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Downey JE, Schone HR, Foldes ST, Greenspon C, Liu F, Verbaarschot C, Biro D, Satzer D, Moon CH, Coffman BA, Youssofzadeh V, Fields D, Hobbs TG, Okorokova E, Tyler-Kabara EC, Warnke PC, Gonzalez-Martinez J, Hatsopoulos NG, Bensmaia SJ, Boninger ML, Gaunt RA, Collinger JL. A roadmap for implanting microelectrode arrays to evoke tactile sensations through intracortical microstimulation. medRxiv 2024:2024.04.26.24306239. [PMID: 38712177 PMCID: PMC11071570 DOI: 10.1101/2024.04.26.24306239] [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: 05/08/2024]
Abstract
Intracortical microstimulation (ICMS) is a method for restoring sensation to people with paralysis as part of a bidirectional brain-computer interface to restore upper limb function. Evoking tactile sensations of the hand through ICMS requires precise targeting of implanted electrodes. Here we describe the presurgical imaging procedures used to generate functional maps of the hand area of the somatosensory cortex and subsequent planning that guided the implantation of intracortical microelectrode arrays. In five participants with cervical spinal cord injury, across two study locations, this procedure successfully enabled ICMS-evoked sensations localized to at least the first four digits of the hand. The imaging and planning procedures developed through this clinical trial provide a roadmap for other brain-computer interface studies to ensure successful placement of stimulation electrodes.
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Xie T, Warnke PC. Comment on: "A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease". Mov Disord 2024; 39:760-761. [PMID: 38661038 DOI: 10.1002/mds.29782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, Illinois, USA
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Al Ali J, Lacy M, Padmanaban M, Abou Chaar W, Hagy H, Warnke PC, Xie T. Cognitive outcomes in patients with essential tremor treated with deep brain stimulation: a systematic review. Front Hum Neurosci 2024; 18:1319520. [PMID: 38371461 PMCID: PMC10869505 DOI: 10.3389/fnhum.2024.1319520] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Essential tremor (ET) is a common neurological disease. Deep brain stimulation (DBS) to the thalamic ventral intermediate nucleus (VIM) or the adjacent structures, such as caudal zona incerta/ posterior subthalamic area (cZi/PSA), can be effective in treating medication refractory tremor. However, it is not clear whether DBS can cause cognitive changes, in which domain, and to what extent if so. Methods We systematically searched PubMed and the Web of Science for available publications reporting on cognitive outcomes in patients with ET who underwent DBS following the PICO (population, intervention, comparators, and outcomes) concept. The PRISMA guideline for systematic reviews was applied. Results Twenty relevant articles were finally identified and included for review, thirteen of which were prospective (one also randomized) studies and seven were retrospective. Cognitive outcomes included attention, memory, executive function, language, visuospatial function, and mood-related variables. VIM and cZi/PSA DBS were generally well tolerated, although verbal fluency and language production were affected in some patients. Additionally, left-sided VIM DBS was associated with negative effects on verbal abstraction, word recall, and verbal memory performance in some patients. Conclusion Significant cognitive decline after VIM or cZi/PSA DBS in ET patients appears to be rare. Future prospective randomized controlled trials are needed to meticulously study the effect of the location, laterality, and stimulation parameters of the active contacts on cognitive outcomes while considering possible medication change post-DBS, timing, standard neuropsychological battery, practice effects, the timing of assessment, and effect size as potential confounders.
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Affiliation(s)
- Jamal Al Ali
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Maureen Lacy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago, IL, United States
| | - Mahesh Padmanaban
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Widad Abou Chaar
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Hannah Hagy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago, IL, United States
| | - Peter C. Warnke
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, United States
| | - Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
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Shelchkova ND, Downey JE, Greenspon CM, Okorokova EV, Sobinov AR, Verbaarschot C, He Q, Sponheim C, Tortolani AF, Moore DD, Kaufman MT, Lee RC, Satzer D, Gonzalez-Martinez J, Warnke PC, Miller LE, Boninger ML, Gaunt RA, Collinger JL, Hatsopoulos NG, Bensmaia SJ. Microstimulation of human somatosensory cortex evokes task-dependent, spatially patterned responses in motor cortex. Nat Commun 2023; 14:7270. [PMID: 37949923 PMCID: PMC10638421 DOI: 10.1038/s41467-023-43140-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
The primary motor (M1) and somatosensory (S1) cortices play critical roles in motor control but the signaling between these structures is poorly understood. To fill this gap, we recorded - in three participants in an ongoing human clinical trial (NCT01894802) for people with paralyzed hands - the responses evoked in the hand and arm representations of M1 during intracortical microstimulation (ICMS) in the hand representation of S1. We found that ICMS of S1 activated some M1 neurons at short, fixed latencies consistent with monosynaptic activation. Additionally, most of the ICMS-evoked responses in M1 were more variable in time, suggesting indirect effects of stimulation. The spatial pattern of M1 activation varied systematically: S1 electrodes that elicited percepts in a finger preferentially activated M1 neurons excited during that finger's movement. Moreover, the indirect effects of S1 ICMS on M1 were context dependent, such that the magnitude and even sign relative to baseline varied across tasks. We tested the implications of these effects for brain-control of a virtual hand, in which ICMS conveyed tactile feedback. While ICMS-evoked activation of M1 disrupted decoder performance, this disruption was minimized using biomimetic stimulation, which emphasizes contact transients at the onset and offset of grasp, and reduces sustained stimulation.
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Affiliation(s)
- Natalya D Shelchkova
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - John E Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA.
| | - Charles M Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | | | - Anton R Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Ceci Verbaarschot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Qinpu He
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Caleb Sponheim
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Ariana F Tortolani
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Dalton D Moore
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Matthew T Kaufman
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
- Neuroscience Institute, University of Chicago, Chicago, IL, USA
| | - Ray C Lee
- Schwab Rehabilitation Hospital, Chicago, IL, USA
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | | | - Peter C Warnke
- Neuroscience Institute, University of Chicago, Chicago, IL, USA
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | - Lee E Miller
- Department of Physiology, Northwestern University, Chicago, IL, USA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Nicholas G Hatsopoulos
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
- Neuroscience Institute, University of Chicago, Chicago, IL, USA
| | - Sliman J Bensmaia
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
- Neuroscience Institute, University of Chicago, Chicago, IL, USA
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5
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Greenspon CM, Shelchkova ND, Valle G, Hobbs TG, Berger-Wolf EI, Hutchison BC, Dogruoz E, Verbarschott C, Callier T, Sobinov AR, Okorokova EV, Jordan PM, Prasad D, He Q, Liu F, Kirsch RF, Miller JP, Lee RC, Satzer D, Gonzalez-Martinez J, Warnke PC, Miller LE, Boninger ML, Ajiboye AB, Graczyk EL, Downey JE, Collinger JL, Hatsopoulos NG, Gaunt RA, Bensmaia SJ. Tessellation of artificial touch via microstimulation of human somatosensory cortex. bioRxiv 2023:2023.06.23.545425. [PMID: 37425877 PMCID: PMC10327055 DOI: 10.1101/2023.06.23.545425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
When we interact with objects, we rely on signals from the hand that convey information about the object and our interaction with it. A basic feature of these interactions, the locations of contacts between the hand and object, is often only available via the sense of touch. Information about locations of contact between a brain-controlled bionic hand and an object can be signaled via intracortical microstimulation (ICMS) of somatosensory cortex (S1), which evokes touch sensations that are localized to a specific patch of skin. To provide intuitive location information, tactile sensors on the robotic hand drive ICMS through electrodes that evoke sensations at skin locations matching sensor locations. This approach requires that ICMS-evoked sensations be focal, stable, and distributed over the hand. To systematically investigate the localization of ICMS-evoked sensations, we analyzed the projected fields (PFs) of ICMS-evoked sensations - their location and spatial extent - from reports obtained over multiple years from three participants implanted with microelectrode arrays in S1. First, we found that PFs vary widely in their size across electrodes, are highly stable within electrode, are distributed over large swaths of each participant's hand, and increase in size as the amplitude or frequency of ICMS increases. Second, while PF locations match the locations of the receptive fields (RFs) of the neurons near the stimulating electrode, PFs tend to be subsumed by the corresponding RFs. Third, multi-channel stimulation gives rise to a PF that reflects the conjunction of the PFs of the component channels. By stimulating through electrodes with largely overlapping PFs, then, we can evoke a sensation that is experienced primarily at the intersection of the component PFs. To assess the functional consequence of this phenomenon, we implemented multichannel ICMS-based feedback in a bionic hand and demonstrated that the resulting sensations are more localizable than are those evoked via single-channel ICMS.
