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Daume J, Kamiński J, Schjetnan AGP, Salimpour Y, Khan U, Kyzar M, Reed CM, Anderson WS, Valiante TA, Mamelak AN, Rutishauser U. Control of working memory by phase-amplitude coupling of human hippocampal neurons. Nature 2024; 629:393-401. [PMID: 38632400 PMCID: PMC11078732 DOI: 10.1038/s41586-024-07309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
Retaining information in working memory is a demanding process that relies on cognitive control to protect memoranda-specific persistent activity from interference1,2. However, how cognitive control regulates working memory storage is unclear. Here we show that interactions of frontal control and hippocampal persistent activity are coordinated by theta-gamma phase-amplitude coupling (TG-PAC). We recorded single neurons in the human medial temporal and frontal lobe while patients maintained multiple items in their working memory. In the hippocampus, TG-PAC was indicative of working memory load and quality. We identified cells that selectively spiked during nonlinear interactions of theta phase and gamma amplitude. The spike timing of these PAC neurons was coordinated with frontal theta activity when cognitive control demand was high. By introducing noise correlations with persistently active neurons in the hippocampus, PAC neurons shaped the geometry of the population code. This led to higher-fidelity representations of working memory content that were associated with improved behaviour. Our results support a multicomponent architecture of working memory1,2, with frontal control managing maintenance of working memory content in storage-related areas3-5. Within this framework, hippocampal TG-PAC integrates cognitive control and working memory storage across brain areas, thereby suggesting a potential mechanism for top-down control over sensory-driven processes.
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Affiliation(s)
- Jonathan Daume
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jan Kamiński
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center of Excellence for Neural Plasticity and Brain Disorders: BRAINCITY, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Andrea G P Schjetnan
- Krembil Research Institute and Division of Neurosurgery, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
| | - Yousef Salimpour
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Umais Khan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Kyzar
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chrystal M Reed
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Taufik A Valiante
- Krembil Research Institute and Division of Neurosurgery, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA.
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2
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Aquino TG, Courellis H, Mamelak AN, Rutishauser U, O Doherty JP. Encoding of Predictive Associations in Human Prefrontal and Medial Temporal Neurons During Pavlovian Appetitive Conditioning. J Neurosci 2024; 44:e1628232024. [PMID: 38423764 PMCID: PMC11044193 DOI: 10.1523/jneurosci.1628-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
Pavlovian conditioning is thought to involve the formation of learned associations between stimuli and values, and between stimuli and specific features of outcomes. Here, we leveraged human single neuron recordings in ventromedial prefrontal, dorsomedial frontal, hippocampus, and amygdala while patients of both sexes performed an appetitive Pavlovian conditioning task probing both stimulus-value and stimulus-stimulus associations. Ventromedial prefrontal cortex encoded predictive value along with the amygdala, and also encoded predictions about the identity of stimuli that would subsequently be presented, suggesting a role for neurons in this region in encoding predictive information beyond value. Unsigned error signals were found in dorsomedial frontal areas and hippocampus, potentially supporting learning of non-value related outcome features. Our findings implicate distinct human prefrontal and medial temporal neuronal populations in mediating predictive associations which could partially support model-based mechanisms during Pavlovian conditioning.
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Affiliation(s)
- Tomas G Aquino
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California 90048
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California 91125
| | - Hristos Courellis
- Biological Engineering, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California 91125
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California 90048
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California 90048
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California 91125
| | - John P O Doherty
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California 91125
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, California 91125
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3
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Mamelak AN. Response to Letter to the Editor from Salle et al.: "A prospective multi-center observational study of surgical versus non-surgical management for pituitary apoplexy". J Clin Endocrinol Metab 2024:dgae091. [PMID: 38381088 DOI: 10.1210/clinem/dgae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Adam N Mamelak
- Professor of Neurosurgery, Co-Director, Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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4
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Mamelak AN. Between a rock and a hard place: the role of DA induced tumor fibrosis in prolactinoma management. J Clin Endocrinol Metab 2024:dgae090. [PMID: 38380908 DOI: 10.1210/clinem/dgae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Adam N Mamelak
- Professor of Neurosurgery, Co-Director, Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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5
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Keles U, Dubois J, Le KJM, Tyszka JM, Kahn DA, Reed CM, Chung JM, Mamelak AN, Adolphs R, Rutishauser U. Multimodal single-neuron, intracranial EEG, and fMRI brain responses during movie watching in human patients. Sci Data 2024; 11:214. [PMID: 38365977 PMCID: PMC10873379 DOI: 10.1038/s41597-024-03029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
We present a multimodal dataset of intracranial recordings, fMRI, and eye tracking in 20 participants during movie watching. Recordings consist of single neurons, local field potential, and intracranial EEG activity acquired from depth electrodes targeting the amygdala, hippocampus, and medial frontal cortex implanted for monitoring of epileptic seizures. Participants watched an 8-min long excerpt from the video "Bang! You're Dead" and performed a recognition memory test for movie content. 3 T fMRI activity was recorded prior to surgery in 11 of these participants while performing the same task. This NWB- and BIDS-formatted dataset includes spike times, field potential activity, behavior, eye tracking, electrode locations, demographics, and functional and structural MRI scans. For technical validation, we provide signal quality metrics, assess eye tracking quality, behavior, the tuning of cells and high-frequency broadband power field potentials to familiarity and event boundaries, and show brain-wide inter-subject correlations for fMRI. This dataset will facilitate the investigation of brain activity during movie watching, recognition memory, and the neural basis of the fMRI-BOLD signal.
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Affiliation(s)
- Umit Keles
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Julien Dubois
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kevin J M Le
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - J Michael Tyszka
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - David A Kahn
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Chrystal M Reed
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey M Chung
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ralph Adolphs
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA.
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA.
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Franklin D, Yamani AS, Boyke AE, Menaker SA, Tang D, Mamelak AN. Spontaneous sphenoid sinus meningocele with associated amenorrhea and headache: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23700. [PMID: 38346300 PMCID: PMC10865469 DOI: 10.3171/case23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Developmental meningoceles of the sphenoid sinus are uncommon. When encountered, they are often associated with cerebrospinal fluid (CSF) rhinorrhea. OBSERVATIONS The authors present the case of a 27-year-old female with a large meningocele eroding through the sella turcica and sphenoid sinus into the nasopharynx. The patient presented with intractable headaches and amenorrhea without CSF rhinorrhea. LESSONS The patient underwent an endoscopic endonasal transsphenoidal reduction of the meningocele with reelevation of the pituitary gland and skull base reconstruction with abdominal fat graft and nasoseptal flap.
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Affiliation(s)
- Deveney Franklin
- School of Medicine, University of North Carolina,
Chapel Hill, North Carolina
| | - Ali S Yamani
- College of Medicine, University of Cincinnati,
Cincinnati, Ohio; and
| | | | | | - Dennis Tang
- Otolaryngology, Cedars-Sinai Medical Center, Los
Angeles, California
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7
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Simmons JK, Nadeem W, Maya MM, Wu AW, Schievink WI, Mamelak AN, Tang DM. CSF-Venous Fistula of the Clival Skull Base: A Unique Case Study and Literature Review. Laryngoscope 2024; 134:645-647. [PMID: 37681943 DOI: 10.1002/lary.31032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
An adolescent male presented with orthostatic headaches following head trauma. MRI showed cerebellar tonsil displacement and a bony defect in the clival skull base. Digital subtraction myelography (DSM) confirmed a cerebrospinal fluid-venous fistula (CVF). This was repaired endoscopically. CVFs cause uncontrolled flow of CSF into the venous system resulting in symptoms of intracranial hypotension. They're often difficult to identify on initial imaging. This is the first reported CVF originating in the central skull base, and the first treated via endoscopic trans-nasal approach. CVFs may elude initial imaging, making DSM crucial for unexplained spontaneous intracranial hypotension. Laryngoscope, 134:645-647, 2024.
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Affiliation(s)
- Jordan K Simmons
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Wasiq Nadeem
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
- San Antonio School of Medicine, University of Texas, San Antonio, Texas, U.S.A
| | - Marcel M Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Arthur W Wu
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Wouter I Schievink
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Dennis M Tang
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
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8
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Kyzar M, Kamiński J, Brzezicka A, Reed CM, Chung JM, Mamelak AN, Rutishauser U. Dataset of human-single neuron activity during a Sternberg working memory task. Sci Data 2024; 11:89. [PMID: 38238342 PMCID: PMC10796636 DOI: 10.1038/s41597-024-02943-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
We present a dataset of 1809 single neurons recorded from the human medial temporal lobe (amygdala and hippocampus) and medial frontal lobe (anterior cingulate cortex, pre-supplementary motor area, ventral medial prefrontal cortex) across 41 sessions from 21 patients that underwent seizure monitoring with depth electrodes. Subjects performed a screening task (907 neurons) to identify images for which highly selective cells were present. Subjects then performed a working memory task (902 neurons), in which they were sequentially presented with 1-3 images for which highly selective cells were present and, following a maintenance period, were asked if the probe was identical to one of the maintained images. This Neurodata Without Borders formatted dataset includes spike times, extracellular spike waveforms, stimuli presented, behavior, electrode locations, and subject demographics. As validation, we replicate previous findings on the selectivity of concept cells and their persistent activity during working memory maintenance. This large dataset of rare human single-neuron recordings and behavior enables the investigation of the neural mechanisms of working memory in humans.
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Affiliation(s)
- Michael Kyzar
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jan Kamiński
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center of Excellence for Neural Plasticity and Brain Disorders: BRAINCITY, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Aneta Brzezicka
- Institute of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Chrystal M Reed
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey M Chung
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA.
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Mamelak AN, Little AS, Gardner PA, Almeida JP, Recinos P, Soni P, Kshettry VR, Jane JA, Barkhoudarian G, Kelly DF, Dodd R, Mukherjee D, Gersey ZC, Fukuhara N, Nishioka H, Kim EH, Litré CF, Sina E, Mazer MW, Cui Y, Bonert V. A Prospective, Multicenter, Observational Study of Surgical vs Nonsurgical Management for Pituitary Apoplexy. J Clin Endocrinol Metab 2024; 109:e711-e725. [PMID: 37698130 DOI: 10.1210/clinem/dgad541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
CONTEXT Pituitary apoplexy (PA) has been traditionally considered a neurosurgical emergency, yet retrospective single-institution studies suggest similar outcomes among patients managed medically. OBJECTIVE We established a multicenter, international prospective registry to compare presentation and outcomes in PA patients treated with surgery or medical management alone. METHODS A centralized database captured demographics, comorbidities, clinical presentation, visual findings, hormonal status, and imaging features at admission. Treatment was determined independently by each site. Key outcomes included visual, oculomotor, and hormonal recovery, complications, and hospital length of stay. Outcomes were also compared based on time from symptom onset to surgery, and from admission or transfer to the treating center. Statistical testing compared treatment groups based on 2-sided hypotheses and P less than .05. RESULTS A total of 100 consecutive PA patients from 12 hospitals were enrolled, and 97 (67 surgical and 30 medical) were evaluable. Demographics, clinical features, presenting symptoms, hormonal deficits, and imaging findings were similar between groups. Severe temporal visual field deficit was more common in surgical patients. At 3 and 6 months, hormonal, visual, and oculomotor outcomes were similar. Stratifying based on severity of visual fields demonstrated no difference in any outcome at 3 months. Timing of surgery did not affect outcomes. CONCLUSION We found that medical and surgical management of PA yield similar 3-month outcomes. Although patients undergoing surgery had more severe visual field deficits, we could not clearly demonstrate that surgery led to better outcomes. Even without surgery, apoplectic tumor volumes regress substantially within 2 to 3 months, indicating that surgery is not always needed to reduce mass effect.
