MUDr. Pavel Filip, Ph.D., MBA

The early 20th century saw the emergence and fall of cisterna magna puncture as a therapeutic and diagnostic tool, purportedly offering distinct advantages over lumbar puncture. However, the renewed interest in this procedure as a potential access point in intrathecal gene therapy indicates that it may not be completely forgotten. In light of the limited reports and the virtual loss of practical expertise with this procedure among specialised clinicians, this instructional video is offered as a valuable resource for clinicians or researchers not only in diagnostic settings, but also as an access to the central distribution point of cerebrospinal fluid with therapeutical intents in the future, as envisaged by medical pioneers a century ago.

Cognitively healthy ageing and its conceptual counterpart, dementia, have long garnered much interest in the research community, the broader public and regulatory bodies alike. Although beta-amyloid deposition is widely regarded as the principal neuropathological hallmark of Alzheimer's disease, its precise role in the causal chain of cognitive decline remains under debate. Applying strict criteria to define neurocognitive health, a selection of 35 participants aged over 60 years was drawn from the Human Connectome Project-Ageing. The evaluation of both cognitive and physical fitness, and comprehensive magnetic resonance imaging (MRI) protocol, encompassing diffusion-weighted imaging, T1w/T2w ratio, resting-state functional MRI and arterial spin labelling, were combined with an additional 18F-florbetaben scan to evaluate beta-amyloid load. Strikingly, beta-amyloid load failed to adhere to the transcription patterns of amyloid precursor protein in all surveyed areas but the entorhinal cortex. Moreover, it was associated with either higher cognitive performance, general fitness, cerebral tissue integrity and cerebral perfusion, or had no discernible impact. This pilot study adds to the growing body of evidence that questions the significance attributed to beta-amyloid build-up and the mechanisms of its accumulation in the ageing brain. The results invite a re-evaluation of established theories on beta-amyloid build-up neurotoxicity at low concentrations as observed in this cohort. Future investigations should focus on recruiting larger populations to ascertain whether a specific threshold of beta-amyloid build-up precipitates cognitive decline or whether beta-amyloid accumulation, in fact, serves as a protective mechanism that ultimately fails.

Ageing is a complex phenomenon affecting a wide range of coexisting biological processes. The homogeneity of the studied population is an essential parameter for valid interpretations of outcomes. The presented study capitalises on the MRI data available in the Human Connectome Project-Aging (HCP-A) and, within individuals over 55 years of age who passed the HCP-A section criteria, compares a subgroup of 37 apparently neurocognitively healthy individuals selected based on stringent criteria with 37 age and sex-matched individuals still representative of typical ageing but who did not pass the stringent definition of neurocognitively healthy. Specifically, structural scans, diffusion weighted imaging and T1w/T2w ratio were utilised. Furthermore, data of 26 HCP-A participants older than 90 years as notional 'super-agers' were analysed. The relationship of age and several microstructural MRI metrics (T1w/T2w ratio, mean diffusivity, intracellular volume fraction and free water volume fraction) differed significantly between typical and healthy ageing cohort in areas highly relevant for ageing such as hippocampus, prefrontal and temporal cortex and cerebellum. However, the trajectories of the healthy ageing population did not show substantially better overlap with the findings in people older than 90 than those of the typical population. Therefore, caution must be exercised in the choice of adequate study group characteristics relevant for respective ageing-related hypotheses. Contrary to typical ageing group, the healthy ageing cohort may show generally stable levels of several MRI metrics of interest.

Patient-specific and interpretable deep brain stimulation optimisation using MRI and clinical review data.

We present a multimodal framework to improve the precision of electrode placement in deep brain stimulation (DBS) by fusing preoperative neuroimaging with intraoperative electrophysiology for accurate electrode co-alignment. The workflow integrates automated subthalamic nucleus (STN) segmentation from preoperative MRI using a two-step convolutional neural network (CNN), classification of microelectrode recordings (MER) with a transformer encoder and spatial co-alignment via a discrete optimisation procedure. Implemented as a 3D Slicer plugin, the pipeline enables real-time visualisation and interactive use during surgery. In validation on retrospective data of 17 trajectories from 12 Parkinson's disease patients, co-alignment reduced the mean lateral localisation error by 0.3 mm relative to an intraoperative reference, indicating improved agreement between electrophysiological and anatomical targets. Automated STN segmentation achieved a Dice similarity of 0.62 ± 0.10, providing a robust starting point for manual refinement. This approach improves the understanding of electrode position within STN during surgery, incorporating preoperative and intraoperative data, offers clinicians a practical, real-time tool to enhance targeting accuracy. By directly integrating imaging and MER evidence, the framework addresses persistent challenges in DBS and represents a step toward more personalised and precise neurosurgical interventions.