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Affiliation(s)
- Charles M Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Giacomo Valle
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Taylor G Hobbs
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Ev I Berger-Wolf
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Efe Dogruoz
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Ceci Verbarschott
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
| | - Thierri Callier
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Anton R Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Patrick M Jordan
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Dillan Prasad
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Qinpu He
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
| | - Fang Liu
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Robert F Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, OH
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Ray C Lee
- Schwab Rehabilitation Hospital, Chicago, IL
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | | | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | - Lee E Miller
- Department of Neuroscience, Northwestern University, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
- Shirley Ryan Ability Lab, Chicago, IL
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Abidemi B Ajiboye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Emily L Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - John E Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Nicholas G Hatsopoulos
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
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6
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Greenspon CM, Valle G, Hobbs TG, Verbaarschot C, Callier T, Okorokova EV, Shelchkova ND, Sobinov AR, Jordan PM, Weiss JM, Fitzgerald EE, Prasad D, van Driesche A, Lee RC, Satzer D, Gonzalez-Martinez J, Warnke PC, Miller LE, Boninger ML, Collinger JL, Gaunt RA, Downey JE, Hatsopoulos NG, Bensmaia SJ. Biomimetic multi-channel microstimulation of somatosensory cortex conveys high resolution force feedback for bionic hands. bioRxiv 2023:2023.02.18.528972. [PMID: 36824713 PMCID: PMC9949113 DOI: 10.1101/2023.02.18.528972] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Manual interactions with objects are supported by tactile signals from the hand. This tactile feedback can be restored in brain-controlled bionic hands via intracortical microstimulation (ICMS) of somatosensory cortex (S1). In ICMS-based tactile feedback, contact force can be signaled by modulating the stimulation intensity based on the output of force sensors on the bionic hand, which in turn modulates the perceived magnitude of the sensation. In the present study, we gauged the dynamic range and precision of ICMS-based force feedback in three human participants implanted with arrays of microelectrodes in S1. To this end, we measured the increases in sensation magnitude resulting from increases in ICMS amplitude and participant's ability to distinguish between different intensity levels. We then assessed whether we could improve the fidelity of this feedback by implementing "biomimetic" ICMS-trains, designed to evoke patterns of neuronal activity that more closely mimic those in natural touch, and by delivering ICMS through multiple channels at once. We found that multi-channel biomimetic ICMS gives rise to stronger and more distinguishable sensations than does its single-channel counterpart. Finally, we implemented biomimetic multi-channel feedback in a bionic hand and had the participant perform a compliance discrimination task. We found that biomimetic multi-channel tactile feedback yielded improved discrimination over its single-channel linear counterpart. We conclude that multi-channel biomimetic ICMS conveys finely graded force feedback that more closely approximates the sensitivity conferred by natural touch.
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Affiliation(s)
- Charles M. Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Giacomo Valle
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Taylor G. Hobbs
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
| | - Ceci Verbaarschot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Thierri Callier
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
| | | | | | - Anton R. Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Patrick M. Jordan
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Jeffrey M. Weiss
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
| | - Emily E. Fitzgerald
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Dillan Prasad
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Ashley van Driesche
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Ray C. Lee
- Schwab Rehabilitation Hospital, Chicago, IL
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | | | - Peter C. Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | - Lee E. Miller
- Department of Neuroscience, Northwestern University, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
- Shirley Ryan Ability Lab, Chicago, IL
| | - Michael L. Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer L. Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Robert A. Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - John E. Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Nicholas G. Hatsopoulos
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| | - Sliman J. Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
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7
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Mendoza-Elias N, Satzer D, Henry J, Nordli DR, Warnke PC. Tailored Hemispherotomy Using Tractography-Guided Laser Interstitial Thermal Therapy. Oper Neurosurg (Hagerstown) 2023; 24:e407-e413. [PMID: 36807222 DOI: 10.1227/ons.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/06/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Medically refractory hemispheric epilepsy is a devastating disease with significant lifetime costs and social burden. Functional hemispherotomy is a highly effective treatment for hemispheric epilepsy but is associated with significant complication rates. Percutaneous hemispherotomy through laser interstitial thermal therapy (LITT) based on morphological MRI has been recently described in a single patient but not replicated in the literature. OBJECTIVE To describe the first 2 cases of tractography-guided interstitial laser hemispherotomy and their short-term outcomes. METHODS Two 11-year-old male patients with medically refractory epilepsy secondary to perinatal large vessel infarcts were referred for hemispherotomy. Both patients underwent multitrajectory LITT to disconnect the remaining pathological hemisphere, using tractography to define targets and assess structural outcomes. RESULTS Both cases had minor complication of small intraventricular/subarachnoid hemorrhage not requiring additional intervention. Both patients remain seizure-free at all follow-up visits. CONCLUSION LITT hemispherotomy can produce seizure freedom with short hospitalization and recovery. Tractography allows surgical planning to be tailored according to individual patient anatomy, which often is distorted in perinatal stroke. Minimally invasive procedures offer the greatest potential for seizure freedom without the risks of an open hemispherotomy.
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Affiliation(s)
- Nasya Mendoza-Elias
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - Julia Henry
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Douglas R Nordli
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
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Lee S, Wu S, Tao JX, Rose S, Warnke PC, Issa NP, van Drongelen W. Manifestation of Hippocampal Interictal Discharges on Clinical Scalp EEG Recordings. J Clin Neurophysiol 2023; 40:144-150. [PMID: 34010227 PMCID: PMC8590709 DOI: 10.1097/wnp.0000000000000867] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Epileptiform activity limited to deep sources such as the hippocampus currently lacks reliable scalp correlates. Recent studies, however, have found that a subset of hippocampal interictal discharges may be associated with visible scalp signals, suggesting that some types of hippocampal activity may be monitored noninvasively. The purpose of this study is to characterize the relationship between these scalp waveforms and the underlying intracranial activity. METHODS Paired intracranial and scalp EEG recordings obtained from 16 patients were used to identify hippocampal interictal discharges. Discharges were grouped by waveform shape, and spike-triggered averages of the intracranial and scalp signals were calculated for each group. Cross-correlation of intracranial and scalp spike-triggered averages was used to determine their temporal relationship, and topographic maps of the scalp were generated for each group. RESULTS Cross-correlation of intracranial and scalp correlates resulted in two classes of scalp waveforms-those with and without time delays from the associated hippocampal discharges. Scalp signals with no delay showed topographies with a broad field with higher amplitudes on the side ipsilateral to the discharges and a left-right flip in polarity-observations consistent with the volume conduction of a single unilateral deep source. In contrast, scalp correlates with time lags showed rotational dynamics, suggesting synaptic propagation mechanisms. CONCLUSIONS The temporal relationship between the intracranial and scalp signals suggests that both volume conduction and synaptic propagation contribute to these scalp manifestations. Furthermore, the topographic evolution of these scalp waveforms may be used to distinguish spikes that are limited to the hippocampus from those that travel to or engage other brain areas.
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Affiliation(s)
- Somin Lee
- Department of Pediatrics, The University of Chicago, Chicago, IL, 60607, USA
- Committee on Neurobiology, The University of Chicago, Chicago, IL, 60607, USA
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA
| | - James X. Tao
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA
| | - Peter C. Warnke
- Department of Surgery, The University of Chicago, Chicago, IL, 60607, USA
| | - Naoum P. Issa
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA
| | - Wim van Drongelen
- Department of Pediatrics, The University of Chicago, Chicago, IL, 60607, USA
- Committee on Neurobiology, The University of Chicago, Chicago, IL, 60607, USA
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA
- Committee on Computational Neuroscience, The University of Chicago, Chicago, IL, 60607, USA
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9
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Satzer D, Esengul YT, Warnke PC, Issa NP, Nordli DR. Source localization of ictal SEEG to predict postoperative seizure outcome. Clin Neurophysiol 2022; 144:142-150. [PMID: 36088217 DOI: 10.1016/j.clinph.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/08/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Stereo-electroencephalography (SEEG) is inherently-three-dimensional and can be modeled using source localization. This study aimed to assess the validity of ictal SEEG source localization. METHODS The dominant frequency at ictal onset was used for source localization in the time and frequency domains using rotating dipoles and current density maps. Validity was assessed by concordance with the epileptologist-defined seizure onset zone (conventional SOZ) and the surgical treatment volume (TV) of seizure-free versus non-seizure-free patients. RESULTS Source localization was performed on 68 seizures from 27 patients. Median distance to nearest contact in the conventional SOZ was 7 (IQR 6-12) mm for time-domain dipoles. Current density predicted ictal activity with up to 86 % (60-87 %) accuracy. Distance from time-domain dipoles to the TV was smaller (P = 0.045) in seizure-free (2 [0-4] mm) versus non-seizure-free (12 [2-17] mm) patients, and predicted surgical outcome with 91 % sensitivity and 63 % specificity. Removing near-field data from contacts within the TV negated outcome prediction (P = 0.51). CONCLUSIONS Source localization of SEEG accurately mapped ictal onset compared with conventional interpretation. Proximity of dipoles to the TV predicted seizure outcome when near-field recordings were analyzed. SIGNIFICANCE Ictal SEEG source localization is useful in corroborating the epileptogenic zone, assuming near-field recordings are obtained.