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Affiliation(s)
- Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Medical Center, Phoenix, AZ 85013, USA
| | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | | | - Pablo Recinos
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Pranay Soni
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Varun R Kshettry
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - John A Jane
- Departments of Neurosurgery, Virginia Tech Medical Center, Roanoke, VA 24014, USA
| | - Garni Barkhoudarian
- Pacific Neuroscience Institute, Saint John's Medical Center, Santa Monica, CA 90404, USA
| | - Daniel F Kelly
- Pacific Neuroscience Institute, Saint John's Medical Center, Santa Monica, CA 90404, USA
| | - Robert Dodd
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA 94305, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Zachary C Gersey
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Noriaki Fukuhara
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Hiroshi Nishioka
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Eui-Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Korea
| | | | - Elliott Sina
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mia W Mazer
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Yujie Cui
- Biostatistic Core, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Vivien Bonert
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Nisson PL, Palsma R, Barnard ZR, Schievink WI, Mamelak AN. Endoscopic endonasal transclival clipping of a cerebellar arteriovenous malformation feeding vessel and associated aneurysm; a 2D operative video. J Clin Neurosci 2023; 118:161-162. [PMID: 37944360 DOI: 10.1016/j.jocn.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
Positioned along the ventral surface of the pons, proximal superior cerebellar artery (SCA) aneurysms account for only 1.7% of all intracranial aneurysms [1]. Unlike more commonly encountered basilar artery aneurysms, patients often experience good outcomes when treated via endovascular coiling or surgical clipping [1,2]. These lesions frequently have a lateral projection and paucity of perforator arteries [2]. With further development of endoscopic endonasal techniques, access to this region is possible via a direct frontal exposure to the ventral brainstem, basilar artery and branching vessels. To date, there are only a limited number of reports describing an endoscopic endonasal transclival (EETC) approach for surgical clipping [3-5]. In this operative video, we detail the surgical clipping of a cerebellar arteriovenous malformation feeding vessel and an associated aneurysm using the EETC approach in a 59-year-old woman who presented with sudden onset of a severe headache. The feeding vessel and aneurysm's midline location, just below the take-off of the SCA made it a good candidate for this surgery. Major steps included in this video include 1) transsphenoidal exposure of and subsequent drilling of the clivus, 2) dural opening into the pre-pontine cistern and dissection of the aneurysm, 3) clipping of the aneurysm, and 4) multi-layered closure of the skull base defect. Overall, the patient tolerated the procedure well and was found to have no residual filling of the aneurysm or the AVM feeding vessel at 2-year follow-up. EETC is a viable surgical option for the treatment of aneurysm located along the midline of the pre-pontine cistern.
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Affiliation(s)
- Peyton L Nisson
- Department of Neurosurgery, Cedars-Sinai, Los Angeles, CA, United States
| | - Ryan Palsma
- Department of Neurosurgery, University of Arizona, Tucson, AZ, United States
| | - Zachary R Barnard
- Department of Neurosurgery, Cedars-Sinai, Los Angeles, CA, United States
| | - Wouter I Schievink
- Department of Neurosurgery, Cedars-Sinai, Los Angeles, CA, United States
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai, Los Angeles, CA, United States.
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11
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Courellis HS, Mixha J, Cardenas AR, Kimmel D, Reed CM, Valiante TA, Salzman CD, Mamelak AN, Fusi S, Rutishauser U. Abstract representations emerge in human hippocampal neurons during inference behavior. bioRxiv 2023:2023.11.10.566490. [PMID: 37986878 PMCID: PMC10659400 DOI: 10.1101/2023.11.10.566490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Humans have the remarkable cognitive capacity to rapidly adapt to changing environments. Central to this capacity is the ability to form high-level, abstract representations that take advantage of regularities in the world to support generalization 1 . However, little is known about how these representations are encoded in populations of neurons, how they emerge through learning, and how they relate to behavior 2,3 . Here we characterized the representational geometry of populations of neurons (single-units) recorded in the hippocampus, amygdala, medial frontal cortex, and ventral temporal cortex of neurosurgical patients who are performing an inferential reasoning task. We find that only the neural representations formed in the hippocampus simultaneously encode multiple task variables in an abstract, or disentangled, format. This representational geometry is uniquely observed after patients learn to perform inference, and consisted of disentangled directly observable and discovered latent task variables. Interestingly, learning to perform inference by trial and error or through verbal instructions led to the formation of hippocampal representations with similar geometric properties. The observed relation between representational format and inference behavior suggests that abstract/disentangled representational geometries are important for complex cognition.
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12
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Risbud A, Kuan EC, Wu AW, Mamelak AN, Tang DM. Postoperative Obstructive Sleep Apnea Management Following Endoscopic Pituitary Surgery: A Systematic Review. World Neurosurg 2023; 176:143-148. [PMID: 37149088 DOI: 10.1016/j.wneu.2023.04.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE There is currently no consensus on the appropriate timing of noninvasive positive pressure ventilation (PPV) resumption in patients with obstructive sleep apnea (OSA) after endoscopic pituitary surgery. We performed a systematic review of the literature to better assess the safety of early PPV use in OSA patients following surgery. METHODS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases in English were searched using the keywords: "sleep apnea," "CPAP," "endoscopic," "skull base," "transsphenoidal" and "pituitary surgery." Case reports, editorials, reviews, meta-analyses, unpublished and abstract-only articles were all excluded. RESULTS Five retrospective studies were identified, comprising 267 patients with OSA who underwent endoscopic endonasal pituitary surgery. The mean age of patients in four studies (n = 198) was 56.3 years (SD = 8.6) and the most common indication for surgery was pituitary adenoma resection. The timing of PPV resumption following surgery was reported in four studies (n = 130), with 29 patients receiving PPV therapy within two weeks. The pooled rate of postoperative cerebrospinal fluid leak associated with PPV resumption was 4.0% (95% CI: 1.3-6.7%) in three studies (n = 27) and there were no reports of pneumocephalus associated with PPV use in the early postoperative period (<2 weeks). CONCLUSIONS Early resumption of PPV in OSA patients after endoscopic endonasal pituitary surgery appears relatively safe. However, the current literature is limited. Additional studies with more rigorous outcome reporting are warranted to assess the true safety of re-initiating PPV postoperatively in this population.
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Affiliation(s)
- Adwight Risbud
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Arthur W Wu
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Adam N Mamelak
- Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis M Tang
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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13
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Cooper O, Lis R, Bonert V, Labadzhyan A, Liu NA, Ben-Shlomo A, Ljubimov V, Krutikova V, Mamelak AN. Fluid Restriction Reduces Delayed Hyponatremia and Hospital Readmissions After Transsphenoidal Surgery. J Clin Endocrinol Metab 2023; 108:e623-e633. [PMID: 36723998 DOI: 10.1210/clinem/dgad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/02/2023]
Abstract
CONTEXT Postoperative hyponatremia leads to prolonged hospital length of stay and readmission within 30 days. OBJECTIVE To assess 3 strategies for reducing rates of postoperative hyponatremia and analyze risk factors for hyponatremia. DESIGN Two retrospective analyses and 1 prospective study. SETTING Tertiary referral hospital. PATIENTS Patients undergoing transsphenoidal surgery for pituitary adenomas and other sellar and parasellar pathologies. INTERVENTION(S) Phase 1: no intervention. Phase 2: postoperative day (POD) 7 sodium testing and patient education. Phase 3: fluid restriction to 1 L/day on discharge in addition to phase 2 interventions. MAIN OUTCOME MEASURES Rates of early and delayed hyponatremia and readmissions. Secondary outcomes were risk factors for hyponatremia and readmission costs. RESULTS In phase 1, 296 patients underwent transsphenoidal surgery. Twenty percent developed early and 28% delayed hyponatremia. Thirty-eight percent underwent POD 7 sodium testing. Readmission rates were 15% overall and 4.3% for hyponatremia. In phase 2 (n = 316), 22% developed early and 25% delayed hyponatremia. Eighty-nine percent complied with POD 7 sodium testing. Readmissions were unchanged although severity of hyponatremia was reduced by 60%. In phase 3 (n = 110), delayed hyponatremia was reduced 2-fold [12.7%, relative risk (RR) = 0.52] and readmissions 3-fold [4.6%, RR = 0.30 (0.12-0.73)]; readmissions for hyponatremia were markedly reduced. Hyponatremia readmission increased costs by 30%. CONCLUSIONS Restricting fluid to 1 L/day on discharge decreases rates of delayed hyponatremia and readmissions by 50%. Standardized patient education and POD 7 sodium testing decreases severity of hyponatremia but does not impact readmission rates. These protocols should be considered standard practice for patients undergoing transsphenoidal surgery.
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Affiliation(s)
- Odelia Cooper
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rita Lis
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Vivien Bonert
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Artak Labadzhyan
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ning-Ai Liu
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anat Ben-Shlomo
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Vladimir Ljubimov
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Adam N Mamelak
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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14
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Aquino TG, Cockburn J, Mamelak AN, Rutishauser U, O'Doherty JP. Neurons in human pre-supplementary motor area encode key computations for value-based choice. Nat Hum Behav 2023; 7:970-985. [PMID: 36959327 PMCID: PMC10330469 DOI: 10.1038/s41562-023-01548-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/02/2023] [Indexed: 03/25/2023]
Abstract
Adaptive behaviour in real-world environments requires that choices integrate several variables, including the novelty of the options under consideration, their expected value and uncertainty in value estimation. Here, to probe how integration over decision variables occurs during decision-making, we recorded neurons from the human pre-supplementary motor area (preSMA), ventromedial prefrontal cortex and dorsal anterior cingulate. Unlike the other areas, preSMA neurons not only represented separate pre-decision variables for each choice option but also encoded an integrated utility signal for each choice option and, subsequently, the decision itself. Post-decision encoding of variables for the chosen option was more widely distributed and especially prominent in the ventromedial prefrontal cortex. Our findings position the human preSMA as central to the implementation of value-based decisions.
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Affiliation(s)
- Tomas G Aquino
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA.
