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The premature brain: developmental and lesional anatomy

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Abstract

Introduction

Neurodevelopmental outcome in prematures who suffer from a neonatal brain injury depends on the lesion itself, and on how the lesion interferes with the still developing functional anatomy.

Methods

Most of the neuronal migration is completed by midgestation. The second part of the gestation corresponds to the development of the connectivity and sulcation, of the maturation of the oligodendrocytic lineage and of the microglia, and of the vascular bed in the parenchyma beyond the germinal matrix.

Results

In this paper, the main processes of the developmental anatomy of the premature brain are reviewed, and are correlated with the findings in a prospective series of 105 premature infants born between 24 and 32 weeks of gestation, and serially examined with MR imaging at birth, at term-equivalent age, at 2 years, and at 4 years. Special emphasis was placed (1) on the intraventricular hemorrhage because of the resulting destruction of the germinal matrix and its impact on the late cellular production, (2) on the periventricular venous hemorrhagic infarction because of the selective destruction of the intermediate zone which is associated, and (3) on the apparently perivenous punctate lesions of the white matter because they involve the intermediate zone also, because they have no convincing explanation yet, and because the microglia seems to be associated with their pathogenesis.

Conclusion

These deep venous injuries appear to preserve the subplate zone, which is likely to be a significant element to consider in the perspective of the neurodevelopmental outcome.

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Abbreviations

CP:

Cortical plate

CST:

Cortico-spinal tract

DTI:

Diffusion tensor imaging

DWI/ADC:

Diffusion-weighted imaging–average diffusion coefficient

GA:

Gestational age

GE:

Ganglionic eminence

GM:

Germinal matrix

HIE:

Hypoxic-ischemic encephalopathy

IVH:

Intra-ventricular hemorrhage

IZ:

Intermediate zone

MRS:

Magnetic resonance spectroscopy

MTR:

Magnetization transfer ration

MZ:

Marginal zone

NICU:

Neonatal intensive care unit

PLIC:

Posterior limb of the internal capsule

PP:

Pre-plate

PVHI:

Periventricular venous hemorrhagic infarction

PVL:

Peri-ventricular leukomalacia

PVZ:

Peri-ventricular zone

SP:

Sub-plate

SVZ:

Subventricular zone

TEA:

Term-equivalent age

VZ:

Ventricular zone

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Acknowledgments

The authors thank John Wiley and Sons for permission to reproduce Fig. 5A from Okudera et al. Microangiographical studies of the medullary venous system of the cerebral hemisphere. Neuropathology 1999, 19:93–111 (reference 52 here).

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Neuroradiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada

    Charles Raybaud, Tahani Ahmad & Manohar Shroff

  2. The Russel H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Neda Rastegar

  3. Department of Diagnostic Imaging, McMaster University Medical Center, Hamilton, ON, Canada

    Mutaz Al Nassar

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  1. Charles Raybaud
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  2. Tahani Ahmad
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  3. Neda Rastegar
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  4. Manohar Shroff
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  5. Mutaz Al Nassar
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Correspondence to Charles Raybaud.

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This article is part of the special supplement “The Premature Brain"—Guest Editor: Charles Raybaud

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Raybaud, C., Ahmad, T., Rastegar, N. et al. The premature brain: developmental and lesional anatomy. Neuroradiology 55 (Suppl 2), 23–40 (2013). https://doi.org/10.1007/s00234-013-1231-0

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  • DOI: https://doi.org/10.1007/s00234-013-1231-0

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