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Affiliation(s)
- David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA.
| | - Yasar T Esengul
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Douglas R Nordli
- Section of Child Neurology, Department of Pediatrics, University of Chicago, Chicago, IL, USA
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10
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Bruzzone MJ, Issa NP, Wu S, Rose S, Esengul YT, Towle VL, Nordli D, Warnke PC, Tao JX. Hippocampal spikes have heterogeneous scalp EEG correlates important for defining IEDs. Epilepsy Res 2022; 182:106914. [DOI: 10.1016/j.eplepsyres.2022.106914] [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] [Received: 07/16/2021] [Revised: 02/20/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022]
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11
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Satzer DI, Mahavadi A, Lacy M, Grant J, Warnke PC. 144 Interstitial Laser Anterior Capsulotomy for Obsessive-compulsive Disorder: Lesion Size and Tractography Correlate with Outcome. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_144] [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: 11/19/2022] Open
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12
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Satzer D, Esengul YT, Warnke PC, Issa NP, Nordli DR. SEEG in 3D: Interictal Source Localization From Intracerebral Recordings. Front Neurol 2022; 13:782880. [PMID: 35211078 PMCID: PMC8861202 DOI: 10.3389/fneur.2022.782880] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/24/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stereo-electroencephalography (SEEG) uses a three-dimensional configuration of depth electrodes to localize epileptiform activity, but traditional analysis of SEEG is spatially restricted to the point locations of the electrode contacts. Interpolation of brain activity between contacts might allow for three-dimensional representation of epileptiform activity and avoid pitfalls of SEEG interpretation. OBJECTIVE The goal of this study was to validate SEEG-based interictal source localization and assess the ability of this technique to monitor far-field activity in non-implanted brain regions. METHODS Interictal epileptiform discharges were identified on SEEG in 26 patients who underwent resection, ablation, or disconnection of the suspected epileptogenic zone. Dipoles without (free) and with (scan) gray matter restriction, and current density (sLORETA and SWARM methods), were calculated using a finite element head model. Source localization results were compared to the conventional irritative zone (IZ) and the surgical treatment volumes (TV) of seizure-free vs. non-seizure-free patients. RESULTS The median distance from dipole solutions to the nearest contact in the conventional IZ was 7 mm (interquartile range 4-15 mm for free dipoles and 4-14 mm for scan dipoles). The IZ modeled with SWARM predicted contacts within the conventional IZ with 83% (75-100%) sensitivity and 94% (88-100%) specificity. The proportion of current within the TV was greater in seizure-free patients (P = 0.04) and predicted surgical outcome with 45% sensitivity and 93% specificity. Dipole solutions and sLORETA results did not correlate with seizure outcome. Addition of scalp EEG led to more superficial modeled sources (P = 0.03) and negated the ability to predict seizure outcome (P = 0.23). Removal of near-field data from contacts within the TV resulted in smearing of the current distribution (P = 0.007) and precluded prediction of seizure freedom (P = 0.20). CONCLUSIONS Source localization accurately represented interictal discharges from SEEG. The proportion of current within the TV distinguished between seizure-free and non-seizure-free patients when near-field recordings were obtained from the surgical target. The high prevalence of deep sources in this cohort likely obscured any benefit of concurrent scalp EEG. SEEG-based interictal source localization is useful in illustrating and corroborating the epileptogenic zone. Additional techniques are needed to localize far-field epileptiform activity from non-implanted brain regions.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Chicago, Chicago, IL, United States
| | - Yasar T Esengul
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Peter C Warnke
- Department of Neurosurgery, University of Chicago, Chicago, IL, United States
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Douglas R Nordli
- Section of Child Neurology, Department of Pediatrics, University of Chicago, Chicago, IL, United States
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13
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Pathmarajah T, Katipally RR, Flores-Martinez E, Farrey KJ, Korpics MC, Sivananthan AP, Warnke PC, Chmura SJ, Yenice KM, Pitroda SP. Linear accelerator-based stereotactic radiosurgery for glossopharyngeal neuralgia is safe and effective - Report of two cases. J Radiosurg SBRT 2022; 8:151-153. [PMID: 36275126 PMCID: PMC9489069] [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] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/05/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Thamilini Pathmarajah
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Rohan R. Katipally
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
| | | | - Karl J. Farrey
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Mark C. Korpics
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Aranee P. Sivananthan
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Peter C. Warnke
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Steven J. Chmura
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Kamil M. Yenice
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Sean P. Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
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14
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Mansour A, Loggini A, El Ammar F, Alvarado-Dyer R, Polster S, Stadnik A, Das P, Warnke PC, Yamini B, Lazaridis C, Kramer C, Mould WA, Hildreth M, Sharrock M, Hanley DF, Goldenberg FD, Awad IA. Post-Trial Enhanced Deployment and Technical Performance with the MISTIE Procedure per Lessons Learned. J Stroke Cerebrovasc Dis 2021; 30:105996. [PMID: 34303090 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/15/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We hypothesize that procedure deployment rates and technical performance with minimally invasive surgery and thrombolysis for intracerebral hemorrhage (ICH) evacuation (MISTIE) can be enhanced in post-trial clinical practice, per Phase III trial results and lessons learned. MATERIALS AND METHODS We identified ICH patients and those who underwent MISTIE procedure between 2017-2021 at a single site, after completed enrollments in the Phase III trial. Deployment rates, complications and technical outcomes were compared to those observed in the trial. Initial and final hematoma volume were compared between site measurements using ABC/2, MISTIE trial reading center utilizing manual segmentation, and a novel Artificial Intelligence (AI) based volume assessment. RESULTS Nineteen of 286 patients were eligible for MISTIE. All 19 received the procedure (6.6% enrollment to screening rate 6.6% compared to 1.6% at our center in the trial; p=0.0018). Sixteen patients (84%) achieved evaculation target < 15 mL residual ICH or > 70% removal, compared to 59.7% in the trial surgical cohort (p=0.034). No poor catheter placement occurred and no surgical protocol deviations. Limitations of ICH volume assessments using the ABC/2 method were shown, while AI based methodology of ICH volume assessments had excellent correlation with manual segmentation by experienced reading centers. CONCLUSIONS Greater procedure deployment and higher technical success rates can be achieved in post-trial clinical practice than in the MISTIE III trial. AI based measurements can be deployed to enhance clinician estimated ICH volume. Clinical outcome implications of this enhanced technical performance cannot be surmised, and will need assessment in future trials.
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Affiliation(s)
- Ali Mansour
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Andrea Loggini
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Faten El Ammar
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Ronald Alvarado-Dyer
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Sean Polster
- Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Agnieszka Stadnik
- Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Paramita Das
- Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Peter C Warnke
- Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Bakhtiar Yamini
- Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Christos Lazaridis
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Christopher Kramer
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - W Andrew Mould
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
| | - Meghan Hildreth
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
| | - Matthew Sharrock
- Division of Neurocritical Care, Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
| | - Fernando D Goldenberg
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Issam A Awad
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
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15
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Satzer D, Tao JX, Warnke PC. Extent of parahippocampal ablation is associated with seizure freedom after laser amygdalohippocampotomy. J Neurosurg 2021:1-10. [PMID: 34087803 DOI: 10.3171/2020.11.jns203261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/31/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to examine the relationship between mesial temporal subregion ablation volume and seizure outcome in a diverse cohort of patients who underwent stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE). METHODS Seizure outcomes and pre- and postoperative images were retrospectively reviewed in patients with MTLE who underwent SLAH at a single institution. Mesial temporal subregions and the contrast-enhancing ablation volume were manually segmented. Pre- and postoperative MR images were coregistered to assess anatomical ablation. Postoperative MRI and ablation volumes were also spatially normalized, enabling the assessment of seizure outcome with heat maps. RESULTS Twenty-eight patients with MTLE underwent SLAH, 15 of whom had mesial temporal sclerosis (MTS). The rate of Engel class I outcome at 1 year after SLAH was 39% overall: 47% in patients with MTS and 31% in patients without MTS. The percentage of parahippocampal gyrus (PHG) ablated was higher in patients with an Engel class I outcome (40% vs 25%, p = 0.04). Subregion analysis revealed that extent of ablation in the parahippocampal cortex (35% vs 19%, p = 0.03) and angular bundle (64% vs 43%, p = 0.02) was positively associated with Engel class I outcome. The degree of amygdalohippocampal complex (AHC) ablated was not associated with seizure outcome (p = 0.30). CONCLUSIONS Although the AHC was the described target of SLAH, seizure outcome in this cohort was associated with degree of ablation for the PHG, not the AHC. Complete coverage of both the AHC and PHG is technically challenging, and more work is needed to optimize seizure outcome after SLAH.
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16
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Chen CC, Freeman D, Warnke PC. Stereotactic and endoscopic treatment of the trapped temporal horn. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.101053] [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: 10/22/2022] Open
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17
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Abumurad S, Issa NP, Wu S, Rose S, Taylan Esengul Y, Nordli D, Warnke PC, Tao JX. Laser interstitial thermal therapy for NPRL3-related epilepsy with multiple seizure foci: A case report. Epilepsy Behav Rep 2021; 16:100459. [PMID: 34235417 PMCID: PMC8249776 DOI: 10.1016/j.ebr.2021.100459] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 10/28/2022] Open
Abstract
Introduction: NPRL3 gene mutations cause autosomal dominant familial focal epilepsy of variable foci (FFEVF) and is characterized by focal epilepsy arising from different brain regions including temporal, frontal, parietal and occipital lobes. About 50% of patients with NPRL3 related epilepsy are resistant to medical treatment. Method: We present a case of 27 years old man with NPRL3 related focal drug-resistant epilepsy. Stereotactic EEG showed two independent seizure foci, namely, left hippocampus and left orbitofrontal cortices. He underwent laser interstitial thermal therapy for ablating both foci in the same procedure that led to seizure cessation. Conclusion: laser interstitial thermal therapy can be an effective treatment for drug resistant NPRL3 related focal epilepsy with better tolerance and less morbidity as compared to open surgical resection, particularly in those with multiple seizure foci.