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jeffrey Cockburn
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ueli Rutishauser
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John P O'Doherty
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
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15
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Daume J, Kaminski J, Schjetnan AGP, Salimpour Y, Khan U, Reed C, Anderson W, Valiante TA, Mamelak AN, Rutishauser U. Control of working memory maintenance by theta-gamma phase amplitude coupling of human hippocampal neurons. bioRxiv 2023:2023.04.05.535772. [PMID: 37066145 PMCID: PMC10104113 DOI: 10.1101/2023.04.05.535772] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Retaining information in working memory (WM) is a demanding process that relies on cognitive control to protect memoranda-specific persistent activity from interference. How cognitive control regulates WM storage, however, remains unknown. We hypothesized that interactions of frontal control and hippocampal persistent activity are coordinated by theta-gamma phase amplitude coupling (TG-PAC). We recorded single neurons in the human medial temporal and frontal lobe while patients maintained multiple items in WM. In the hippocampus, TG-PAC was indicative of WM load and quality. We identified cells that selectively spiked during nonlinear interactions of theta phase and gamma amplitude. These PAC neurons were more strongly coordinated with frontal theta activity when cognitive control demand was high, and they introduced information-enhancing and behaviorally relevant noise correlations with persistently active neurons in the hippocampus. We show that TG-PAC integrates cognitive control and WM storage to improve the fidelity of WM representations and facilitate behavior.
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Affiliation(s)
- Jonathan Daume
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jan Kaminski
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Nencki Institute of Experimental Biology, Warsaw, Poland
| | - Andrea G P Schjetnan
- Krembil Research Institute and Division of Neurosurgery, University Health Network (UHN), University of Toronto, Toronto, ON, Canada
| | - Yousef Salimpour
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Umais Khan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chrystal Reed
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Taufik A Valiante
- Krembil Research Institute and Division of Neurosurgery, University Health Network (UHN), University of Toronto, Toronto, ON, Canada
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
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16
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Liu NA, Ben-Shlomo A, Carmichael JD, Wang C, Swerdloff RS, Heaney AP, Barkhoudarian G, Kelly D, Noureddin M, Lu L, Desai M, Stolyarov Y, Yuen K, Mamelak AN, Mirocha J, Tighiouart M, Melmed S. Treatment of Cushing Disease With Pituitary-Targeting Seliciclib. J Clin Endocrinol Metab 2023; 108:726-735. [PMID: 36214832 DOI: 10.1210/clinem/dgac588] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/04/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Preclinical studies show seliciclib (R-roscovitine) suppresses neoplastic corticotroph proliferation and pituitary adrenocorticotrophic hormone (ACTH) production. OBJECTIVE To evaluate seliciclib as an effective pituitary-targeting treatment for patients with Cushing disease (CD). METHODS Two prospective, open-label, phase 2 trials, conducted at a tertiary referral pituitary center, included adult patients with de novo, persistent, or recurrent CD who received oral seliciclib 400 mg twice daily for 4 consecutive days each week for 4 weeks. The primary endpoint in the proof-of-concept single-center study was normalization of 24-hour urinary free cortisol (UFC; ≤ 50 µg/24 hours) at study end; in the pilot multicenter study, primary endpoint was UFC normalization or ≥ 50% reduction in UFC from baseline to study end. RESULTS Sixteen patients were consented and 9 were treated. Mean UFC decreased by 42%, from 226.4 ± 140.3 µg/24 hours at baseline to 131.3 ± 114.3 µg/24 hours by study end. Longitudinal model showed significant UFC reductions from baseline to each treatment week. Three patients achieved ≥ 50% UFC reduction (range, 55%-75%), and 2 patients exhibited 48% reduction; none achieved UFC normalization. Plasma ACTH decreased by 19% (P = 0.01) in patients who achieved ≥ 48% UFC reduction. Three patients developed grade ≤ 2 elevated liver enzymes, anemia, and/or elevated creatinine, which resolved with dose interruption/reduction. Two patients developed grade 4 liver-related serious adverse events that resolved within 4 weeks of seliciclib discontinuation. CONCLUSION Seliciclib may directly target pituitary corticotrophs in CD and reverse hypercortisolism. Potential liver toxicity of seliciclib resolves with treatment withdrawal. The lowest effective dose requires further determination.
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Affiliation(s)
- Ning-Ai Liu
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Anat Ben-Shlomo
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - John D Carmichael
- Pituitary Center, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA
| | - Christina Wang
- Department of Medicine, The Lundquist Institute and Harbor-UCLA Medical Center, Torrance, CA 90509, USA
| | - Ronald S Swerdloff
- Department of Medicine, The Lundquist Institute and Harbor-UCLA Medical Center, Torrance, CA 90509, USA
| | - Anthony P Heaney
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, USA
| | - Garni Barkhoudarian
- Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, CA 90404, USA
| | - Daniel Kelly
- Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, CA 90404, USA
| | - Mazen Noureddin
- Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Lin Lu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Manish Desai
- Southern California Permanente Group-Antelope Valley, Lancaster, CA 93534, USA
| | | | - Kevin Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ 85013, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - James Mirocha
- Biostatistics Core, Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mourad Tighiouart
- Biostatistics Core, Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Shlomo Melmed
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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17
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Mamelak AN. In Reply: Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results. Oper Neurosurg (Hagerstown) 2022; 23:e218-e219. [PMID: 35972124 DOI: 10.1227/ons.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Adam N Mamelak
- Department of Neurological Surgery, Functional and Epilepsy Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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18
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Cooper O, Bonert V, Mamelak AN, Bannykh S, Melmed S. Dural Invasion as a Marker of Aggressive Pituitary Adenomas. Neurosurgery 2022; 90:775-783. [PMID: 35262532 PMCID: PMC9514742 DOI: 10.1227/neu.0000000000001912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/16/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Predictive markers of aggressive pituitary tumors have not been consistently demonstrated. Dural invasion and invasion-associated proteins, including matrix metalloproteinase-9 (MMP9) and cofilin, have been proposed to predict aggressive behavior and recurrence, but findings to date have been inconsistent. OBJECTIVE To assess whether microscopic dural invasion predicts aggressive pituitary adenoma behavior and whether MMP9 and cofilin expression correlates with pathological and clinical invasion markers. METHODS We retrospectively studied 328 consecutive pituitary mass resections by a single neurosurgeon at a single center; 254 were adenomas, and 98 had dural biopsies sent for routine pathological evaluation. Assessments included clinical features, postoperative course, and immunochemical expression of MMP9, cofilin, and phospho-cofilin. Recurrence was evaluated in those with at least 12 months of postoperative follow-up. RESULTS Dural invasion was evident in 48% of biopsy specimens and was associated with male sex, larger tumors, suprasellar extension and sphenoid sinus invasion, cranial nerve palsies, and hypogonadism. Recurrence rates and the expression of MMP9, cofilin, and phospho-cofilin did not differ between those with and without dural invasion. However, differential expression of phospho-cofilin was associated with growth hormone deficiency and compressive pituitary mass effects. CONCLUSION Dural invasion is associated with larger tumors, suprasellar and sphenoid sinus invasion, and pituitary failure but is not predictive of a more aggressive postoperative course. Routine dural biopsy is therefore of limited benefit in predicting postoperative recurrences. Cofilin expression may be an adjunctive biomarker of invasion in recurrent tumors, but MMP9 expression does not predict tumor behavior.
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Affiliation(s)
- Odelia Cooper
- Pituitary Center, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Vivien Bonert
- Pituitary Center, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Adam N. Mamelak
- Pituitary Center, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Serguei Bannykh
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shlomo Melmed
- Pituitary Center, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
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19
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Fu Z, Beam D, Chung JM, Reed CM, Mamelak AN, Adolphs R, Rutishauser U. The geometry of domain-general performance monitoring in the human medial frontal cortex. Science 2022; 376:eabm9922. [PMID: 35511978 DOI: 10.1126/science.abm9922] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Controlling behavior to flexibly achieve desired goals depends on the ability to monitor one's own performance. It is unknown how performance monitoring can be both flexible, to support different tasks, and specialized, to perform each task well. We recorded single neurons in the human medial frontal cortex while subjects performed two tasks that involve three types of cognitive conflict. Neurons encoding conflict probability, conflict, and error in one or both tasks were intermixed, forming a representational geometry that simultaneously allowed task specialization and generalization. Neurons encoding conflict retrospectively served to update internal estimates of conflict probability. Population representations of conflict were compositional. These findings reveal how representations of evaluative signals can be both abstract and task-specific and suggest a neuronal mechanism for estimating control demand.
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Affiliation(s)
- Zhongzheng Fu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Danielle Beam
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey M Chung
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chrystal M Reed
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ralph Adolphs
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.,Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA, USA.,Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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20
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Tay ASMS, Menaker SA, Chan JL, Mamelak AN. Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results. Oper Neurosurg (Hagerstown) 2022; 22:e150-e157. [PMID: 35289779 PMCID: PMC10602512 DOI: 10.1227/ons.0000000000000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Robotic systems are gaining acceptance as a preferred tool for the placement of electrodes for stereotactic electroencephalography (SEEG) studies. OBJECTIVE To describe the technical methods for insertion of SEEG using the Medtronic Stealth Autoguide robotic system and detailed outcomes in the initial 9 patients implanted. METHODS Nine patients underwent placement of electrodes for SEEG studies with the use of the Autoguide system. Patients had at least 10 electrodes placed. Targets were planned on a Stealth S8 planning station, and electrodes were placed under general anesthesia. A technique for placement is described in detail. Patient outcomes and accuracy of electrode placement were evaluated. Methods to improve accuracy were investigated. Comparison of postoperative MRIs with preoperative planning MRIs was performed to determine the accuracy of electrode placement. RESULTS One hundred two electrodes were placed in 9 patients. Methods for placement and technical nuances are detailed. The distance from the planned target to the actual position of the electrode tip was measured in 8 of the 9 patients. The mean Euclidean distance was 4.67 ± 0.27 mm. There was 1 placement-related hemorrhage deficit in the first patient, and no deaths or infections. Adequate positioning of electrodes for seizure monitoring was obtained in all patients. CONCLUSION Autoguide can be used for placement of electrodes for SEEG studies with acceptable degrees of patient safety, accuracy, and efficiency. Considering the cost of Autoguide compared with other robotic devices, it may be attractive option.
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Affiliation(s)
| | - Simon A. Menaker
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Julie L. Chan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Adam N. Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA;
- Comprehensive Epilepsy Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
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21
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Staudigl T, Minxha J, Mamelak AN, Gothard KM, Rutishauser U. Saccade-related neural communication in the human medial temporal lobe is modulated by the social relevance of stimuli. Sci Adv 2022; 8:eabl6037. [PMID: 35302856 PMCID: PMC8932656 DOI: 10.1126/sciadv.abl6037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/26/2022] [Indexed: 05/31/2023]
Abstract
Humans predominantly explore their environment by moving their eyes. To optimally communicate and process visual information, neural activity needs to be coordinated with the execution of eye movements. We investigated the coordination between visual exploration and interareal neural communication by analyzing local field potentials and single neuron activity in patients with epilepsy. We demonstrated that during the free viewing of images, neural communication between the human amygdala and hippocampus is coordinated with the execution of eye movements. The strength and direction of neural communication and hippocampal saccade-related phase alignment were strongest for fixations that landed on human faces. Our results argue that the state of the human medial temporal lobe network is selectively coordinated with motor behavior. Interareal neural communication was facilitated for social stimuli as indexed by the category of the attended information.
