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He Q, Yang Y, Ge P, Li S, Chai X, Luo Z, Zhao J. The brain nebula: minimally invasive brain-computer interface by endovascular neural recording and stimulation. J Neurointerv Surg 2024:jnis-2023-021296. [PMID: 38388478 DOI: 10.1136/jnis-2023-021296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
A brain-computer interface (BCI) serves as a direct communication channel between brain activity and external devices, typically a computer or robotic limb. Advances in technology have led to the increasing use of intracranial electrical recording or stimulation in the treatment of conditions such as epilepsy, depression, and movement disorders. This indicates that BCIs can offer clinical neurological rehabilitation for patients with disabilities and functional impairments. They also provide a means to restore consciousness and functionality for patients with sequelae from major brain diseases. Whether invasive or non-invasive, the collected cortical or deep signals can be decoded and translated for communication. This review aims to provide an overview of the advantages of endovascular BCIs compared with conventional BCIs, along with insights into the specific anatomical regions under study. Given the rapid progress, we also provide updates on ongoing clinical trials and the prospects for current research involving endovascular electrodes.
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Affiliation(s)
- Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Center for Neurological Disorders, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- National Research Center for Rehabilitation Technical Aids, Beijing, China
- Chinese Institute for Brain Research, Beijing, People's Republic of China
- Beijing Institute of Brain Disorders, Beijing, People's Republic of China
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sining Li
- Tianjin Key Laboratory of Brain Science and Intelligent Rehabilitation, College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Xiaoke Chai
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongqiu Luo
- Department of Neurosurgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Center for Neurological Disorders, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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Li L, Ibayashi K, Piscopo A, Deifelt Streese C, Chen H, Greenlee JDW, Hasan DM. Intraarterial encephalography from an acutely implanted aneurysm embolization device in awake humans. J Neurosurg 2023; 138:785-792. [PMID: 35932270 DOI: 10.3171/2022.6.jns22932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endovascular electroencephalography (evEEG) uses the cerebrovascular system to record electrical activity from adjacent neural structures. The safety, feasibility, and efficacy of using the Woven EndoBridge Aneurysm Embolization System (WEB) for evEEG has not been investigated. METHODS Seventeen participants undergoing awake WEB endovascular treatment of unruptured cerebral aneurysms were included. After WEB deployment and before detachment, its distal deployment wire was connected to an EEG receiver, and participants performed a decision-making task for 10 minutes. WEB and scalp recordings were captured. RESULTS All patients underwent successful embolization and evEEG with no complications. Event-related potentials were detected on scalp EEG in 9/17 (53%) patients. Of these 9 patients, a task-related low-gamma (30-70 Hz) response on WEB channels was captured in 8/9 (89%) cases. In these 8 patients, the WEB was deployed in 2 middle cerebral arteries, 3 anterior communicating arteries, the terminal internal carotid artery, and 2 basilar tip aneurysms. Electrocardiogram artifact on WEB channels was present in 12/17 cases. CONCLUSIONS The WEB implanted within cerebral aneurysms of awake patients is capable of capturing task-specific brain electrical activities. Future studies are warranted to establish the efficacy of and support for evEEG as a tool for brain recording, brain stimulation, and brain-machine interface applications.
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Affiliation(s)
- Luyuan Li
- 1Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Kenji Ibayashi
- 2Department of Neurosurgery, Jichi Medical University, Tochigi, Japan; and
| | - Anthony Piscopo
- 1Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | | | - Haiming Chen
- 1Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | | | - David M Hasan
- 3Department of Neurosurgery, Duke University, Durham, North Carolina
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Thielen B, Xu H, Fujii T, Rangwala SD, Jiang W, Lin M, Kammen A, Liu C, Selvan P, Song D, Mack WJ, Meng E. Making a case for endovascular approaches for neural recording and stimulation. J Neural Eng 2023; 20:10.1088/1741-2552/acb086. [PMID: 36603221 PMCID: PMC9928900 DOI: 10.1088/1741-2552/acb086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/05/2023] [Indexed: 01/06/2023]
Abstract
There are many electrode types for recording and stimulating neural tissue, most of which necessitate direct contact with the target tissue. These electrodes range from large, scalp electrodes which are used to non-invasively record averaged, low frequency electrical signals from large areas/volumes of the brain, to penetrating microelectrodes which are implanted directly into neural tissue and interface with one or a few neurons. With the exception of scalp electrodes (which provide very low-resolution recordings), each of these electrodes requires a highly invasive, open brain surgical procedure for implantation, which is accompanied by significant risk to the patient. To mitigate this risk, a minimally invasive endovascular approach can be used. Several types of endovascular electrodes have been developed to be delivered into the blood vessels in the brain via a standard catheterization procedure. In this review, the existing body of research on the development and application of endovascular electrodes is presented. The capabilities of each of these endovascular electrodes is compared to commonly used direct-contact electrodes to demonstrate the relative efficacy of the devices. Potential clinical applications of endovascular recording and stimulation and the advantages of endovascular versus direct-contact approaches are presented.