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Affiliation(s)
- Sumayyah Abumurad
- Departments of Neurology, Pediatrics, and Surgery, The University of Chicago, Chicago, IL 60637, USA
| | - Naoum P Issa
- Departments of Neurology, Pediatrics, and Surgery, The University of Chicago, Chicago, IL 60637, USA
| | - Shasha Wu
- Departments of Neurology, Pediatrics, and Surgery, The University of Chicago, Chicago, IL 60637, USA
| | - Sandra Rose
- Departments of Neurology, Pediatrics, and Surgery, The University of Chicago, Chicago, IL 60637, USA
| | - Yasar Taylan Esengul
- Departments of Neurology, Pediatrics, and Surgery, The University of Chicago, Chicago, IL 60637, USA
| | - Douglas Nordli
- Departments of Neurology, Pediatrics, and Surgery, The University of Chicago, Chicago, IL 60637, USA
| | - Peter C Warnke
- Departments of Neurology, Pediatrics, and Surgery, The University of Chicago, Chicago, IL 60637, USA
| | - James X Tao
- Departments of Neurology, Pediatrics, and Surgery, The University of Chicago, Chicago, IL 60637, USA
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18
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Wu S, Issa NP, Lacy M, Satzer D, Rose SL, Yang CW, Collins JM, Liu X, Sun T, Towle VL, Nordli DR, Warnke PC, Tao JX. Surgical Outcomes and EEG Prognostic Factors After Stereotactic Laser Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy. Front Neurol 2021; 12:654668. [PMID: 34079512 PMCID: PMC8165234 DOI: 10.3389/fneur.2021.654668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/17/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess the seizure outcomes of stereotactic laser amygdalohippocampectomy (SLAH) in consecutive patients with mesial temporal lobe epilepsy (mTLE) in a single center and identify scalp EEG and imaging factors in the presurgical evaluation that correlate with post-surgical seizure recurrence. Methods: We retrospectively reviewed the medical and EEG records of 30 patients with drug-resistant mTLE who underwent SLAH and had at least 1 year of follow-up. Surgical outcomes were classified using the Engel scale. Univariate hazard ratios were used to evaluate the risk factors associated with seizure recurrence after SLAH. Results: The overall Engel class I outcome after SLAH was 13/30 (43%), with a mean postoperative follow-up of 48.9 ± 17.6 months. Scalp EEG findings of interictal regional slow activity (IRSA) on the side of surgery (HR = 4.05, p = 0.005) and non-lateralizing or contra-lateralizing seizure onset (HR = 4.31, p = 0.006) were negatively correlated with postsurgical seizure freedom. Scalp EEG with either one of the above features strongly predicted seizure recurrence after surgery (HR = 7.13, p < 0.001) with 100% sensitivity and 71% specificity. Significance: Understanding the factors associated with good or poor surgical outcomes can help choose the best candidates for SLAH. Of the variables assessed, scalp EEG findings were the most clearly associated with seizure outcomes after SLAH.
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Affiliation(s)
- Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Naoum P Issa
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Maureen Lacy
- Department of Psychiatry, The University of Chicago, Chicago, IL, United States
| | - David Satzer
- Department of Neurosurgery, The University of Chicago, Chicago, IL, United States
| | - Sandra L Rose
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Carina W Yang
- Department of Radiology, The University of Chicago, Chicago, IL, United States
| | - John M Collins
- Department of Radiology, The University of Chicago, Chicago, IL, United States
| | - Xi Liu
- Department of Neurology, Wuhan University, Wuhan, China
| | - Taixin Sun
- Department of Neurology, Beijing Electric Power Hospital, Beijing, China
| | - Vernon L Towle
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Douglas R Nordli
- Department of Pediatric Neurology, The University of Chicago, Chicago, IL, United States
| | - Peter C Warnke
- Department of Neurosurgery, The University of Chicago, Chicago, IL, United States
| | - James X Tao
- Department of Neurology, The University of Chicago, Chicago, IL, United States
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19
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Freeman D, Chen CC, Warnke PC. Stereotactic Treatment of the Trapped Temporal Horn. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_642] [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: 11/12/2022] Open
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20
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Satzer D, Yu H, Wells M, Padmanaban M, Burns MR, Warnke PC, Xie T. Deep Brain Stimulation Impedance Decreases Over Time Even When Stimulation Settings Are Held Constant. Front Hum Neurosci 2020; 14:584005. [PMID: 33240066 PMCID: PMC7680729 DOI: 10.3389/fnhum.2020.584005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/16/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: To study whether and to what extent the therapeutic impedance and current change under long-term deep brain stimulation (DBS) with constant stimulation settings, which could inform the role of constant current stimulation. Methods: Therapy impedance and current measurements were retrospectively collected from patients with Parkinson’s disease (PD) undergoing DBS of the subthalamic nucleus (STN) or essential tremor (ET) undergoing ventral intermediate nucleus (VIM). Baseline and follow-up measurements were obtained for intervals of at least 6 months without changes in stimulation settings. The single longest interval of constant stimulation for each electrode was included. Temporal trends in impedance and current were analyzed as absolute and relative differences and as the rate of change. Results: Impedance and current data from 79 electrodes (60 in STN, 19 in VIM) in 44 patients (32 with PD, 12 with ET) met inclusion criteria. The duration between baseline and follow-up measurements with constant stimulation settings was 17 months (median, with an interquartile range of 12–26 months) in the mixed group. Therapy impedance decreased by 27 ± 12 Ω/year (mean ± 2 standard errors; p < 0.0001), and therapy current increased at a rate of 0.142 ± 0.063 mA/year (p < 0.0001). Similar results were observed in the STN and VIM subgroups. Conclusions: Impedance decreases gradually over time, even when stimulation settings are kept constant. The rate of decrease is smaller than previously reported, suggesting that changes in stimulation settings contribute to impedance drift. Stimulation-independent impedance drift is gradual but relevant to constant-current programming.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Chicago Medicine, Chicago, IL, United States
| | - Huiyan Yu
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Meredith Wells
- Department of Neurobiology, University of Chicago Medicine, Chicago, IL, United States
| | - Mahesh Padmanaban
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Matthew R Burns
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States.,Department of Neurology, University of Florida College of Medicine, Chicago, IL, United States
| | - Peter C Warnke
- Department of Neurosurgery, University of Chicago Medicine, Chicago, IL, United States
| | - Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
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21
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Tao JX, Satzer D, Issa NP, Collins J, Wu S, Rose S, Henry J, Santos de Lima F, Nordli D, Warnke PC. Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome. Epilepsia 2020; 61:1190-1200. [DOI: 10.1111/epi.16535] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/27/2022]
Affiliation(s)
- James X. Tao
- Department of Neurology University of Chicago Chicago IL USA
| | - David Satzer
- Department of Neurosurgery University of Chicago Chicago IL USA
| | - Naoum P. Issa
- Department of Neurology University of Chicago Chicago IL USA
| | - John Collins
- Department of Radiology University of Chicago Chicago IL USA
| | - Shasha Wu
- Department of Neurology University of Chicago Chicago IL USA
| | - Sandra Rose
- Department of Neurology University of Chicago Chicago IL USA
| | - Julia Henry
- Department of Pediatrics University of Chicago Chicago IL USA
| | | | - Douglas Nordli
- Department of Pediatrics University of Chicago Chicago IL USA
| | - Peter C. Warnke
- Department of Neurosurgery University of Chicago Chicago IL USA
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22
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Polster SP, Dougherty MC, Zeineddine HA, Lyne SB, Smith HL, MacKenzie C, Pytel P, Yang CW, Tonsgard JH, Warnke PC, Frim DM. Dural Ectasia in Neurofibromatosis 1: Case Series, Management, and Review. Neurosurgery 2020; 86:646-655. [PMID: 31350851 DOI: 10.1093/neuros/nyz244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/18/2018] [Accepted: 04/06/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The natural history and management of dural ectasia in Neurofibromatosis 1 (NF1) is still largely unknown. Dural ectasias are one of the common clinical manifestations of NF1; however, the treatment options for dural ectasias remain unstudied. OBJECTIVE To investigate the natural history, diagnosis, management, and outcome of the largest case series of patients with NF1-associated dural ectasia to date. METHODS Records from our NF1 clinic were reviewed to identify NF1 patients with computed tomography or magnetic resonance imaging evidence of dural ectasia(s) to determine their clinical course. Demographics, symptoms, radiographic and histopathologic findings, treatment, and clinical course were assessed. RESULTS Thirty-four of 37 patients were managed without surgery. Of the 18 initially asymptomatic patients, 5 (27.8%) progressed to symptoms attributable to a dural ectasia (onset of 2.7% per patient-year). Three patients required surgical intervention because of extraspinal mass effect. All 3 initially improved but had symptom recurrence within 2 yr. Reoperation involved shunt placement for cerebrospinal fluid (CSF) diversion. On imaging review, 26 (76.5%) of the nonsurgical patients harbored an associated nearby plexiform neurofibroma. Pathology of one surgical case revealed dural infiltration by diffuse neurofibroma. CONCLUSION Using the largest NF1-associated dural ectasia group to date, we report the first symptom-onset rate for nonsurgical patients. In the few cases requiring surgery for decompression, primary resection, and patching of ectasias failed, subsequently requiring CSF shunting. We demonstrate imaging evidence of nearby plexiform neurofibroma in a majority of cases, which, when combined with histopathology, provides a novel explanation for the formation of dural ectasias.