Introduction: Deep brain stimulation (DBS) of the internal globus pallidus (GPi) is a well-established, effective treatment for dystonia. Substantial variability of therapeutic success has been the one of the drivers of an ongoing debate about proper stimulation site and settings, with several indications of the notional sweet spot pointing to the lower GPi or even subpallidal area. Methods: The presented patient-blinded, random-order study with cross-sectional verification against healthy controls enrolled 17 GPi DBS idiopathic, cervical or generalised dystonia patients to compare the effect of the stimulation in the upper and lower GPi area, with the focus on sensorimotor network connectivity and local activity measured using functional magnetic resonance. Results: Stimulation brought both these parameters to levels closer to the state detected in healthy controls. This effect was much more pronounced during the stimulation in the lower GPi area or beneath it than in slightly higher positions, with stimulation-related changes detected by both metrics of interest in the sensorimotor cortex, striatum, thalamus and cerebellum. Conclusions: All in all, this study not only replicated the results of previous studies on GPi DBS as a modality restoring sensorimotor network connectivity and local activity in dystonia towards the levels in healthy population, but also showed that lower GPi area or even subpallidal structures, be it white matter or even small, but essential nodes in the zona incerta as nucleus basalis of Meynert, are important regions to consider when programming DBS in dystonia patients.

Sleep is crucial for maintaining brain homeostasis and individuals with insufficient sleep are prone to more pronounced brain atrophy as compared to sufficiently sleeping peers. Moreover, sleep quality deteriorates with ageing and ageing is also associated with cerebral structural and functional changes, pointing to their mutual bidirectional interrelationship. This study aimed at determining whether sleep quality and age, separately, affect brain integrity and subsequently, whether sleep significantly modulates the effect of age on brain structural and functional integrity. 113 healthy volunteers underwent a multi-modal MRI imaging to extract information about the microstructure and function of major nodes of the ascending reticular activating system. Sleep quality was assessed by self-administered Pittsburgh's sleep quality index (PSQI) questionnaire. Subject were divided into good (global PSQI score <5) and poor (global PSQI score ≥5) sleep quality group. Whereas only borderline correlations were found between sleep quality and MRI metrics, age exhibited widespread correlations with both functional and microstructural MRI metrics. The latter effect was significantly modulated by sleep quality in ascending reticular activating system, hypothalamus, thalamus and also hippocampus in MRI metrics associated with iron load, cellularity and connectivity, mainly in the subgroup with poor sleep quality. Ergo, our results indicate sleep quality as a substantial contributor to both microstructural and functional brain changes in ageing and call for further research in this emerging topic.

Background and objectives: The intricate relationship between deep brain stimulation (DBS) in Parkinson ' s disease (PD) and cognitive impairment has lately garnered substantial attention. The presented study evaluated pre-DBS structural and microstructural cerebral patterns as possible predictors of future cognitive decline in PD DBS patients. Methods: Pre-DBS MRI data in 72 PD patients were combined with neuropsychological examinations and followup for an average of 2.3 years after DBS implantation procedure using a screening cognitive test validated for diagnosis of mild cognitive impairment in PD in a Czech population - Dementia Rating Scale 2. Results: PD patients who would exhibit post-DBS cognitive decline were found to have, already at the pre-DBS stage, significantly lower cortical thickness and lower microstructural complexity than cognitively stable PD patients. Differences in the regions directly related to cognition as bilateral parietal, insular and cingulate cortices, but also occipital and sensorimotor cortex were detected. Furthermore, hippocampi, putamina, cerebellum and upper brainstem were implicated as well, all despite the absence of pre-DBS differences in cognitive performance and in the position of DBS leads or stimulation parameters between the two groups. Conclusions: Our findings indicate that the cognitive decline in the presented PD cohort was not attributable primarily to DBS of the subthalamic nucleus but was associated with a clinically silent structural and microstructural predisposition to future cognitive deterioration present already before the DBS system implantation.

Background The research on possible cerebral involvement in Crohn's disease (CD) has been largely marginalized and failed to capitalize on recent developments in magnetic resonance imaging (MRI).Objective This cross-sectional pilot study searches for eventual macrostructural and microstructural brain affection in CD in remission and early after the disease onset.Methods 14 paediatric CD patients and 14 healthy controls underwent structural, diffusion weighted imaging and quantitative relaxation metrics acquisition, both conventional free precession and adiabatic rotating frame transverse and longitudinal relaxation time constants as markers of myelination, iron content and cellular loss.Results While no inter-group differences in cortical thickness and relaxation metrics were found, lower mean diffusivity and higher intracellular volume fraction were detected in CD patients over vast cortical regions essential for the regulation of the autonomous nervous system, sensorimotor processing, cognition and behavior, pointing to wide-spread cytotoxic oedema in the absence of demyelination, iron deposition or atrophy.Conclusion Although still requiring further validation in longitudinal projects enrolling larger numbers of subjects, this study provides an indication of wide-spread cortical oedema in CD patients very early after the disease onset and sets possible directions for further research.