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Affiliation(s)
- Tobias Staudigl
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
| | - Juri Minxha
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
- Center for Theoretical Neuroscience, Columbia University, New York, NY 10027, USA
| | - Adam N. Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Katalin M. Gothard
- Department of Physiology, College of Medicine, University of Arizona, Tucscon, AZ 85724, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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22
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Zheng J, Schjetnan AGP, Yebra M, Gomes BA, Mosher CP, Kalia SK, Valiante TA, Mamelak AN, Kreiman G, Rutishauser U. Neurons detect cognitive boundaries to structure episodic memories in humans. Nat Neurosci 2022; 25:358-368. [PMID: 35260859 PMCID: PMC8966433 DOI: 10.1038/s41593-022-01020-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
Abstract
While experience is continuous, memories are organized as discrete events. Cognitive boundaries are thought to segment experience and structure memory, but how this process is implemented remains unclear. We recorded the activity of single neurons in the human medial temporal lobe during the formation and retrieval of memories with complex narratives. Here we show that neurons responded to abstract cognitive boundaries between different episodes. Boundary-induced neural state changes during encoding predicted subsequent recognition accuracy but impaired event order memory, mirroring a fundamental behavioral tradeoff between content and time memory. Furthermore, the neural state following boundaries was reinstated during both successful retrieval and false memories. These findings reveal a neuronal substrate for detecting cognitive boundaries that transform experience into mnemonic episodes and structure mental time travel during retrieval.
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Affiliation(s)
- Jie Zheng
- Department of Ophthalmology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea G P Schjetnan
- Krembil Brain Institute and Division of Neurosurgery, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
| | - Mar Yebra
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bernard A Gomes
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Clayton P Mosher
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Suneil K Kalia
- Krembil Brain Institute and Division of Neurosurgery, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
| | - Taufik A Valiante
- Krembil Brain Institute and Division of Neurosurgery, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada.,Department of Surgery (Neurosurgery), Institute of Biomedical Engineering, and Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada.,Max Planck-University of Toronto Center for Neural Science and Technology, University of Toronto, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gabriel Kreiman
- Department of Ophthalmology, Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Center for Brains, Minds and Machines, Cambridge, MA, USA.
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA.
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Penner C, Minxha J, Chandravadia N, Mamelak AN, Rutishauser U. Properties and hemispheric differences of theta oscillations in the human hippocampus. Hippocampus 2022; 32:335-341. [PMID: 35231153 PMCID: PMC9067167 DOI: 10.1002/hipo.23412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/11/2022]
Abstract
The left and right primate hippocampi (LH and RH) are thought to support distinct functions, but little is known about differences between the hemispheres at the neuronal level. We recorded single-neuron and local field potentials from the human hippocampus in epilepsy patients implanted with depth electrodes. We detected theta-frequency bouts of oscillatory activity while patients performed a visual recognition memory task. Theta appeared in bouts of 3.16 cycles, with sawtooth-shaped oscillations that had a prolonged downswing period. Outside the seizure onset zone, the average frequency of theta bouts was higher in the RH compared to the LH (6.0 vs. 5.3 Hz). LH theta bouts had lower amplitudes and a higher prevalence compared to the RH (26% vs. 21% of total time). Additionally, the RH contained a population of thin spiking visually tuned neurons that were not present in the LH. These data show that human theta appears in short oscillatory bouts whose properties vary between hemispheres, thereby revealing neurophysiological properties of the hippocampus that differ between the hemispheres.
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Affiliation(s)
- Cooper Penner
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Juri Minxha
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Center for Theoretical Neuroscience, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nand Chandravadia
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California, USA.,Department of Biomedical Sciences, Center for Neural Science and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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24
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Wang R, Zhou C, McCormack AI, Mamelak AN. Editorial: Refractory Pituitary Adenoma-Current Challenges and Emerging Treatments. Front Endocrinol (Lausanne) 2022; 13:868174. [PMID: 35355554 PMCID: PMC8959341 DOI: 10.3389/fendo.2022.868174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital (CAMS), Beijing, China
- *Correspondence: Renzhi Wang,
| | - Cuiqi Zhou
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Ann I. McCormack
- Department of Endocrinology, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia
| | - Adam N. Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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25
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Marcus HJ, Khan DZ, Borg A, Buchfelder M, Cetas JS, Collins JW, Dorward NL, Fleseriu M, Gurnell M, Javadpour M, Jones PS, Koh CH, Layard Horsfall H, Mamelak AN, Mortini P, Muirhead W, Oyesiku NM, Schwartz TH, Sinha S, Stoyanov D, Syro LV, Tsermoulas G, Williams A, Winder MJ, Zada G, Laws ER. Pituitary society expert Delphi consensus: operative workflow in endoscopic transsphenoidal pituitary adenoma resection. Pituitary 2021; 24:839-853. [PMID: 34231079 PMCID: PMC8259776 DOI: 10.1007/s11102-021-01162-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Surgical workflow analysis seeks to systematically break down operations into hierarchal components. It facilitates education, training, and understanding of surgical variations. There are known educational demands and variations in surgical practice in endoscopic transsphenoidal approaches to pituitary adenomas. Through an iterative consensus process, we generated a surgical workflow reflective of contemporary surgical practice. METHODS A mixed-methods consensus process composed of a literature review and iterative Delphi surveys was carried out within the Pituitary Society. Each round of the survey was repeated until data saturation and > 90% consensus was reached. RESULTS There was a 100% response rate and no attrition across both Delphi rounds. Eighteen international expert panel members participated. An extensive workflow of 4 phases (nasal, sphenoid, sellar and closure) and 40 steps, with associated technical errors and adverse events, were agreed upon by 100% of panel members across rounds. Both core and case-specific or surgeon-specific variations in operative steps were captured. CONCLUSIONS Through an international expert panel consensus, a workflow for the performance of endoscopic transsphenoidal pituitary adenoma resection has been generated. This workflow captures a wide range of contemporary operative practice. The agreed "core" steps will serve as a foundation for education, training, assessment and technological development (e.g. models and simulators). The "optional" steps highlight areas of heterogeneity of practice that will benefit from further research (e.g. methods of skull base repair). Further adjustments could be made to increase applicability around the world.
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Affiliation(s)
- Hani J Marcus
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | - Danyal Z Khan
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Anouk Borg
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Justin S Cetas
- Department of Neurosurgery, Oregon Health & Science University, Portland, USA
| | - Justin W Collins
- Department of Uro-Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil L Dorward
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Maria Fleseriu
- Department of Neurosurgery, Oregon Health & Science University, Portland, USA
- Departments of Medicine (Endocrinology), Oregon Health & Science University, Portland, USA
| | - Mark Gurnell
- Division of Clinical Endocrinology & NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Mohsen Javadpour
- Department of Neurosurgery, National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
| | - Pamela S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Chan Hee Koh
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Hugo Layard Horsfall
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Adam N Mamelak
- Department of Neurosurgery and Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Pietro Mortini
- Department of Neurosurgery, San Raffaele University Health Institute Milan, Milan, Italy
| | - William Muirhead
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Nelson M Oyesiku
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine (Endocrinology), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA
| | - Saurabh Sinha
- Department of Neurosurgery, Royal Hallamshire Hospital & Sheffield Children's Hospital, Sheffield, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Luis V Syro
- Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin-Grupo Quirónsalud, Medellin, Colombia
| | - Georgios Tsermoulas
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Adam Williams
- Department of Neurosurgery, Southmead Hospital Bristol, Bristol, UK
| | - Mark J Winder
- Department of Neurosurgery, St Vincent's Public and Private Hospitals, Sydney, Australia
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women's Hospital, BTM 4, 60 Fenwood Road, Boston, USA
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26
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Khalafallah AM, Rakovec M, Bettegowda C, Jackson CM, Gallia GL, Weingart JD, Lim M, Esquenazi Y, Zacharia BE, Goldschmidt E, Ziu M, Ivan ME, Venteicher AS, Nduom EK, Mamelak AN, Chu RM, Yu JS, Sheehan JP, Nahed BV, Carter BS, Berger MS, Sawaya R, Mukherjee D. A Crowdsourced Consensus on Supratotal Resection Versus Gross Total Resection for Anatomically Distinct Primary Glioblastoma. Neurosurgery 2021; 89:712-719. [PMID: 34320218 DOI: 10.1093/neuros/nyab257] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/16/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Gross total resection (GTR) of contrast-enhancing tumor is associated with increased survival in primary glioblastoma. Recently, there has been increasing interest in performing supratotal resections (SpTRs) for glioblastoma. OBJECTIVE To address the published results, which have varied in part due to lack of consensus on the definition and appropriate use of SpTR. METHODS A crowdsourcing approach was used to survey 21 neurosurgical oncologists representing 14 health systems nationwide. Participants were presented with 11 definitions of SpTR and asked to rate the appropriateness of each definition. Participants reviewed T1-weighed postcontrast and fluid-attenuated inversion-recovery magnetic resonance imaging for 22 anatomically distinct glioblastomas. Participants were asked to assess the tumor location's eloquence, the perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. RESULTS Most neurosurgeons surveyed (n = 18, 85.7%) agree that GTR plus resection of some noncontrast enhancement is an appropriate definition for SpTR. Overall, moderate inter-rater agreement existed regarding eloquence, equipoise, and personal treatment plans. The 4 neurosurgeons who had performed >10 SpTRs for glioblastomas in the past year were more likely to recommend it as their treatment plan (P < .005). Cases were divided into 3 anatomically distinct groups based upon perceived eloquence. Anterior temporal and right frontal glioblastomas were considered the best randomization candidates. CONCLUSION We established a consensus definition for SpTR of glioblastoma and identified anatomically distinct locations deemed most amenable to SpTR. These results may be used to plan prospective trials investigating the potential clinical utility of SpTR for glioblastoma.
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Affiliation(s)
- Adham M Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maureen Rakovec
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jon D Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Ezequiel Goldschmidt
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mateo Ziu
- Inova Neuroscience and Spine Institute, University of Virginia Medical School-Inova Campus, Falls Church, Virginia, USA
| | - Michael E Ivan
- Sylvester Comprehensive Cancer Center, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew S Venteicher
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Edjah K Nduom
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ray M Chu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John S Yu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bob S Carter
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Raymond Sawaya
- Division of Surgery, Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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27
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Lee SJ, Beam DE, Schjetnan AGP, Paul LK, Chandravadia N, Reed CM, Chung JM, Ross IB, Valiante TA, Mamelak AN, Rutishauser U. Single-neuron correlate of epilepsy-related cognitive deficits in visual recognition memory in right mesial temporal lobe. Epilepsia 2021; 62:2082-2093. [PMID: 34289113 PMCID: PMC8403636 DOI: 10.1111/epi.17010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Impaired memory is a common comorbidity of refractory temporal lobe epilepsy (TLE) and often perceived by patients as more problematic than the seizures themselves. The objective of this study is to understand what the relationship of these behavioral impairments is to the underlying pathophysiology, as there are currently no treatments for these deficits, and it remains unknown what circuits are affected. METHODS We recorded single neurons in the medial temporal lobes (MTLs) of 62 patients (37 with refractory TLE) who performed a visual recognition memory task to characterize the relationship between behavior, tuning, and anatomical location of memory selective and visually selective neurons. RESULTS Subjects with a seizure onset zone (SOZ) in the right but not left MTL demonstrated impaired ability to recollect as indicated by the degree of asymmetry of the receiver operating characteristic curve. Of the 1973 recorded neurons, 159 were memory selective (MS) and 366 were visually selective (VS) category cells. The responses of MS neurons located within right but not left MTL SOZs were impaired during high-confidence retrieval trials, mirroring the behavioral deficit seen both in our task and in standardized neuropsychological tests. In contrast, responses of VS neurons were unimpaired in both left and right MTL SOZs. Our findings show that neuronal dysfunction within SOZs in the MTL was specific to a functional cell type and behavior, whereas other cell types respond normally even within the SOZ. We show behavioral metrics that detect right MTL SOZ-related deficits and identify a neuronal correlate of this impairment. SIGNIFICANCE Together, these findings show that single-cell responses can be used to assess the causal effects of local circuit disruption by an SOZ in the MTL, and establish a neural correlate of cognitive impairment due to epilepsy that can be used as a biomarker to assess the efficacy of novel treatments.