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Affiliation(s)
- Sean P Polster
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Mark C Dougherty
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Hussein A Zeineddine
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Seán B Lyne
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Heather L Smith
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Cynthia MacKenzie
- Ambulatory Program for Neurofibromatosis, Department of Pediatrics and Neurology, University of Chicago Medicine, Chicago, Illinois
| | - Peter Pytel
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois
| | - Carina W Yang
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - James H Tonsgard
- Ambulatory Program for Neurofibromatosis, Department of Pediatrics and Neurology, University of Chicago Medicine, Chicago, Illinois
| | - Peter C Warnke
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - David M Frim
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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23
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Satzer D, Tao JX, Issa NP, Chen Z, Wu S, Rose S, Collins J, Awad IA, Warnke PC. Stereotactic laser interstitial thermal therapy for epilepsy associated with solitary and multiple cerebral cavernous malformations. Neurosurg Focus 2020; 48:E12. [DOI: 10.3171/2020.1.focus19866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors sought to perform a preliminary assessment of the safety and effectiveness of stereotactic laser interstitial thermal therapy (LITT) for patients with cerebral cavernous malformation (CCM)–related epilepsy.METHODSThe authors retrospectively analyzed 6 patients with CCM-related epilepsy who underwent LITT. Pre-, intra-, and postoperative brain MRI studies were used to characterize preoperative CCM volume, ablation volume, and postablation hemosiderin volume. Clinical outcomes were assessed postoperatively during clinic follow-up visits or phone interviews.RESULTSLITT was performed in 7 CCMs in 6 patients. Two patients had familial CCM disease with multifocal lesions. Four treated CCMs were extratemporal, and 3 were in or near the visual pathways. The median follow-up was 25 (range 12–39) months. Five of 6 (83%) patients achieved seizure freedom (Engel I classification), of whom 4 (67%) were Engel IA and 1 was Engel IC after a single seizure on postoperative day 4. The remaining patient had rare seizures (Engel II). One patient had a nondisabling visual field deficit. There were no hemorrhagic complications. All patients were discharged within 24 hours postablation. MRI 3–11 months after ablation demonstrated expected focal necrosis and trace hemosiderin-related T2 hypointensity measuring 9%–44% (median 24%) of the original lesion volume, with significant (p = 0.04) volume reduction.CONCLUSIONSLITT is a minimally invasive option for treating CCM-related epilepsy with seizure outcomes comparable to those achieved with open lesionectomy. The precision of LITT allows for the obliteration of eloquent, deep, small, and multifocal lesions with low complication rates, minimal postoperative discomfort, and short hospital stays. In this study the feasibility and benefits of this method were demonstrated in 2 patients with multifocal lesions.
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Affiliation(s)
| | | | | | - Ziyi Chen
- 4Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | | | | | - John Collins
- 3Radiology, University of Chicago, Illinois; and
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Satzer D, Warnke PC. Technical note: accuracy and precision in stereotactic stem cell transplantation. Acta Neurochir (Wien) 2019; 161:2059-2064. [PMID: 31273445 DOI: 10.1007/s00701-019-03964-8] [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: 03/25/2019] [Accepted: 05/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND While multiple trials have employed stereotactic stem cell transplantation, injection techniques have received little critical attention. Precise cell delivery is critical for certain applications, particularly when targeting deep nuclei. METHODS Ten patients with a history of ischemic stroke underwent CT-guided stem cell transplantation. Cells were delivered along 3 tracts adjacent to the infarcted area. Intraoperative air deposits and postoperative T2-weighted MRI fluid signals were mapped in relation to calculated targets. RESULTS The deepest air deposit was found 4.5 ± 1.0 mm (mean ± 2 SEM) from target. The apex of the T2-hyperintense tract was found 2.8 ± 0.8 mm from target. On average, air pockets were found anterior (1.2 ± 1.1 mm, p = 0.04) and superior (2.4 ± 1.0 mm, p < 0.001) to the target; no directional bias was noted for the apex of the T2-hyperintense tract. Location and distribution of air deposits were variable and were affected by the relationship of cannula trajectory to stroke cavity. CONCLUSIONS Precise stereotactic cell transplantation is a little-studied technical challenge. Reflux of cell suspension and air, and the structure of the injection tract affect delivery of cell suspensions. Intraoperative CT allows assessment of delivery and potential trajectory correction.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Chicago, 5841 S. Maryland Avenue, MC 3026, Chicago, IL, 60637, USA.
| | - Peter C Warnke
- Department of Neurosurgery, University of Chicago, 5841 S. Maryland Avenue, MC 3026, Chicago, IL, 60637, USA
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Warnke PC, Mahavadi A, Grant J. Interstitial Laser Capsulotomy for Refractory Obsessive-Compulsive Disorder-Lesion Size and Energy Deposition Determine Outcome. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Current neurosurgical treatment of refractory severe Obsessive Compulsive Disorder either using radiosurgery, deep brain stimulation or lately focused ultrasound results in moderate and/or delayed responses. We describe the first case series in the literature applying high energy interstitial laser ablation (LITT) to successfully treat refractory OCD with immediate and sustained response.
METHODS
Four patients with OCD underwent bilateral LITT capsulotomy from 2015 to 2019. All patients were reviewed by the Psychiatric Neurosurgery Board of the institution Inclusion criteria were based upon Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score above 30 and inability to function in daily life. Each patient's pre- and postoperative partial and full Y-BOCS scores were collected. The partial Y-BOCS score was assessed 24 h post surgery. Ablation parameters such as total energy delivered, average power, and ablation volume were collected. Extent of connectome disruptions were assessed with volumetric diffusion tensor MRI.
RESULTS
All patients had YBOCS scores between 31 and 40. Immediate improvement on partial Y-BOCS was noted in all patients 24 h post surgery. (Mean reduction of 83.3 + 20.1%) YBOCS scores after 3 mo went from 35.6 + 3.8 to 17.6 + 4.7, a more than 50% reduction. Lesion volumes were large with an average of 3.13 + 1.1 cc on T2 MRI. Energy deposited ranged from 402.75 to 868.5 Watts (700 C) consistently higher on the right side to create symmetric lesions (P < .01) .Orbito-frontal thalamic connections were reduced by more than 85% on DTI 24 h post surgery and consistently 3 mo postop.
CONCLUSION
LITT is capable of creating large targeted lesions with real time MR monitoring leading to unprecedented almost immediate and extensive improvement in refractory OCD. Larger lesions due to higher energy deposition resulting in maximum disruption of the hyperactive circuitry underlying OCD are possible with LITT. Also, symptom reduction is superior to alternative techniques.
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Lee S, Issa NP, Rose S, Tao JX, Warnke PC, Towle VL, van Drongelen W, Wu S. DC shifts, high frequency oscillations, ripples and fast ripples in relation to the seizure onset zone. Seizure 2019; 77:52-58. [PMID: 31101405 DOI: 10.1016/j.seizure.2019.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 11/06/2018] [Revised: 01/22/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
Abstract
Efforts to improve epilepsy surgery outcomes have led to increased interest in the study of electroencephalographic oscillations outside the conventional EEG bands. These include fast activity above the gamma band, known as high frequency oscillations (HFOs), and infraslow activity (ISA) below the delta band, sometimes referred to as direct current (DC) or ictal baseline shifts (IBS). HFOs in particular have been extensively studied as potential biomarkers for epileptogenic tissue in light of evidence showing that resection of brain tissue containing HFOs is associated with good surgical outcomes. Not all HFOs are conclusively pathological, however, as they can be recorded in nonepileptic tissue and induced by cognitive, visual, or motor tasks. Consequently, efforts to distinguish between pathological and physiological HFOs have identified several traits specific to pathological HFOs, such as coupling with interictal spikes, association with delta waves, and stereotypical morphologies. On the opposite end of the EEG spectrum, sub-delta oscillations have been shown to co-localize with the seizure onset zones (SOZ) and appear in a narrower spatial distribution than activity in the conventional EEG frequency bands. In this report, we review studies that implicate HFOs and ISA in ictogenesis and discuss current limitations such as inter-observer variability and poor standardization of recording techniques. Furthermore, we propose that HFOs and ISA should be analyzed in addition to activity in the conventional EEG band during intracranial presurgical EEG monitoring to identify the best possible surgical margin.
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Affiliation(s)
- Somin Lee
- Department of Pediatrics, The University of Chicago, Chicago, IL, 60607, USA; Committee on Neurobiology, The University of Chicago, Chicago, IL, 60607, USA
| | - Naoum P Issa
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA
| | - James X Tao
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA
| | - Peter C Warnke
- Department of Surgery, The University of Chicago, Chicago, IL, 60607, USA
| | - Vernon L Towle
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA; Department of Surgery, The University of Chicago, Chicago, IL, 60607, USA; Committee on Computational Neuroscience, The University of Chicago, Chicago, IL, 60607, USA
| | - Wim van Drongelen
- Department of Pediatrics, The University of Chicago, Chicago, IL, 60607, USA; Committee on Neurobiology, The University of Chicago, Chicago, IL, 60607, USA; Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA; Committee on Computational Neuroscience, The University of Chicago, Chicago, IL, 60607, USA
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL, 60607, USA.