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Affiliation(s)
- Brianna Thielen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Huijing Xu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Tatsuhiro Fujii
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shivani D. Rangwala
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wenxuan Jiang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Michelle Lin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexandra Kammen
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charles Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Neurorestoration Center, University of Southern California, Los Angeles, CA, USA
| | - Pradeep Selvan
- The Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Dong Song
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - William J. Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ellis Meng
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
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Fujimoto A, Matsumaru Y, Masuda Y, Marushima A, Hosoo H, Araki K, Ishikawa E. Endovascular Electroencephalogram Records Simultaneous Subdural Electrode-Detectable, Scalp Electrode-Undetectable Interictal Epileptiform Discharges. Brain Sci 2022; 12:brainsci12030309. [PMID: 35326265 PMCID: PMC8946704 DOI: 10.3390/brainsci12030309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: We hypothesized that an endovascular electroencephalogram (eEEG) can detect subdural electrode (SDE)-detectable, scalp EEG-undetectable epileptiform discharges. The purpose of this study is, therefore, to measure SDE-detectable, scalp EEG-undetectable epileptiform discharges by an eEEG on a pig. Methods: A pig under general anesthesia was utilized to measure an artificially generated epileptic field by an eEEG that was able to be detected by an SDE, but not a scalp EEG as a primary outcome. We also compared the phase lag of each epileptiform discharge that was detected by the eEEG and SDE as a secondary outcome. Results: The eEEG electrode detected 113 (97%) epileptiform discharges (97% sensitivity). Epileptiform discharges that were localized within the three contacts (contacts two, three and four), but not spread to other parts, were detected by the eEEG with a 92% sensitivity. The latency between peaks of the eEEG and right SDE earliest epileptiform discharge ranged from 0 to 48 ms (mean, 13.3 ms; median, 11 ms; standard deviation, 9.0 ms). Conclusion: In a pig, an eEEG could detect epileptiform discharges that an SDE could detect, but that a scalp EEG could not.
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Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka 988-056, Japan;
- School of Rehabilitation Sciences, Seirei Christopher University, Shizuoka 988-056, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
- E.P. Medical Inc., 403 Nihonbashi-Life-Science Building, 2-3-11, Honcho, Nihonbashi, Chuo-ku, Tokyo 103-0023, Japan
- Correspondence: ; Tel.: +81-29-853-3900; Fax: +81-29-853-3214
| | - Yosuke Masuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Kota Araki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
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Soldozy S, Young S, Kumar JS, Capek S, Felbaum DR, Jean WC, Park MS, Syed HR. A systematic review of endovascular stent-electrode arrays, a minimally invasive approach to brain-machine interfaces. Neurosurg Focus 2020; 49:E3. [PMID: 32610291 DOI: 10.3171/2020.4.focus20186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to systematically review the feasibility and safety of minimally invasive neurovascular approaches to brain-machine interfaces (BMIs). METHODS A systematic literature review was performed using the PubMed database for studies published between 1986 and 2019. All studies assessing endovascular neural interfaces were included. Additional studies were selected based on review of references of selected articles and review articles. RESULTS Of the 53 total articles identified in the original literature search, 12 studies were ultimately selected. An additional 10 articles were included from other sources, resulting in a total of 22 studies included in this systematic review. This includes primarily preclinical studies comparing endovascular electrode recordings with subdural and epidural electrodes, as well as studies evaluating stent-electrode gauge and material type. In addition, several clinical studies are also included. CONCLUSIONS Endovascular stent-electrode arrays provide a minimally invasive approach to BMIs. Stent-electrode placement has been shown to be both efficacious and safe, although further data are necessary to draw comparisons between subdural and epidural electrode measurements given the heterogeneity of the studies included. Greater access to deep-seated brain regions is now more feasible with stent-electrode arrays; however, further validation is needed in large clinical trials to optimize this neural interface. This includes the determination of ideal electrode material type, venous versus arterial approaches, the feasibility of deep brain stimulation, and more streamlined computational decoding techniques.
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Affiliation(s)
- Sauson Soldozy
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Steven Young
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jeyan S Kumar
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Stepan Capek
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Daniel R Felbaum
- 2Department of Neurosurgery, Georgetown University, Washington, DC; and
| | - Walter C Jean
- 3Department of Neurosurgery, George Washington University, Washington, DC
| | - Min S Park
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Hasan R Syed
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Fan JZ, Lopez-Rivera V, Sheth SA. Over the Horizon: The Present and Future of Endovascular Neural Recording and Stimulation. Front Neurosci 2020; 14:432. [PMID: 32435184 PMCID: PMC7218134 DOI: 10.3389/fnins.2020.00432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
The past decade has witnessed an explosion in applications for neural recording and stimulation in the treatment of clinical disorders. Neuromodulatory approaches are now a mainstay of care for essential tremor and Parkinson's disease, and are expanding rapidly into a wide range of other neurological and psychiatric diseases. In parallel, advancements in endovascular approaches to cerebrovascular diseases have resulted in minimally invasive techniques that deliver devices to neural tissue in the central and peripheral nervous systems, with significantly improved safety and efficacy. In this review, we discuss the history of endovascular neural recording and stimulation, its current progress, and applications for neurological disease.
