The Open Operculum in Infants with Congenital ... - For Members

2001 ASNR Annual Meeting Abstracts
01-O-332-ASNR
The Open Operculum in Infants with Congenital Heart
Disease
Traipe, E. * Bilaniuk, L. T. * Zimmerman, R. A. * Clancy, R. R.
Children's Hospital of Philadelphia, Philadelphia, PA
Purpose
To determine the incidence of open opercula in infants surviving newborn heart surgery for
congenital heart disease (CHD). The cerebral operculum is a region comprised of structures from
the frontal, temporal, and parietal lobes. Its formation usually is complete by term, rendering the
operculum closed. An incompletely formed operculum is open and considered a developmental
brain anomaly of uncertain clinical significance. Postmortem brain examinations (1) have
revealed an open operculum in 8 of 39 (20%) infants with the hypoplastic left heart syndrome
(HLHS). No data exist in those with other forms of CHD (non-HLHS). We reviewed brain MR
examinations in 74 infants who survived newborn heart surgery for CHD. The proportions of
HLHS and non-HLHS patients with open opercula and quantitative measurements of the
opercular walls were determined (2).
Materials & Methods
Study subjects constitute 74 infants who underwent and survived CHD surgery at our institution
from 1995 to 1997. The dimensions (mm) of the walls of the operculum were measured in each
infant on axial and coronal views from T1, T2 and FLAIR sequences.
Results
Study subjects (43 males, 31 females) were between 6 days and 10 months with gestational ages
between 29 and 41 weeks. All were postterm at the time of their MR exams. Completely closed
opercula were uncommon (18/74; 24%). A variable degree of bilaterally open opercula occurred
in 34/74 (46%), unilateral (left) open operculum in 20/74 (27%) and unilateral (right) open
operculum in 2/74 (3%).
Conclusion
Among the known functions of opercular cortex are taste aversion behavior and regulation of
heart rate and sympathetic tone(3, 4). The relatively high proportion of CHD infants with open
opercula raises the concern that there could be an association between this anomaly and disorders
of cardiac rhythm and feeding which are common in this population.
References
1. Glauser TA, Rorke LB, Weinberg P, Clancy RR. Congenital brain anomalies associated
with the hypoplastic left heart syndrome. Pediatrics 1990;85:984–990
2. Chen C, Zimmerman RA, Faro S, Parrish B, Wang Z, Bilaniuk L, et al. MR of the cerebral
operculum: abnormal opercular formation in infants and children. AJNR Am J Neuroradiol
1996;17:1303–1311
3. Nerad L, Ramirez-Amaya V, Ormsby CE, Bermudez-Rattoni F. Differential effects of

anterior and posterior insular cortex lesions on the acquisition of conditioned taste aversion
and spatial learning. Neurobiol Learning Memory 1996;66:44–50
4. Oppenheimer S. The anatomy and physiology of cortical mechanisms of cardiac control.
Stroke 1993;24:I3–15