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Warnke PC. Epilepsy surgery at its best: randomised prospective controlled trials in neurosurgery are no magic. J Neurol Neurosurg Psychiatry 2019; 90:249. [PMID: 30355609 DOI: 10.1136/jnnp-2017-317683] [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: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Peter C Warnke
- Neurosurgery, University of Chicago, Chicago, IL 60637, USA
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Liu X, Issa NP, Rose S, Wu S, Sun T, Towle LV, Warnke PC, Tao JX. The first-hour-of-the-day sleep EEG reliably identifies interictal epileptiform discharges during long-term video-EEG monitoring. Seizure 2018; 63:48-51. [PMID: 30399461 DOI: 10.1016/j.seizure.2018.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/11/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To determine the usefulness of the first-hour sleep EEG recording in identifying interictal epileptiform discharges (IEDs) during long-term video-EEG monitoring. METHOD We retrospectively reviewed 255 consecutive patients who underwent continuous long-term video-EEG monitoring in the adult epilepsy monitoring unit (EMU) at the University of Chicago. The complete video-EEG recording was reviewed, and the occurrence of IEDs was determined for each patient. We compared the occurrence of IEDs observed during the first-hour sleep EEG recordings with the occurrence of IEDs observed during the complete video-EEG recordings. RESULTS Overall, IEDs were observed in 134 (53%) of 255 patients during the full long-term video-EEG recording with a mean duration of 4 days. IEDs were identified in the first-hour sleep EEG in 125 (49%) of 225 patients. Comparing to reviewing full records, the first hour sleep EEG identified IEDs in 125 (93%) of 134 patients. Of the IED subtypes, the first-hour sleep EEG identified 92 (94%) of 98 patients with temporal lobe IEDs, 11 (92%) of 12 patients with frontal lobe IEDs, 3 (100%) of 3 patients with parietal lobe IEDs, 1(50%) of the 2 patients with occipital lobe IEDs, 16 (94%) of 17 patients with generalized IEDs, and 2 (100%) 2 patients with multi-focal IEDs. CONCLUSIONS The first-hour sleep EEG reliably predicts the occurrence of IEDs during the long-term video-EEG recording, and therefore can be a time-efficient tool for identifying patients with IEDs during long-term video-EEG recording in the adult epilepsy monitoring unit.
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Affiliation(s)
- Xi Liu
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei Province, PR China.
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
| | - Sandra Rose
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
| | - Taixin Sun
- Department of Neurology, Beijing Electric Power Hospital, Beijing, PR China
| | - Leo V Towle
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
| | - Peter C Warnke
- Department of Neurosurgery, University of Chicago, Chicago, IL 60637, USA
| | - James X Tao
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
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Issa NP, Lee S, Wu S, Rose S, Towle VL, Warnke PC, van Drongelen W, Tao JX. Reply to “which small sharp spikes are benign epileptiform transients of sleep?”. Clin Neurophysiol 2018; 129:2495-2496. [DOI: 10.1016/j.clinph.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
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Issa NP, Wu S, Rose S, Towle VL, Warnke PC, Tao JX. Small sharp spikes as EEG markers of mesiotemporal lobe epilepsy. Clin Neurophysiol 2018; 129:1796-1803. [DOI: 10.1016/j.clinph.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/15/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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Tao JX, Issa NP, Wu S, Rose S, Collins J, Warnke PC. Interstitial Stereotactic Laser Anterior Corpus Callosotomy: A Report of 2 Cases with Operative Technique and Effectiveness. Neurosurgery 2018; 85:E569-E574. [DOI: 10.1093/neuros/nyy273] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/25/2018] [Indexed: 11/14/2022] Open
Abstract
AbstractBACKGROUND AND IMPORTANCECorpus callosotomy is an effective palliative treatment for medically intractable Lennox–Gastaut syndrome (LGS) that disrupts the interhemispheric synchronization of epileptiform discharges. However, traditional open corpus callosotomy carries a significant risk of surgical complications associated with craniotomy and a parafalcine approach to the corpus callosum. Here, we report 2 cases of anterior corpus callosotomy using MRI-guided stereotactic laser interstitial thermal therapy (LITT) as a minimally invasive technique for mitigating the risks of craniotomy while achieving favorable outcomes.CLINICAL PRESENTATIONTwo patients with medically intractable LGS underwent stereotactic laser anterior corpus callosotomy using a 2 laser-fiber approach. Ablation of 70%-80% of the corpus callosum was confirmed by postoperative MRI diffusion tensor imaging and volumetric analysis. Marked reduction of epileptiform activity was observed in both patients during postoperative video-EEG studies as compared to preoperative video-EEG studies. Freedom from disabling seizures including drop attacks was achieved in 1 patient for 18 mo, and more than a 90% reduction of disabling seizures was achieved in the other patient for 7 mo with cognitive improvement and without surgical complications.CONCLUSIONThese early data demonstrate the technical feasibility, safety, and favorable outcomes of MRI-guided stereotactic laser anterior corpus callosotomy in patients with LGS, making it a potentially safe and effective alternative to traditional open corpus callosotomy and other stereotactic methods including radiofrequency ablation and radiosurgery due to the ability to monitor the ablation in real time with MRI.
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Affiliation(s)
- James X Tao
- Department of Neurology, The University of Chicago, Chicago, Illinois
| | - Naoum P Issa
- Department of Neurology, The University of Chicago, Chicago, Illinois
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, Illinois
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, Illinois
| | - John Collins
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Peter C Warnke
- Department of Neurosurgery, The University of Chicago, Chicago, Illinois
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Tao JX, Wu S, Lacy M, Rose S, Issa NP, Yang CW, Dorociak KE, Bruzzone M, Kim J, Daif A, Choi J, Towle VL, Warnke PC. Stereotactic EEG-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2018; 89:542-548. [PMID: 29183959 DOI: 10.1136/jnnp-2017-316833] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the outcomes of combined stereo-electroencephalography-guided and MRI-guided stereotactic laser interstitial thermal therapy (LITT) in the treatment of patients with drug-resistant mesial temporal lobe epilepsy (mTLE). METHODS We prospectively assessed the surgical and neuropsychological outcomes in 21 patients with medically refractory mTLE who underwent LITT at the University of Chicago Medical Center. We further compared the surgical outcomes in patients with and without mesial temporal sclerosis (MTS). RESULTS Of the 21 patients, 19 (90%) underwent Invasive EEG study and 11 (52%) achieved freedom from disabling seizures with a mean duration of postoperative follow-up of 24±11 months after LITT. Eight (73%) of 11 patients with MTS achieved freedom from disabling seizures, whereas 3 (30 %) of 10 patients without MTS achieved freedom from disabling seizures. Patients with MTS were significantly more likely to become seizure-free, as compared with those without MTS (P=0.002). There was no significant difference in total ablation volume and the percentage of the ablated amygdalohippocampal complex between seizure-free and non-seizure-free patients. Presurgical and postsurgical neuropsychological assessments were obtained in 10 of 21 patients. While there was no group decline in any neuropsychological assessment, a significant postoperative decline in verbal memory and confrontational naming was observed in individual patients. CONCLUSIONS MRI-guided LITT is a safe and effective alternative to selective amygdalohippocampectomy and anterior temporal lobectomy for mTLE with MTS. Nevertheless, its efficacy in those without MTS seems modest. Large multicentre and prospective studies are warranted to further determine the efficacy and safety of LITT.
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Affiliation(s)
- James X Tao
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Maureen Lacy
- Department of Psychiatry, The University of Chicago, Chicago, Illinois, USA
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Naoum P Issa
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Carina W Yang
- Department of Radiology, The University of Chicago, Chicago, Illinois, USA
| | | | - Maria Bruzzone
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Jisoon Kim
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Ahmad Daif
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Jason Choi
- Department of Neurosurgery, The University of Chicago, Chicago, Illinois, USA
| | - Vernon L Towle
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurosurgery, The University of Chicago, Chicago, Illinois, USA
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Warnke PC. Commentary: Cystic Craniopharyngiomas: Microsurgical or Stereotactic Treatment? Neurosurgery 2017; 80:744-745. [PMID: 28327937 DOI: 10.1093/neuros/nyx031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/25/2017] [Indexed: 11/12/2022] Open
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Lam S, Lin Y, Curry DJ, Reddy GD, Warnke PC. Revision surgeries following vagus nerve stimulator implantation. J Clin Neurosci 2016; 30:83-87. [DOI: 10.1016/j.jocn.2016.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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Lai G, Mahadevan A, Hackney D, Warnke PC, Nigim F, Kasper E, Wong ET, Carter BS, Chen CC. Diagnostic Accuracy of PET, SPECT, and Arterial Spin-Labeling in Differentiating Tumor Recurrence from Necrosis in Cerebral Metastasis after Stereotactic Radiosurgery. AJNR Am J Neuroradiol 2015; 36:2250-5. [PMID: 26427832 DOI: 10.3174/ajnr.a4475] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/03/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Radiographic assessment of cerebral metastasis after stereotactic radiosurgery remains a major challenge in neuro-oncology. It is often difficult to distinguish tumor progression from radiation necrosis in this setting using conventional MR imaging. The objective of this study was to compare the diagnostic sensitivity and specificity of different functional imaging modalities for detecting tumor recurrence after stereotactic radiosurgery. MATERIALS AND METHODS We retrospectively reviewed patients treated between 2007 and 2010 and identified 14 patients with cerebral metastasis who had clinical or radiographic progression following stereotactic radiosurgery and were imaged with arterial spin-labeling, FDG-PET, and thallium SPECT before stereotactic biopsy. Diagnostic accuracy, specificity, sensitivity, positive predictive value, and negative predictive value were calculated for each imaging technique by using the pathologic diagnosis as the criterion standard. RESULTS Six patients (42%) had tumor progression, while 8 (58%) developed radiation necrosis. FDG-PET and arterial spin-labeling were equally sensitive in detecting tumor progression (83%). However, the specificity of arterial spin-labeling was superior to that of the other modalities (100%, 75%, and 50%, respectively). A combination of modalities did not augment the sensitivity, specificity, positive predictive value, or negative predictive value of arterial spin-labeling. CONCLUSIONS In our series, arterial spin-labeling positivity was closely associated with the pathologic diagnosis of tumor progression after stereotactic radiosurgery. Validation of this finding in a large series is warranted.