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Affiliation(s)
- Seung J Lee
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FLA, USA
| | - Danielle E Beam
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Lynn K Paul
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Nand Chandravadia
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chrystal M Reed
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey M Chung
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ian B Ross
- Department of Neurosurgery, Huntington Memorial Hospital, Pasadena, CA, USA
| | - Taufik A Valiante
- Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA.,Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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28
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Sisterson ND, Carlson AA, Rutishauser U, Mamelak AN, Flagg M, Pouratian N, Salimpour Y, Anderson WS, Richardson RM. Electrocorticography During Deep Brain Stimulation Surgery: Safety Experience From 4 Centers Within the National Institute of Neurological Disorders and Stroke Research Opportunities in Human Consortium. Neurosurgery 2021; 88:E420-E426. [PMID: 33575799 DOI: 10.1093/neuros/nyaa592] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Intraoperative research during deep brain stimulation (DBS) surgery has enabled major advances in understanding movement disorders pathophysiology and potential mechanisms for therapeutic benefit. In particular, over the last decade, recording electrocorticography (ECoG) from the cortical surface, simultaneously with subcortical recordings, has become an important research tool for assessing basal ganglia-thalamocortical circuit physiology. OBJECTIVE To provide confirmation of the safety of performing ECoG during DBS surgery, using data from centers involved in 2 BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative-funded basic human neuroscience projects. METHODS Data were collected separately at 4 centers. The primary endpoint was complication rate, defined as any intraoperative event, infection, or postoperative magnetic resonance imaging abnormality requiring clinical follow-up. Complication rates for explanatory variables were compared using point biserial correlations and Fisher exact tests. RESULTS A total of 367 DBS surgeries involving ECoG were reviewed. No cortical hemorrhages were observed. Seven complications occurred: 4 intraparenchymal hemorrhages and 3 infections (complication rate of 1.91%; CI = 0.77%-3.89%). The placement of 2 separate ECoG research electrodes through a single burr hole (84 cases) did not result in a significantly different rate of complications, compared to placement of a single electrode (3.6% vs 1.5%; P = .4). Research data were obtained successfully in 350 surgeries (95.4%). CONCLUSION Combined with the single report previously available, which described no ECoG-related complications in a single-center cohort of 200 cases, these findings suggest that research ECOG during DBS surgery did not significantly alter complication rates.
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Affiliation(s)
- Nathaniel D Sisterson
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - April A Carlson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mitchell Flagg
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Yousef Salimpour
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - William S Anderson
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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29
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Mosher CP, Wei Y, Kamiński J, Nandi A, Mamelak AN, Anastassiou CA, Rutishauser U. Cellular Classes in the Human Brain Revealed In Vivo by Heartbeat-Related Modulation of the Extracellular Action Potential Waveform. Cell Rep 2021; 30:3536-3551.e6. [PMID: 32160555 DOI: 10.1016/j.celrep.2020.02.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/23/2019] [Accepted: 02/05/2020] [Indexed: 01/01/2023] Open
Abstract
Determining cell types is critical for understanding neural circuits but remains elusive in the living human brain. Current approaches discriminate units into putative cell classes using features of the extracellular action potential (EAP); in absence of ground truth data, this remains a problematic procedure. We find that EAPs in deep structures of the brain exhibit robust and systematic variability during the cardiac cycle. These cardiac-related features refine neural classification. We use these features to link bio-realistic models generated from in vitro human whole-cell recordings of morphologically classified neurons to in vivo recordings. We differentiate aspiny inhibitory and spiny excitatory human hippocampal neurons and, in a second stage, demonstrate that cardiac-motion features reveal two types of spiny neurons with distinct intrinsic electrophysiological properties and phase-locking characteristics to endogenous oscillations. This multi-modal approach markedly improves cell classification in humans, offers interpretable cell classes, and is applicable to other brain areas and species.
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Affiliation(s)
- Clayton P Mosher
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Yina Wei
- Allen Institute for Brain Science, Seattle, WA 98109, USA
| | - Jan Kamiński
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Division of Biology and Biological Engineering, Caltech, Pasadena, CA 91125, USA
| | - Anirban Nandi
- Allen Institute for Brain Science, Seattle, WA 98109, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Costas A Anastassiou
- Allen Institute for Brain Science, Seattle, WA 98109, USA; Division of Neurology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Center for Neural Science and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Division of Biology and Biological Engineering, Caltech, Pasadena, CA 91125, USA.
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30
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Mosher CP, Mamelak AN, Malekmohammadi M, Pouratian N, Rutishauser U. Distinct roles of dorsal and ventral subthalamic neurons in action selection and cancellation. Neuron 2021; 109:869-881.e6. [PMID: 33482087 PMCID: PMC7933114 DOI: 10.1016/j.neuron.2020.12.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022]
Abstract
The subthalamic nucleus (STN) supports action selection by inhibiting all motor programs except the desired one. Recent evidence suggests that STN can also cancel an already selected action when goals change, a key aspect of cognitive control. However, there is little neurophysiological evidence for dissociation between selecting and cancelling actions in the human STN. We recorded single neurons in the STN of humans performing a stop-signal task. Movement-related neurons suppressed their activity during successful stopping, whereas stop-signal neurons activated at low-latencies near the stop-signal reaction time. In contrast, STN and motor-cortical beta-bursting occurred only later in the stopping process. Task-related neuronal properties varied by recording location from dorsolateral movement to ventromedial stop-signal tuning. Therefore, action selection and cancellation coexist in STN but are anatomically segregated. These results show that human ventromedial STN neurons carry fast stop-related signals suitable for implementing cognitive control.
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Affiliation(s)
- Clayton P Mosher
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mahsa Malekmohammadi
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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31
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Abstract
Management of aggressive pituitary adenomas is challenging due to a paucity of rigorous evidence supporting available treatment approaches. Recent guidelines emphasize the need to maximize standard therapies as well as the use of temozolomide and radiation therapy to treat disease recurrence. However, often these adenomas continue to progress over time, necessitating the use of additional targeted therapies which also impact quality of life and long-term outcomes. In this review, we present 9 cases of aggressive pituitary adenomas to illustrate the importance of a multidisciplinary, individualized approach. The timing and rationale for surgery, radiation therapy, temozolomide, somatostatin receptor ligands, and EGFR, VEGF, and mTOR inhibitors in each case are discussed within the context of evidence-based guidelines and clarify strategies for implementing an individualized approach in the management of these difficult-to-treat-adenomas.
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Affiliation(s)
- Odelia Cooper
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- *Correspondence: Odelia Cooper,
| | - Vivien Bonert
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Ning-Ai Liu
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Adam N. Mamelak
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Khalafallah AM, Liang A, Jimenez A, Rowan N, Oyesiku NM, Mamelak AN, Mukherjee D. Trends in Endoscopic and Microscopic Transsphenoidal Surgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Starr PA, Tröster A, Schrock L, House PA, Giroux M, Hebb AO, Farris S, Whiting DM, Lechliter T, Ostrem JL, Palenzuela MS, Galifianakis N, Metman LV, Sani S, Karl J, Siddiqui M, Tatter SB, ul Haq I, Machado A, Gostkowski M, Tagliati M, Mamelak AN, Okun MS, Foote KD, Moguel-Cobos G, Ponce FA, Pahwa R, Nazzaro JM, Buetefisch C, Gross RE, Luca C, Jagid JR, Revuelta G, Takacs I, Pourfar M, Mogilner AY, Duker A, Mandybur GT, Rosenow JM, Cooper S, Park M, Khandhar S, Sedrak M, Pilitsis JG, Phibbs F, Uitti RJ, Chen L, Roshini J, Vitek JL. Three-Year Follow-Up of a Prospective, Double Blinded Multi-Center RCT Evaluating DBS with a Multiple Source, Constant-Current Rechargeable System for Treatment of Parkinson's Disease (INTREPID). Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
PURPOSE We report a case of a pregnant female presenting with pituitary apoplexy and simultaneous SARS-CoV-2 infection with a focus on management decisions. CLINICAL HISTORY A 28-year-old G5P1 38w1d female presented with 4 days of blurry vision, left dilated pupil, and headache. She tested positive for SARS-CoV-2 on routine nasal swab testing but denied cough or fever. Endocrine testing demonstrated an elevated serum prolactin level, and central hypothyroidism. MRI showed a cystic-solid lesion with a fluid level in the pituitary fossa and expansion of the sella consistent with pituitary apoplexy. Her visual symptoms improved with corticosteroid administration and surgery was delayed to two weeks after her initial COVID-19 infection and to allow for safe delivery of the child. A vaginal delivery under epidural anesthetic occurred at 39 weeks. Two days later, transsphenoidal resection of the mass was performed under strict COVID-19 precautions including use of Powered Air Purifying Respirators (PAPRs) and limited OR personnel given high risk of infection during endonasal procedures. Pathology demonstrated a liquefied hemorrhagic mass suggestive of pituitary apoplexy. She made a full recovery and was discharged home two days after surgery. CONCLUSION Here we demonstrate the first known case of successful elective induction of vaginal delivery and transsphenoidal intervention in a near full term gravid patient presenting with pituitary apoplexy and acute SARS-CoV-2 infection. Further reports may help determine if there is a causal relationship or if these events are unrelated. Close adherence to guidelines for caregivers can greatly reduce risk of infection.