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Affiliation(s)
| | | | - Sunil A. Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX, United States
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Sefcik RK, Opie NL, John SE, Kellner CP, Mocco J, Oxley TJ. The evolution of endovascular electroencephalography: historical perspective and future applications. Neurosurg Focus 2017; 40:E7. [PMID: 27132528 DOI: 10.3171/2016.3.focus15635] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current standard practice requires an invasive approach to the recording of electroencephalography (EEG) for epilepsy surgery, deep brain stimulation (DBS), and brain-machine interfaces (BMIs). The development of endovascular techniques offers a minimally invasive route to recording EEG from deep brain structures. This historical perspective aims to describe the technical progress in endovascular EEG by reviewing the first endovascular recordings made using a wire electrode, which was followed by the development of nanowire and catheter recordings and, finally, the most recent progress in stent-electrode recordings. The technical progress in device technology over time and the development of the ability to record chronic intravenous EEG from electrode arrays is described. Future applications for the use of endovascular EEG in the preoperative and operative management of epilepsy surgery are then discussed, followed by the possibility of the technique's future application in minimally invasive operative approaches to DBS and BMI.
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Affiliation(s)
| | - Nicholas L Opie
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Sam E John
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | | | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Thomas J Oxley
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and.,Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
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He BD, Ebrahimi M, Palafox L, Srinivasan L. Signal quality of endovascular electroencephalography. J Neural Eng 2016; 13:016016. [DOI: 10.1088/1741-2560/13/1/016016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Teplitzky BA, Connolly AT, Bajwa JA, Johnson MD. Computational modeling of an endovascular approach to deep brain stimulation. J Neural Eng 2014; 11:026011. [PMID: 24608363 DOI: 10.1088/1741-2560/11/2/026011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) therapy currently relies on a transcranial neurosurgical technique to implant one or more electrode leads into the brain parenchyma. In this study, we used computational modeling to investigate the feasibility of using an endovascular approach to target DBS therapy. APPROACH Image-based anatomical reconstructions of the human brain and vasculature were used to identify 17 established and hypothesized anatomical targets of DBS, of which five were found adjacent to a vein or artery with intraluminal diameter ≥1 mm. Two of these targets, the fornix and subgenual cingulate white matter (SgCwm) tracts, were further investigated using a computational modeling framework that combined segmented volumes of the vascularized brain, finite element models of the tissue voltage during DBS, and multi-compartment axon models to predict the direct electrophysiological effects of endovascular DBS. MAIN RESULTS The models showed that: (1) a ring-electrode conforming to the vessel wall was more efficient at neural activation than a guidewire design, (2) increasing the length of a ring-electrode had minimal effect on neural activation thresholds, (3) large variability in neural activation occurred with suboptimal placement of a ring-electrode along the targeted vessel, and (4) activation thresholds for the fornix and SgCwm tracts were comparable for endovascular and stereotactic DBS, though endovascular DBS was able to produce significantly larger contralateral activation for a unilateral implantation. SIGNIFICANCE Together, these results suggest that endovascular DBS can serve as a complementary approach to stereotactic DBS in select cases.
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Affiliation(s)
- Benjamin A Teplitzky
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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Bower MR, Stead M, Van Gompel JJ, Bower RS, Sulc V, Asirvatham SJ, Worrell GA. Intravenous recording of intracranial, broadband EEG. J Neurosci Methods 2013; 214:21-6. [PMID: 23313850 DOI: 10.1016/j.jneumeth.2012.12.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/30/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
Abstract
The most direct evaluation of human brain activity has been obtained from intracranial electrodes placed either on the surface of the brain or inserted into the brain to record from deep brain structures. Currently, the placement of intracranial electrodes implies transcranial surgery, either through a burr hole or a craniotomy, but the high degree of invasiveness and potential for morbidity of such major surgical procedures limits the applicability of intracranial recording. The vascular system provides a natural avenue to reach many brain regions that currently are reached by transcranial approaches, along with deep brain structures that cannot be reached via a transcranial approach without significant risk. To determine the applicability of intravascular approaches to high-frequency intracranial monitoring, a catheter containing multiple macro- and micro-electrodes was placed into the superior sagittal sinus of anesthetized pigs in parallel with clinical, subdural electrode grids to record epileptiform activity induced by direct, cortical injection of penicillin and to record responses to electrical stimulation. Intravascular electrodes recorded epileptiform spikes with similar magnitudes and waveshapes to those obtained by surface electrodes, both for macroelectrodes and microelectrodes, including the spatiotemporal evolution of epileptiform activity, suggesting that intravascular electrodes might provide localizing information regarding seizure foci. Sinusoidal electrical stimulation showed that intravascular electrodes provide sufficient broadband fidelity to record high-frequency, physiological events that may also prove useful in localizing seizure onset zones. As intravascular techniques have transformed cardiology, so intravascular neurophysiology may transform intracranial monitoring, in general, and the treatment of epilepsy, in particular.
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Affiliation(s)
- Mark R Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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