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Affiliation(s)
- G Lai
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
| | | | | | - P C Warnke
- Division of Neurosurgery (P.C.W.), University of Chicago, Chicago, Illinois
| | - F Nigim
- Division of Neurosurgery (F.N., E.K.)
| | - E Kasper
- Division of Neurosurgery (F.N., E.K.)
| | - E T Wong
- Department of Neurology (E.T.W.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - B S Carter
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
| | - C C Chen
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
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Warnke PC, Ostertag CB, Hobbs J. 196 Long-term Outcome After Stereotactic Cysto-Ventricular Shunt and Radiotherapy in Craniopharyngiomas—The Neuromythology of Aseptic Meningitis/Ventriculitis. Neurosurgery 2015. [DOI: 10.1227/01.neu.0000467160.51784.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Warnke PC. Deep brain stimulation surgery under general anaesthesia with microelectrode recording: the best of both worlds or a little bit of everything? J Neurol Neurosurg Psychiatry 2014; 85:1063. [PMID: 24591455 DOI: 10.1136/jnnp-2014-307745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
While traditional computed tomography (CT) and magnetic resonance (MR) imaging illustrate the structural morphology of brain pathology, newer, dynamic imaging techniques are able to show the movement of contrast throughout the brain parenchyma and across the blood-brain barrier (BBB). These data, in combination with pharmacokinetic models, can be used to investigate BBB permeability, which has wide-ranging applications in the diagnosis and management of central nervous system (CNS) tumors in children. In the first part of this paper, we review the technical principles underlying four imaging modalities used to evaluate BBB permeability: PET, dynamic CT, dynamic T1-weighted contrast-enhanced MR imaging, and dynamic T2-weighted susceptibility contrast MR. We describe the data that can be derived from each method, provide some caveats to data interpretation, and compare the advantages and disadvantages of the different techniques. In the second part of this paper, we review the clinical applications that have been reported with permeability imaging data, including diagnosing the nature of a lesion found on imaging (neoplastic versus non-neoplastic, tumor type, tumor grade, recurrence versus pseudoprogression), predicting the natural history of a tumor, monitoring angiogenesis and tracking response to anti-angiogenic agents, optimizing chemotherapy agent selection, and aiding in the development of new antineoplastic drugs and methods to increase local delivery of chemotherapeutics.
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Affiliation(s)
- Sandi Lam
- 1 Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA ; 2 Functional and Stereotactic Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Yimo Lin
- 1 Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA ; 2 Functional and Stereotactic Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- 1 Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA ; 2 Functional and Stereotactic Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
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McDuff SGR, Taich ZJ, Lawson JD, Sanghvi P, Wong ET, Barker FG, Hochberg FH, Loeffler JS, Warnke PC, Murphy KT, Mundt AJ, Carter BS, McDonald CR, Chen CC. Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases. J Neurol Neurosurg Psychiatry 2013; 84:1384-91. [PMID: 23715918 DOI: 10.1136/jnnp-2013-305166] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The treatment of metastatic brain lesions remains a central challenge in oncology. Because most chemotherapeutic agents do not effectively cross the blood-brain barrier, it is widely accepted that radiation remains the primary modality of treatment. The mode by which radiation should be delivered has, however, become a source of intense controversy in recent years. The controversy involves whether patients with a limited number of brain metastases should undergo whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) delivered only to the radiographically visible tumours. Survival is comparable for patients treated with either modality. Instead, the controversy involves the neurocognitive function (NCF) of radiating cerebrum that appeared radiographically normal relative to effects of the growth from micro-metastatic foci. A fundamental question in this debate involves quantifying the effect of WBRT in patients with cerebral metastasis. To disentangle the effects of WBRT on neurocognition from the effects inherent to the underlying disease, we analysed the results from randomised controlled studies of prophylactic cranial irradiation in oncology patients as well as studies where patients with limited cerebral metastasis were randomised to SRS versus SRS+WBRT. In aggregate, these results suggest deleterious effects of WBRT in select neurocognitive domains. However, there are insufficient data to resolve the controversy of upfront WBRT versus SRS in the management of patients with limited cerebral metastases.
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Affiliation(s)
- Susan G R McDuff
- Center for Theoretical and Applied Neuro-Oncology, University of California, , La Jolla, California, USA
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Waters JD, Gonda DD, Reddy H, Kasper EM, Warnke PC, Chen CC. Diagnostic yield of stereotactic needle-biopsies of sub-cubic centimeter intracranial lesions. Surg Neurol Int 2013; 4:S176-81. [PMID: 23682345 PMCID: PMC3654772 DOI: 10.4103/2152-7806.110677] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 02/11/2013] [Accepted: 02/26/2013] [Indexed: 11/22/2022] Open
Abstract
Background: Stereotactic brain biopsies are widely used for establishing the diagnosis of intracranial lesions. Here we examine whether stereotactic biopsy of smaller brain lesions, defined for this study as being less than 1 cubic centimeter (1 cc) in volume, are associated with lowered diagnostic yield. Methods: We conducted a retrospective analysis of 267 consecutive patients who underwent stereotactic brain biopsy between 2007 and 2011. Lesion volumes were calculated and were stratified by <1 or >1 cc. Results: A total of 13 of 246 (5.2%) biopsies for lesions >1 cc resulted in nondiagnostic tissue or an incorrect diagnosis. In contrast, 5 of 21 (23.8%) biopsies for <1 cc lesions yielded nondiagnostic or incorrect diagnosis. Posthoc review of tissue from the <1 cc lesions suggests the neuropathologist's expertise in the handling and analysis of limited specimen as a critical parameter of successful diagnosis. The operative morbidities were low for both the <1 and >1 cc biopsies (0% and 1%, respectively). Conclusion: This study demonstrates that stereotactic cerebral biopsy of lesions less than a cubic centimeter in volume results in a lower diagnostic yield versus larger lesions (76.2% versus 94.8%). While auxiliary measures may be taken to improve diagnostic yield, these patients may be best managed in a specialized center with experienced stereotactic neurosurgeons and neuropathologists.
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Affiliation(s)
- J Dawn Waters
- Division of Neurosurgery, University of California, San Diego, USA ; Center for Theoretic and Applied Neuro-Oncology, University of California, San Diego, USA
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Gonda DD, Kim TE, Warnke PC, Kasper EM, Carter BS, Chen CC. Ventriculoperitoneal shunting versus endoscopic third ventriculostomy in the treatment of patients with hydrocephalus related to metastasis. Surg Neurol Int 2012; 3:97. [PMID: 23061013 PMCID: PMC3463839 DOI: 10.4103/2152-7806.100185] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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: 03/19/2012] [Accepted: 07/12/2012] [Indexed: 12/21/2022] Open
Abstract
Background: Between 2005 and 2010, we treated patients with hydrocephalus related to cerebral metastases, who were not good candidates for surgical resection by either endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting (VPS). Patients were excluded from ETV if they had a clinical history suggestive of non-obstructive hydrocephalus, including: (1) history of infection or ventricular hemorrhage and (2) leptomeningeal carcinomatosis. The rest of the patients were treated with VPS. Methods: We analyzed the clinical outcome of these patient cohorts, to determine whether the efficacy of VPS was compromised due to a history of infection, ventricular hemorrhage, or leptomeningeal carcinomatosis, and compared these results to those patients who underwent ETV. Results: Sixteen patients were treated with ETV and 36 patients were treated with VPS. The overall efficacy of symptomatic palliation was comparable in the ETV and VPS patients (ETV = 69%, VPS = 75%). In both groups, patients with more severe hydrocephalic symptoms such as nausea, vomiting, and lethargy were more likely to benefit from the procedure. The overall complication rate for the two groups was comparable (ETV = 12.6%, VPS = 19.4%), although the spectrum of complications differed. The overall survival, initial Karnofsky performance status (KPS), and three-month KPS, were similarly comparable (median survival: ETV 3 months, VPS 5.5 months; initial KPS: ETV = 66 ± 7, VPS = 69 ± 12; 3 months KPS: ETV = 86 ± 7, KPS = 84 ± 12). Conclusion: VPS remains a reasonable option for poor RPA grade metastasis patients with hydrocephalus, even in the setting of a previous infection, hemorrhage, or in those with leptomeningeal disease. Optimal treatment of this population will involve the judicious consideration of the relative merits of VPS and ETV.