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Affiliation(s)
- Julie L Chan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Cedars-Sinai Medical Center, Maternal Fetal Medicine, Los Angeles, CA, USA
| | - Sarah S Smithson
- Cedars-Sinai Medical Center, Maternal Fetal Medicine, Los Angeles, CA, USA
| | - Mariam Naqvi
- Cedars-Sinai Medical Center, Maternal Fetal Medicine, Los Angeles, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Khalafallah AM, Liang AL, Jimenez AE, Rowan NR, Oyesiku NM, Mamelak AN, Mukherjee D. Trends in endoscopic and microscopic transsphenoidal surgery: a survey of the international society of pituitary surgeons between 2010 and 2020. Pituitary 2020; 23:526-533. [PMID: 32441022 DOI: 10.1007/s11102-020-01054-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE This comparative survey of surgical practice patterns between 2010 and 2020 aims to elicit trends in practice patterns for transsphenoidal surgery and to identify areas for improvement. METHODS Web-based surveys were sent to the International Society of Pituitary Surgeons via a membership listserv in 2010 and 2020. These 33-item surveys collected information on demographics, surgical approach, perceived advantages and disadvantages, and recommendations for improvements. Statistical analyses were conducted using the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. RESULTS There were 51 respondents in 2010 and 82 respondents in 2020. The majority were full-time academic surgeons from the United States or Europe. Preference for a purely endoscopic technique increased from 43% in 2010 to 87% in 2020. Preference for routinely working with an otolaryngologist or second neurosurgeon increased from 35 to 51%. Most surgeons (74%) reported that they were more likely to achieve a greater extent of resection with the endoscope, though 51% noted increased operating time. The most commonly rated advantage (34%) of endoscopic TSS was fewer postoperative nasoseptal perforations; the most commonly (34%) rated disadvantage was more postoperative complications, including cerebrospinal fluid leak. Respondents were divided on whether microscopic TSS should continue to be taught in residency. Many (32%) advocated for improved endoscopic instrumentation and team training. CONCLUSION Endoscopic TSS is now the clearly preferred method for surgery amongst a cohort of higher-volume academic neurosurgeons. This trend is likely to continue, and this provides guidelines for future training.
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Affiliation(s)
- Adham M Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Angela L Liang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Adrian E Jimenez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Nicholas R Rowan
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nelson M Oyesiku
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
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Minxha J, Adolphs R, Fusi S, Mamelak AN, Rutishauser U. Flexible recruitment of memory-based choice representations by the human medial frontal cortex. Science 2020; 368:eaba3313. [PMID: 32586990 PMCID: PMC7531893 DOI: 10.1126/science.aba3313] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/04/2020] [Indexed: 11/02/2022]
Abstract
Decision-making in complex environments relies on flexibly using prior experience. This process depends on the medial frontal cortex (MFC) and the medial temporal lobe, but it remains unknown how these structures implement selective memory retrieval. We recorded single neurons in the MFC, amygdala, and hippocampus while human subjects switched between making recognition memory-based and categorization-based decisions. The MFC rapidly implemented changing task demands by using different subspaces of neural activity and by representing the currently relevant task goal. Choices requiring memory retrieval selectively engaged phase-locking of MFC neurons to amygdala and hippocampus field potentials, thereby enabling the routing of memories. These findings reveal a mechanism for flexibly and selectively engaging memory retrieval and show that memory-based choices are preferentially represented in the frontal cortex when required.
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Affiliation(s)
- Juri Minxha
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Computation and Neural Systems Program, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
- Center for Theoretical Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ralph Adolphs
- Computation and Neural Systems Program, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Stefano Fusi
- Center for Theoretical Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Computation and Neural Systems Program, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
- Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Aquino TG, Minxha J, Dunne S, Ross IB, Mamelak AN, Rutishauser U, O'Doherty JP. Value-Related Neuronal Responses in the Human Amygdala during Observational Learning. J Neurosci 2020; 40:4761-4772. [PMID: 32376780 PMCID: PMC7294800 DOI: 10.1523/jneurosci.2897-19.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/25/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023] Open
Abstract
The amygdala plays an important role in many aspects of social cognition and reward learning. Here, we aimed to determine whether human amygdala neurons are involved in the computations necessary to implement learning through observation. We performed single-neuron recordings from the amygdalae of human neurosurgical patients (male and female) while they learned about the value of stimuli through observing the outcomes experienced by another agent interacting with those stimuli. We used a detailed computational modeling approach to describe patients' behavior in the task. We found a significant proportion of amygdala neurons whose activity correlated with both expected rewards for oneself and others, and in tracking outcome values received by oneself or other agents. Additionally, a population decoding analysis suggests the presence of information for both observed and experiential outcomes in the amygdala. Encoding and decoding analyses suggested observational value coding in amygdala neurons occurred in a different subset of neurons than experiential value coding. Collectively, these findings support a key role for the human amygdala in the computations underlying the capacity for learning through observation.SIGNIFICANCE STATEMENT Single-neuron studies of the human brain provide a unique window into the computational mechanisms of cognition. In this study, epilepsy patients implanted intracranially with hybrid depth electrodes performed an observational learning (OL) task. We measured single-neuron activity in the amygdala and found a representation for observational rewards as well as observational expected reward values. Additionally, distinct subsets of amygdala neurons represented self-experienced and observational values. This study provides a rare glimpse into the role of human amygdala neurons in social cognition.
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Affiliation(s)
- Tomas G Aquino
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125
| | - Juri Minxha
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125
| | - Simon Dunne
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125
| | - Ian B Ross
- Department of Neurosurgery, Huntington Memorial Hospital, Pasadena, CA 91105
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Pasadena, CA 90048
| | - Ueli Rutishauser
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125
- Department of Neurosurgery, Cedars-Sinai Medical Center, Pasadena, CA 90048
| | - John P O'Doherty
- Computation and Neural Systems, Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125
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Wang S, Mamelak AN, Adolphs R, Rutishauser U. Abstract goal representation in visual search by neurons in the human pre-supplementary motor area. Brain 2020; 142:3530-3549. [PMID: 31549164 DOI: 10.1093/brain/awz279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/14/2019] [Accepted: 07/11/2019] [Indexed: 01/18/2023] Open
Abstract
The medial frontal cortex is important for goal-directed behaviours such as visual search. The pre-supplementary motor area (pre-SMA) plays a critical role in linking higher-level goals to actions, but little is known about the responses of individual cells in this area in humans. Pre-SMA dysfunction is thought to be a critical factor in the cognitive deficits that are observed in diseases such as Parkinson's disease and schizophrenia, making it important to develop a better mechanistic understanding of the pre-SMA's role in cognition. We simultaneously recorded single neurons in the human pre-SMA and eye movements while subjects performed goal-directed visual search tasks. We characterized two groups of neurons in the pre-SMA. First, 40% of neurons changed their firing rate whenever a fixation landed on the search target. These neurons responded to targets in an abstract manner across several conditions and tasks. Responses were invariant to motor output (i.e. button press or not), and to different ways of defining the search target (by instruction or pop-out). Second, ∼50% of neurons changed their response as a function of fixation order. Together, our results show that human pre-SMA neurons carry abstract signals during visual search that indicate whether a goal was reached in an action- and cue-independent manner. This suggests that the pre-SMA contributes to goal-directed behaviour by flexibly signalling goal detection and time elapsed since start of the search, and this process occurs regardless of task. These observations provide insights into how pre-SMA dysfunction might impact cognitive function.
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Affiliation(s)
- Shuo Wang
- Department of Chemical and Biomedical Engineering, and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.,Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ralph Adolphs
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Ueli Rutishauser
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Vitek JL, Jain R, Chen L, Tröster AI, Schrock LE, House PA, Giroux ML, Hebb AO, Farris SM, Whiting DM, Leichliter TA, Ostrem JL, San Luciano M, Galifianakis N, Verhagen Metman L, Sani S, Karl JA, Siddiqui MS, Tatter SB, Ul Haq I, Machado AG, Gostkowski M, Tagliati M, Mamelak AN, Okun MS, Foote KD, Moguel-Cobos G, Ponce FA, Pahwa R, Nazzaro JM, Buetefisch CM, Gross RE, Luca CC, Jagid JR, Revuelta GJ, Takacs I, Pourfar MH, Mogilner AY, Duker AP, Mandybur GT, Rosenow JM, Cooper SE, Park MC, Khandhar SM, Sedrak M, Phibbs FT, Pilitsis JG, Uitti RJ, Starr PA. Subthalamic nucleus deep brain stimulation with a multiple independent constant current-controlled device in Parkinson's disease (INTREPID): a multicentre, double-blind, randomised, sham-controlled study. Lancet Neurol 2020; 19:491-501. [PMID: 32470421 DOI: 10.1016/s1474-4422(20)30108-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus is an established therapeutic option for managing motor symptoms of Parkinson's disease. We conducted a double-blind, sham-controlled, randomised controlled trial to assess subthalamic nucleus DBS, with a novel multiple independent contact current-controlled (MICC) device, in patients with Parkinson's disease. METHODS This trial took place at 23 implanting centres in the USA. Key inclusion criteria were age between 22 and 75 years, a diagnosis of idiopathic Parkinson's disease with over 5 years of motor symptoms, and stable use of anti-parkinsonian medications for 28 days before consent. Patients who passed screening criteria were implanted with the DBS device bilaterally in the subthalamic nucleus. Patients were randomly assigned in a 3:1 ratio to receive either active therapeutic stimulation settings (active group) or subtherapeutic stimulation settings (control group) for the 3-month blinded period. Randomisation took place with a computer-generated data capture system using a pre-generated randomisation table, stratified by site with random permuted blocks. During the 3-month blinded period, both patients and the assessors were masked to the treatment group while the unmasked programmer was responsible for programming and optimisation of device settings. The primary outcome was the difference in mean change from baseline visit to 3 months post-randomisation between the active and control groups in the mean number of waking hours per day with good symptom control and no troublesome dyskinesias, with no increase in anti-parkinsonian medications. Upon completion of the blinded phase, all patients received active treatment in the open-label period for up to 5 years. Primary and secondary outcomes were analysed by intention to treat. All patients who provided informed consent were included in the safety analysis. The open-label phase is ongoing with no new enrolment, and current findings are based on the prespecified interim analysis of the first 160 randomly assigned patients. The study is registered with ClinicalTrials.gov, NCT01839396. FINDINGS Between May 17, 2013, and Nov 30, 2017, 313 patients were enrolled across 23 sites. Of these 313 patients, 196 (63%) received the DBS implant and 191 (61%) were randomly assigned. Of the 160 patients included in the interim analysis, 121 (76%) were randomly assigned to the active group and 39 (24%) to the control group. The difference in mean change from the baseline visit (post-implant) to 3 months post-randomisation in increased ON time without troublesome dyskinesias between the active and control groups was 3·03 h (SD 4·52, 95% CI 1·3-4·7; p<0·0001). 26 serious adverse events in 20 (13%) patients occurred during the 3-month blinded period. Of these, 18 events were reported in the active group and 8 in the control group. One death was reported among the 196 patients before randomisation, which was unrelated to the procedure, device, or stimulation. INTERPRETATION This double-blind, sham-controlled, randomised controlled trial provides class I evidence of the safety and clinical efficacy of subthalamic nucleus DBS with a novel MICC device for the treatment of motor symptoms of Parkinson's disease. Future trials are needed to investigate potential benefits of producing a more defined current field using MICC technology, and its effect on clinical outcomes. FUNDING Boston Scientific.
