUDVSHFWRIWKHVXSUDPDUJLQDOLVJ\UXV 60* 60*$* 7KH60*DQG$QJXODU*\UXV $* EHORQJWRWKHLQIHULRUSDULHWDOOREXOHDQGDUHVHSDUDWHG IURPWKHVXSHULRUSDULHWDOOREHE\WKHLQWUDSDUHWDOVXOFXV6XSUDPDUJLQDOJ\UXV 60* LVIRXQGWREHDVWKHPRVWSRVWHULRUSRLQWRI6\OYLDQ¿VVXUH 6) ZKLOHDQJXODUJ\UXVLV IRXQGWREHDVWKHPRVWSRVWHULRUSDUWRIVXSHULRUWHPSRUDOVXOFXV 676 7KHVXOFXVWKDW GLYLGHV60*IURP$*LVFDOOHGWKHVXOFXVRI-DQVHQ 2pisthocranon (the most prominent occipital cranial point) 2S LDPEGD VXWXUDODPEGRLGHD±VXWXUDVDJLWDOLVPHHWLQJSRLQW±EHWZHHQFPDERYH La opisthocranon) ,QLRQ±SURWXEHUDQWLDRFFLSLWDOLVH[WHUQDDSSUR[LPDWHO\FPEHOORZWKHRSLVWRFUDQRQ ,Q
Figure 3. CT angiogram 6KRZLQJWKHWXPRU¶VYDVFXODUL]DWLRQLWLVRIKXJHLPSRUWDQFHIRUWKHVXUJLFDOSODQQLQJ © Medical University Pleven Mladenovski M, et al. %DVLFQHXURQDYLJDWLRQRSWLRQVIRUFRUWLFDODQGVXEFRUWLFDOEUDLQ
Figure 4.,53DQG%UHJPDDVDFUDQLRPHWULFSRLQWV &7WRSRJUDPKHOSVIRUSUHFLVHFUDQLRWRP\
Figure 5a.%RQHÀDSLVHOHYDWHG Figure 5b. 'XUDORSHQLQJDQGPHQLQJLRPDLVLQWKH FHQWHURIWKHWUHSDQDWLRQ
Figure 6a.7KHWXPRULVEHLQJPRELOL]HG Figure 6b.(QEORFNWXPRUUHVHFWLRQ
MRI scans/topograms IRU FRPSOH[ FRUWLFDO RU GHHS SDWKRORJLFDO 05, KDV UHFHQWO\ EHFRPH D YLWDOO\ LPSRUWDQW OHVLRQVDQGUHODWLYHO\OHVVRIWHQIRUGLDJQRVWLF GLDJQRVWLF WHFKQLTXH 1HXURVXUJHRQV RIWHQ SXUSRVHV VLQFH GLDJQRVLQJ XVLQJ &7 VFDQV UHO\ RQ 05, LPDJHV ZKLOH SODQQLQJ VXUJHU\ LV OHVV H[SHQVLYH $ UHODWLYHO\ ODUJH JURXS © Medical University Pleven J Biomed Clin Res Volume 11 Number 2, 2018
RI QHXURVXUJHRQV UHOLHV RQ DGYDQFHG LPDJH Results JXLGDQFHWHFKQRORJ\LQWKHLUSUDFWLFH$GHWDLOHG KLJKTXDOLW\ QHXURUDGLRORJLFDO LQYHVWLJDWLRQ 5HWURVSHFWLYHO\ ZH DQDO\]HG FUDQLDO SURYLGLQJUHOLDEOHLQIRUPDWLRQDQGLQWHUSUHWDWLRQ RSHUDWLRQVIRUWXPRUOHVLRQV 7DEOH RQ WKH H[DFW UHODWLRQV RI D WXPRU WR DGMDFHQW 2QH KXQGUHG VL[W\VHYHQ SDWLHQWV KDG EHHQ VWUXFWXUHV DQG LWV YDVFXODUL]DWLRQ LV RI FUXFLDO GLDJQRVHG YLD KHDG &7 2QH KXQGUHG WZHQW\ LPSRUWDQFH$Q05,VFDQWRSRJUDPDVDPHDQV HLJKWSDWLHQWVKDGEHHQGLDJQRVHGE\KHDG05, RI RULHQWDWLRQ LV RQH RI WKRVH PRVW FRPPRQO\ Forty-six patients had had CT prior to admission, XVHGLQFDVHVRIFRUWLFDODQGVXEFRUWLFDOOHVLRQV DQG 05, LQYHVWLJDWLRQV ZHUH FDUULHG RXW IRU )LJXUH PRUHSUHFLVHHYDOXDWLRQ7KHVXFFHVVUDWHRIWKH SURMHFWLRQVXVHGZDVJUDGHG RQDVFDOHIURPRQH Intraoperative real-time WRWKUHH 7DEOH ultrasonography Grade 1: Projections exactly matched the 7KLV WHFKQLTXH DOORZV GHWHUPLQLQJ WKH H[DFW DFWXDOWXPRU WKHWXPRUZDVLQWKHFHQWHURIWKH ORFDWLRQ RI GHHSO\ VLWXDWHG LQWUDFUDQLDO OHVLRQV trepanation). WKXVUHGXFLQJWKHULVNRILQWUDRSHUDWLYHGDPDJH *UDGH 7KH PDUJLQ RI HUURU EHWZHHQ WKH WR QRUPDO WLVVXH DQG KHOSLQJ WR GHWHUPLQH WKH SURMHFWLRQDQGWKHWXPRUZDVOHVVWKDQPP WKH H[WHQW RI WXPRU UHVHFWLRQ ,W DOVR UHGXFHV WKH OHVLRQZDVLQH[WHUQDOPDUJLQVRIWKHWUHSDQDWLRQ VXUJHU\WLPH )LJXUH EXWLQWKHVXUJLFDO¿HOG
Figure 7.05,VFDQWRSRJUDPVKRZLQJRFFLSLWDOPHWD
Table 3. 'LDJQRVWLF PHWKRGV XVHG WR LGHQWLI\ WKH EUDLQWXPRU
Patients Number CT scan* 05,VFDQ 128 Total 295
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Table 4. *UDGLQJWKHVXFFHVVRIWKHSURMHFWLRQVLQWKHRSHUDWHGSDWLHQWV
Grades Cortical Tu (n=118) Subcortical Tu (177) Grade 1* Grade 2* *UDGH
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