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Affiliation(s)
- Jerrold L Vitek
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Roshini Jain
- Division of Neuromodulation, Boston Scientific, Valencia, CA, USA
| | - Lilly Chen
- Division of Neuromodulation, Boston Scientific, Valencia, CA, USA
| | - Alexander I Tröster
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Lauren E Schrock
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | | | - Monique L Giroux
- Movement and Neuroperformance Center of Colorado, Englewood, CO, USA; Clinical Research Neurology, Eisai, Woodcliff Lake, NJ, USA
| | - Adam O Hebb
- Department of Neurological Surgery, Kaiser Permanente, Denver, CO, USA
| | - Sierra M Farris
- Division of Neuromodulation, Boston Scientific, Valencia, CA, USA; Movement and Neuroperformance Center of Colorado, Englewood, CO, USA
| | - Donald M Whiting
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Marta San Luciano
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Galifianakis
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Leo Verhagen Metman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sepehr Sani
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jessica A Karl
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ihtsham Ul Haq
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andre G Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Michal Gostkowski
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael S Okun
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Corneliu C Luca
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
| | - Jonathan R Jagid
- Department of Neurosurgery, University of Miami School of Medicine, Miami, FL, USA
| | - Gonzalo J Revuelta
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Istvan Takacs
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Michael H Pourfar
- Department of Neurology, New York University Medical Center, New York City, NY, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, New York University Medical Center, New York City, NY, USA
| | - Andrew P Duker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - George T Mandybur
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University School of Medicine, Chicago, IL, USA
| | - Scott E Cooper
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Suketu M Khandhar
- Department of Neurology, Kaiser Permanente Medical Center, Sacramento, CA, USA
| | - Mark Sedrak
- Department of Neurosurgery, Kaiser Permanente Medical Center, Redwood City, CA, USA
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Philip A Starr
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
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Kamiński J, Brzezicka A, Mamelak AN, Rutishauser U. Combined Phase-Rate Coding by Persistently Active Neurons as a Mechanism for Maintaining Multiple Items in Working Memory in Humans. Neuron 2020; 106:256-264.e3. [PMID: 32084331 PMCID: PMC7217299 DOI: 10.1016/j.neuron.2020.01.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/25/2019] [Accepted: 01/23/2020] [Indexed: 01/01/2023]
Abstract
Maintaining multiple items in working memory (WM) is central to human behavior. Persistently active neurons are thought to be a mechanism to maintain WMs, but it remains unclear how such activity is coordinated when multiple items are kept in memory. We show that memoranda-selective persistently active neurons in the human medial temporal lobe phase lock to ongoing slow-frequency (1-7 Hz) oscillations during WM maintenance. The properties of phase locking are dependent on memory content and load. During high memory loads, the phase of the oscillatory activity to which neurons phase lock provides information about memory content not available in the firing rate of the neurons. We provide a computational model that reveals that inhibitory-feedback-mediated competition between multiple persistently active neurons reproduces this phenomenon. This work reveals a mechanism for the active maintenance of multiple items in WM that relies on persistently active neurons whose activation is orchestrated by oscillatory activity.
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Affiliation(s)
- Jan Kamiński
- Department of Neurosurgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; Division of Biology and Biological Engineering, California Institute of Technology, 1200 E California Boulevard, Pasadena, CA 91125, USA.
| | - Aneta Brzezicka
- Department of Neurosurgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; Institute of Psychology, SWPS University of Social Sciences and Humanities, Warsaw 03-815, Poland
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; Department of Neurology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; Division of Biology and Biological Engineering, California Institute of Technology, 1200 E California Boulevard, Pasadena, CA 91125, USA.
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Lee SJ, Cohen J, Chan J, Walgama E, Wu A, Mamelak AN. Infectious Complications of Expanded Endoscopic Transsphenoidal Surgery: A Retrospective Cohort Analysis of 100 Cases. J Neurol Surg B Skull Base 2019; 81:497-504. [PMID: 33134016 DOI: 10.1055/s-0039-1696999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022] Open
Abstract
Objective To identify perioperative factors that may predict postoperative cerebrospinal fluid (CSF) leak and meningitis following expanded endoscopic transsphenoidal surgery (EETS). Study Design This is a retrospective study. This study was set at the Cedars-Sinai Medical Center, Los Angeles. A total of 78 patients who underwent EETS between January 2007 and November 2018 were participated. The main outcome measures were CSF leak and meningitis. Results A total of 78 patients underwent a total of 100 EETS procedures; 17.9 and 10.3% of patients developed postoperative CSF leaks and meningitis, respectively. Out of eight, three patients with meningitis did not develop an observable CSF leak. The risk of developing meningitis in patients with a CSF leak was significantly higher than those without a leak, with an odds ratio (OR) of 11.48 (95% confidence interval, 2.33-56.47; p = 0.004). Pituicytomas were significantly associated with meningitis compared with other pathologies. No other patient-specific factors were identified as risks for leak or meningitis, including method of skull base repair, sex, tumor volume, or body mass index, although there was a strong trend toward reduced CSF leak rates in patient with nasoseptal flaps used for skull base repair, compared with those without (9.5 vs. 25%). CSF protein was consistently elevated on the first CSF values obtained when meningitis was suspected. Conclusion CSF leak and meningitis are common complications of expanded endonasal surgery No statistically significant risk factors for developing a postoperative leak other than the pathology of pituicytoma were identified, including method of skull base repair, although the use of a vascularized nasoseptal flap did trend toward a reduced CSF leak rate. CSF protein is the most sensitive marker for the presumptive diagnosis and timely treatment of meningitis.
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Affiliation(s)
- Seung J Lee
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Justin Cohen
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Julie Chan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Evan Walgama
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Arthur Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
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Abstract
Although removal of pituitary tumors yields excellent surgical outcomes, perturbations in the hypothalamic-pituitary axis are not uncommon. Careful assessment of postoperative hormone status with supplementation or further medical therapy is critical to successful outcomes. Although many centers routinely use perioperative steroids, they can be associated with worse outcomes in the absence of intact preoperative adrenal function or damage to the pituitary gland or stalk during surgery. Postoperative assessment of prolactin, cortisol, and growth hormone can be prognostic of surgical cure. Hormonal axes should be reevaluated routinely several weeks after surgery, because longitudinal monitoring is important for surgical and medical outcomes.
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Affiliation(s)
- Anshu Buttan
- Department of Medicine, Division of Endocrinology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Becker B-131, Los Angeles, CA 90048, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, 127 S San Vicente Boulevard, A6600, Los Angeles, CA 90048, USA.
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43
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Abstract
Intracranial recordings from patients with intractable epilepsy provide a unique opportunity to study the activity of individual human neurons during active behavior. An important tool for quantifying behavior is eye tracking, which is an indispensable tool for studying visual attention. However, eye tracking is challenging to use concurrently with invasive electrophysiology and this approach has consequently been little used. Here, we present a proven experimental protocol to conduct single-neuron recordings with simultaneous eye tracking in humans. We describe how the systems are connected and the optimal settings to record neurons and eye movements. To illustrate the utility of this method, we summarize results that were made possible by this setup. This data shows how using eye tracking in a memory-guided visual search task allowed us to describe a new class of neurons called target neurons, whose response was reflective of top-down attention to the current search target. Lastly, we discuss the significance and solutions to potential problems of this setup. Together, our protocol and results suggest that single-neuron recordings with simultaneous eye tracking in humans are an effective method to study human brain function. It provides a key missing link between animal neurophysiology and human cognitive neuroscience.
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Affiliation(s)
- Shuo Wang
- Department of Chemical and Biomedical Engineering, and Rockefeller Neuroscience Institute, West Virginia University;
| | - Nand Chandravadia
- Departments of Neurosurgery and Neurology, Cedars-Sinai Medical Center
| | - Adam N Mamelak
- Departments of Neurosurgery and Neurology, Cedars-Sinai Medical Center;
| | - Ueli Rutishauser
- Departments of Neurosurgery and Neurology, Cedars-Sinai Medical Center; Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center; Division of Biology and Biological Engineering, California Institute of Technology;
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44
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Patil R, Galstyan A, Sun T, Shatalova ES, Butte P, Mamelak AN, Carico C, Kittle DS, Grodzinski ZB, Chiechi A, Ding H, Black KL, Ljubimova JY, Holler E. Polymalic acid chlorotoxin nanoconjugate for near-infrared fluorescence guided resection of glioblastoma multiforme. Biomaterials 2019; 206:146-159. [PMID: 30933776 PMCID: PMC6574176 DOI: 10.1016/j.biomaterials.2019.03.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/01/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022]
Abstract
Maximal surgical resection of glioma remains the single most effective treatment. Tools to guide the resection while avoiding removal of normal brain tissues can aid surgeons in achieving optimal results. One strategy to achieve this goal is to rely upon interoperative fluorescence staining of tumor cells in vivo, that can be visualized by the surgeon during resection. Towards this goal we have designed a biodegradable fluorescent mini nano imaging agent (NIA) with high specificity for U87MG glioma cells and previously unmet high light emission. The NIA is the conjugate of polymalic acid (PMLA) with chlorotoxin for tumor targeting, indocyanine green (ICG) for NIR fluorescence and the tri-leucin peptide as fluorescence enhancer. PMLA as a multivalent platform carries several molecules of ICG and the other ligands. The NIA recognizes multiple sites on glioma cell surface, demonstrated by the effects of single and combined competitors. Systemic IV injection into xenogeneic mouse model carrying human U87MG glioblastoma indicated vivid tumor cell binding and internalization of NIA resulting in intensive and long-lasting tumor fluorescence. The NIA is shown to greatly improve tumor removal supporting its utility in clinical applications.
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Affiliation(s)
- Rameshwar Patil
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Anna Galstyan
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Tao Sun
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Ekaterina S Shatalova
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Pramod Butte
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Adam N Mamelak
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Christine Carico
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | - David S Kittle
- Blaze Bioscience, Inc. Seattle, Washington, United States
| | - Zachary B Grodzinski
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Antonella Chiechi
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Hui Ding
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Keith L Black
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Julia Y Ljubimova
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Eggehard Holler
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
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45
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Patil CG, Walker DG, Miller DM, Butte P, Morrison B, Kittle DS, Hansen SJ, Nufer KL, Byrnes-Blake KA, Yamada M, Lin LL, Pham K, Perry J, Parrish-Novak J, Ishak L, Prow T, Black K, Mamelak AN. Phase 1 Safety, Pharmacokinetics, and Fluorescence Imaging Study of Tozuleristide (BLZ-100) in Adults With Newly Diagnosed or Recurrent Gliomas. Neurosurgery 2019; 85:E641-E649. [DOI: 10.1093/neuros/nyz125] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDFluorescence-guided surgery (FGS) can improve extent of resection in gliomas. Tozuleristide (BLZ-100), a near-infrared imaging agent composed of the peptide chlorotoxin and a near-infrared fluorophore indocyanine green, is a candidate molecule for FGS of glioma and other tumor types.OBJECTIVETo perform a phase 1 dose-escalation study to characterize the safety, pharmacokinetics, and fluorescence imaging of tozuleristide in adults with suspected glioma.METHODSPatients received a single intravenous dose of tozuleristide 3 to 29 h before surgery. Fluorescence images of tumor and cavity in Situ before and after resection and of excised tissue ex Vivo were acquired, along with safety and pharmacokinetic measures.RESULTSA total of 17 subjects received doses between 3 and 30 mg. No dose-limiting toxicity was observed, and no reported adverse events were considered related to tozuleristide. At doses of 9 mg and above, the terminal serum half-life for tozuleristide was approximately 30 min. Fluorescence signal was detected in both high- and low-grade glial tumors, with high-grade tumors generally showing greater fluorescence intensity compared to lower grade tumors. In high-grade tumors, signal intensity increased with increased dose levels of tozuleristide, regardless of the time of dosing relative to surgery.CONCLUSIONThese results support the safety of tozuleristide at doses up to 30 mg and suggest that tozuleristide imaging may be useful for FGS of gliomas.
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Affiliation(s)
| | - David G Walker
- NEWRO Foundation, Brisbane, Australia
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | | | - Pramod Butte
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | - Kaitlin L Nufer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | | | - Miko Yamada
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
- Future Industries Institute, University of South Australia, Adelaide, Australia
| | - Lynlee L Lin
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Kim Pham
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Jeff Perry
- Blaze Bioscience, Inc, Seattle, Washington
| | | | | | - Tarl Prow
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
- Future Industries Institute, University of South Australia, Adelaide, Australia
| | - Keith Black
- Cedars-Sinai Medical Center, Los Angeles, California
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46
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Brzezicka A, Kamiński J, Reed CM, Chung JM, Mamelak AN, Rutishauser U. Working Memory Load-related Theta Power Decreases in Dorsolateral Prefrontal Cortex Predict Individual Differences in Performance. J Cogn Neurosci 2019; 31:1290-1307. [PMID: 31037988 DOI: 10.1162/jocn_a_01417] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Holding information in working memory (WM) is an active and effortful process that is accompanied by sustained load-dependent changes in oscillatory brain activity. These proportional power increases are often reported in EEG studies recording theta over frontal midline sites. Intracranial recordings, however, yield mixed results, depending on the brain area being recorded from. We recorded intracranial EEG with depth electrodes in 13 patients with epilepsy who were performing a Sternberg WM task. Here, we investigated patterns of theta power changes as a function of memory load during maintenance in three areas critical for WM: dorsolateral prefrontal cortex (DLPFC), dorsal ACC (dACC), and hippocampus. Theta frequency power in both hippocampus and dACC increased during maintenance. In contrast, theta frequency power in the DLPFC decreased during maintenance, and this decrease was proportional to memory load. Only the power decreases in DLPFC, but not the power increases in hippocampus and dACC, were predictive of behavior in a given trial. The extent of the load-related theta power decreases in the DLPFC in a given participant predicted a participant's RTs, revealing that DLPFC theta explains individual differences in WM ability between participants. Together, these data reveal a pattern of theta power decreases in the DLPFC that is predictive of behavior and that is opposite of that in other brain areas. This result suggests that theta band power changes serve different cognitive functions in different brain areas and specifically that theta power decreases in DLPFC have an important role in maintenance of information.
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Affiliation(s)
- Aneta Brzezicka
- Cedars-Sinai Medical Center, Los Angeles, CA.,SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Jan Kamiński
- Cedars-Sinai Medical Center, Los Angeles, CA.,California Institute of Technology
| | | | | | | | - Ueli Rutishauser
- Cedars-Sinai Medical Center, Los Angeles, CA.,California Institute of Technology
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47
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Sun T, Patil R, Galstyan A, Klymyshyn D, Ding H, Chesnokova A, Cavenee WK, Furnari FB, Ljubimov VA, Shatalova ES, Wagner S, Li D, Mamelak AN, Bannykh SI, Patil CG, Rudnick JD, Hu J, Grodzinski ZB, Rekechenetskiy A, Falahatian V, Lyubimov AV, Chen YL, Leoh LS, Daniels-Wells TR, Penichet ML, Holler E, Ljubimov AV, Black KL, Ljubimova JY. Blockade of a Laminin-411-Notch Axis with CRISPR/Cas9 or a Nanobioconjugate Inhibits Glioblastoma Growth through Tumor-Microenvironment Cross-talk. Cancer Res 2019; 79:1239-1251. [PMID: 30659021 DOI: 10.1158/0008-5472.can-18-2725] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/07/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023]
Abstract
There is an unmet need for the treatment of glioblastoma multiforme (GBM). The extracellular matrix, including laminins, in the tumor microenvironment is important for tumor invasion and progression. In a panel of 226 patient brain glioma samples, we found a clinical correlation between the expression of tumor vascular laminin-411 (α4β1γ1) with higher tumor grade and with expression of cancer stem cell (CSC) markers, including Notch pathway members, CD133, Nestin, and c-Myc. Laminin-411 overexpression also correlated with higher recurrence rate and shorter survival of GBM patients. We also showed that depletion of laminin-411 α4 and β1 chains with CRISPR/Cas9 in human GBM cells led to reduced growth of resultant intracranial tumors in mice and significantly increased survival of host animals compared with mice with untreated cells. Inhibition of laminin-411 suppressed Notch pathway in normal and malignant human brain cell types. A nanobioconjugate potentially suitable for clinical use and capable of crossing blood-brain barrier was designed to block laminin-411 expression. Nanobioconjugate treatment of mice carrying intracranial GBM significantly increased animal survival and inhibited multiple CSC markers, including the Notch axis. This study describes an efficient strategy for GBM treatment via targeting a critical component of the tumor microenvironment largely independent of heterogeneous genetic mutations in glioblastoma.Significance: Laminin-411 expression in the glioma microenvironment correlates with Notch and other cancer stem cell markers and can be targeted by a novel, clinically translatable nanobioconjugate to inhibit glioma growth.
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Affiliation(s)
- Tao Sun
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rameshwar Patil
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.,Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anna Galstyan
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dmytro Klymyshyn
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hui Ding
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.,Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alexandra Chesnokova
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Webster K Cavenee
- Ludwig Institute for Cancer Research, University of California San Diego, La Jolla, California
| | - Frank B Furnari
- Ludwig Institute for Cancer Research, University of California San Diego, La Jolla, California
| | - Vladimir A Ljubimov
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ekaterina S Shatalova
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shawn Wagner
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Adam N Mamelak
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Serguei I Bannykh
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chirag G Patil
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeremy D Rudnick
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jethro Hu
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zachary B Grodzinski
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Vida Falahatian
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Clinical Research Training Program (CRTP), Durham, North Carolina
| | - Alexander V Lyubimov
- Toxicology Research Laboratory (TRL), Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois
| | - Yongmei L Chen
- Toxicology Research Laboratory (TRL), Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois
| | - Lai S Leoh
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Tracy R Daniels-Wells
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Manuel L Penichet
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.,Department of Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine at University of California, Los Angeles; Jonsson Comprehensive Cancer Center, the Molecular Biology Institute, AIDS Institute, the California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California
| | - Eggehard Holler
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.,Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California.,Institut für Biophysik und Physikalische Biochemie, Universität Regensburg, Regensburg, Germany
| | - Alexander V Ljubimov
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Biomedical Sciences, Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Keith L Black
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.,Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Julia Y Ljubimova
- Nanomedicine Research Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California. .,Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
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48
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Fu Z, Wu DAJ, Ross I, Chung JM, Mamelak AN, Adolphs R, Rutishauser U. Single-Neuron Correlates of Error Monitoring and Post-Error Adjustments in Human Medial Frontal Cortex. Neuron 2019; 101:165-177.e5. [PMID: 30528064 PMCID: PMC6354767 DOI: 10.1016/j.neuron.2018.11.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/12/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Abstract
Humans can self-monitor errors without explicit feedback, resulting in behavioral adjustments on subsequent trials such as post-error slowing (PES). The error-related negativity (ERN) is a well-established macroscopic scalp EEG correlate of error self-monitoring, but its neural origins and relationship to PES remain unknown. We recorded in the frontal cortex of patients performing a Stroop task and found neurons that track self-monitored errors and error history in dorsal anterior cingulate cortex (dACC) and pre-supplementary motor area (pre-SMA). Both the intracranial ERN (iERN) and error neuron responses appeared first in pre-SMA, and ∼50 ms later in dACC. Error neuron responses were correlated with iERN amplitude on individual trials. In dACC, such error neuron-iERN synchrony and responses of error-history neurons predicted the magnitude of PES. These data reveal a human single-neuron correlate of the ERN and suggest that dACC synthesizes error information to recruit behavioral control through coordinated neural activity.
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Affiliation(s)
- Zhongzheng Fu
- Division of Engineering and Applied Sciences, California Institute of Technology, Pasadena, CA, USA; Control and Dynamical Systems Program, California Institute of Technology, Pasadena, CA, USA; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Daw-An J Wu
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Ian Ross
- Department of Neurosurgery, Huntington Memorial Hospital, Pasadena, CA, USA
| | - Jeffrey M Chung
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ralph Adolphs
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA; Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA; Computation and Neural Systems Program, California Institute of Technology, Pasadena, CA, USA
| | - Ueli Rutishauser
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA; Computation and Neural Systems Program, California Institute of Technology, Pasadena, CA, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Center for Neural Science and Medicine, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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49
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Carlson AA, Rutishauser U, Mamelak AN. Safety and Utility of Hybrid Depth Electrodes for Seizure Localization and Single-Unit Neuronal Recording. Stereotact Funct Neurosurg 2018; 96:311-319. [PMID: 30326475 DOI: 10.1159/000493548] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Invasive electrode monitoring provides more precise localization of epileptogenic foci in patients with medically refractory epilepsy. The use of hybrid depth electrodes that include microwires for simultaneous single-neuron monitoring is becoming more widespread. OBJECTIVE To determine the safety and utility of hybrid depth electrodes for intracranial monitoring of medically refractory epilepsy. METHODS We reviewed the medical charts of 53 cases of medically refractory epilepsy operated on from 2006 to 2017, where both non-hybrid and hybrid microwire depth electrodes were used for intracranial monitoring. We assessed the localization accuracy and complications that arose to assess the relative safety and utility of hybrid depth electrodes compared with standard electrodes. RESULTS A total of 555 electrodes were implanted in 52 patients. The overall per-electrode complication rate was 2.3%, with a per-case complication rate of 20.8%. There were no infections or deaths. Serious or hemorrhagic complications occurred in 2 patients (0.4% per-electrode risk). Complications did not correlate with the use of any particular electrode type, and hybrids were equally as reliable as standard electrodes in localizing seizure onset zones. CONCLUSIONS Hybrid depth electrodes appear to be as safe and effective as standard depth electrodes for intracranial monitoring and provide unique opportunities to study the human brain at single-neuron resolution.
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Affiliation(s)
- April A Carlson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ueli Rutishauser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California,
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50
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Hogg E, During E, E. Tan E, Athreya K, Eskenazi J, Wertheimer J, Mamelak AN, Alterman RL, Tagliati M. Sustained quality-of-life improvements over 10 years after deep brain stimulation for dystonia. Mov Disord 2018; 33:1160-1167. [DOI: 10.1002/mds.27426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Elliot Hogg
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Emmanuel During
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Echo E. Tan
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Kishore Athreya
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Jonathan Eskenazi
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Jeffrey Wertheimer
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Adam N. Mamelak
- Department of Neurosurgery; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Ron L. Alterman
- Department of Neurosurgery; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
| | - Michele Tagliati
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
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