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Affiliation(s)
- David D Gonda
- Department of Neurosurgery, University of California, San Diego, USA ; Center for Theoretic and Applied Neuro-Oncology, University of California, San Diego, USA
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Chen CC, Kasper EM, Zinn PO, Warnke PC. Management of entrapped temporal horn by temporal horn to prepontine cistern shunting. World Neurosurg 2011; 79:404.e7-10. [PMID: 22120406 DOI: 10.1016/j.wneu.2011.02.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 12/23/2010] [Accepted: 02/07/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Entrapped temporal horn syndrome secondary to obstructive neoplastic lesions is most frequently treated by surgical excision of the offending lesion. Here we describe an alternate approach involving temporal horn to prepontine cistern shunting followed by radiosurgery of the offending lesion. METHODS A 41-year-old woman with a history of meningiomatosis presented with progressive, incapacitating headache. Magnetic resonance imaging (MRI) showed growth of a right trigone meningioma, causing entrapment of the right temporal horn. A ventricular catheter was placed using frame-based stereotaxy and image fusion computed tomography/MRI to connect the entrapped lateral ventricle to the prepontine cistern. The patient reported complete resolution of her symptoms after the procedure. RESULTS Postoperative MRI revealed decompression of the temporal horn. The trigonal meningioma was treated with stereotactic radiosurgery. The patient remained asymptomatic at the 2-year follow-up. CONCLUSIONS Trapped temporal horn syndrome secondary to obstructive neoplastic lesions can be treated by internal shunting followed by radiosurgery.
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Affiliation(s)
- Clark C Chen
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Wang CC, Floyd SR, Chang CH, Warnke PC, Chio CC, Kasper EM, Mahadevan A, Wong ET, Chen CC. Cyberknife hypofractionated stereotactic radiosurgery (HSRS) of resection cavity after excision of large cerebral metastasis: efficacy and safety of an 800 cGy × 3 daily fractions regimen. J Neurooncol 2011; 106:601-10. [PMID: 21879395 DOI: 10.1007/s11060-011-0697-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
Abstract
Development of hypofractionated stereotactic radiosurgery (HSRS) has expanded the size of lesion that can be safely treated by focused radiation in a limited number of treatment sessions. However, clinical data regarding the efficacy and morbidity of HSRS in the treatment of cerebral metastasis is lacking. Here, we review our experience with CyberKnife(®) HSRS for this indication. From 2005 to 2010, we identified 37 patients with large (>3 cm in diameter) cerebral metastases resection cavity that was treated with HSRS. This constituted approximately 8% of all treated resection cavities. We reviewed dose regimens, local control, distal control, and treatment associated morbidities. Primary sites for the metastatic lesions included: lung (n = 10), melanoma (n = 12), breast (n = 9), kidney (n = 4), and colon (n = 2). All patients underwent resection of the cerebral metastasis and received 800 cGy × 3 daily fractions to the resection cavity. Of the 37 patients treated, one-year follow-up data was available for 35 patients. The median survival was 5.5 months. Actuarial local control rate at 6 months was 80%. Local failures did not correlate with prior WBRT, or tumor histology. Distant recurrence occurred in 7 of the 35 patients. Morbidities associated with HSRS totaled 9%, including radiation necrosis (n = 1, 2.9%), prolonged steroid use (n = 1, 2.9%), and new-onset seizures (n = 1, 2.9%). This study demonstrates the safety and efficacy of an 800 cGy × 3 daily fractions CyberKnife(®) HSRS regimen for irradiation of large resection cavity. The efficacy compares favorably to historical data derived from patients undergoing WBRT, SRS, or brachytherapy.
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Affiliation(s)
- Che-Chuan Wang
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
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Abstract
Low-grade gliomas in adults have an incidence of 0.8 to 1.2 per 100,000, and their causes are unknown. Despite their histological classification as low-grade, they cannot be cured by any current treatment mode, and no class I evidence exists to guide initial treatment of these tumors. Median survival ranges between 7.5 years and 10 years, with a 5-year survival probability between 55% and 86%. The prognosis depends on age, World Health Organization (WHO) tumor grade, Karnofsky performance score, cytological type (oligodendroglioma vs astrocytoma), and, potentially, the extent of resection. Oligodendrogliomas with loss of heterozygosity on chromosomes 1p and 19q have a distinctly more favorable prognosis and therapeutic response rate. Low-grade tumors progress to high-grade gliomas with aggressive biological behavior at increasing frequency with advancing age. Ms P is a young woman with a previously treated oligodendroglioma, WHO grade II, with loss of heterozygosity on chromosomes 1p and 19q, which at a third resection had transformed into an oligodendroglioma of WHO grade III. She wants to know her current and future therapeutic options.
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Affiliation(s)
- Peter C Warnke
- Harvard Medical School, and Division of Neurological Surgery, Beth Israel Deaconess Medical Center, 110 Francis St, Ste 3B, Boston, MA 02215, USA.
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Jenkinson MD, Smith TS, Haylock B, Husband D, Shenoy A, Vinjamuri S, Walker C, Pietronigro D, Warnke PC. Phase II trial of intratumoral BCNU injection and radiotherapy on untreated adult malignant glioma. J Neurooncol 2010; 99:103-13. [PMID: 20063175 DOI: 10.1007/s11060-010-0113-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 01/04/2010] [Indexed: 11/30/2022]
Abstract
DTI-015 (BCNU dissolved in ethanol) utilizes solvent facilitated perfusion (SFP) for intratumoral drug delivery. A phase II clinical trial of DTI-015 and fractionated external beam radiotherapy on newly diagnosed, malignant gliomas investigated early changes in tumour physiology and metabolism, clinical outcome and safety. Pre- and post DTI-015 injection neuro-imaging included computed tomography (CT) cerebral blood flow and volume, glucose and thallium single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Clinical status was determined before and after DTI-015, prior to radiotherapy and 3 monthly thereafter until progression (defined by Macdonald criteria). Primary endpoint was radiographic response. Secondary endpoints were progression free (PFS) and overall survival (OS). Twelve patients were enrolled; eight glioblastoma multiforme (GBM), four anaplastic astrocytoma (AA). Three days after DTI-015 injection, mean tumour blood flow (Paired t-test; P < 0.001) and blood volume (Paired t-test; P = 0.001) were significantly reduced. There was a significant decrease in glucose utilization (Paired t-test; P < 0.001) and thallium uptake (Paired t-test; P < 0.001) at 6 days. Tumour blood volume had a sustained reduction (Paired t-test; P = 0.001) at 26 days after DTI-015. There were two serious adverse events. Two patients with AA achieved a partial response. Median PFS was 39 weeks for AA and 27 weeks for GBM; median OS for GBM was 47 weeks and 132 weeks for AA. The imaging data forms a biological basis for understanding the effects of high dose BCNU delivered intratumorally by SFP, and suggests early effects on tumour vasculature and metabolism.
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Affiliation(s)
- Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool L9 7LJ, UK.
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Abstract
BACKGROUND Oligodendroglial tumors with 1p/19q loss are more likely to be chemosensitive and have longer survival than those with intact 1p/19q, but not all respond to chemotherapy, warranting investigation of the biological basis of chemosensitivity. METHODS Gene expression profiling was performed using amplified antisense RNA from 28 oligodendroglial tumors treated with chemotherapy (26 serial stereotactic biopsy, 2 resection). Expression of differentially expressed genes was validated by real-time PCR. RESULTS Unsupervised hierarchical clustering showed clustering of multiple samples from the same case in 14/17 cases and identified subgroups associated with tumor grade and 1p/19q status. 176 genes were differentially expressed, 164 being associated with 1p/19q loss (86% not on 1p or 19q). 94 genes differed between responders and non-responders to chemotherapy; 12 were not associated with 1p/19q loss. Significant differential expression was confirmed in 11/13 selected genes. Novel genes associated with response to therapy included SSBP2, GFRA1, FAP and RASD1. IQGAP1, INA, TGIF1, NR2F2 and MYCBP were differentially expressed in oligodendroglial tumors with 1p/19q loss. CONCLUSION Gene expression profiling using serial stereotactic biopsies indicated greater homogeneity within tumors than between tumors. Genes associated with 1p/19q status or response were identified warranting further elucidation of their role in oligodendroglial tumors.
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Affiliation(s)
- Elisabeth J Shaw
- School of Cancer Studies, University of Liverpool, Liverpool, UK.
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Jenkinson MD, Smith TS, Brodbelt AR, Joyce KA, Warnke PC, Walker C. Apparent diffusion coefficients in oligodendroglial tumors characterized by genotype. J Magn Reson Imaging 2008; 26:1405-12. [PMID: 17968881 DOI: 10.1002/jmri.21062] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate whether oligodendroglial tumors with or without 1p/19q loss differ in their diffusion-weighted imaging characteristics. Oligodendroglial tumors with or without 1p/19q loss differ in their therapeutic responsiveness and prognosis, and recent reports also suggest that these tumors may differ in their magnetic resonance characteristics and blood volume. MATERIALS AND METHODS Apparent diffusion coefficients (ADCs) were assessed in three grade II oligodendrogliomas, nine grade II and five grade III oligoastrocytomas with known 1p/19q status. Regions of interest (ROIs) were placed on ADC maps: 1) around tumor margins to generate pixel histograms; 2) over minimum and maximum tumor ADC; 3) on areas comparable to the highest choline (Cho)/creatine (Cr) ratio determined from chemical shift imaging (CSI); and 4) across tumor margins to measure the ADC transition coefficient (ATC). RESULTS Tumor ADC was significantly different from normal brain (P < 0.001). ADC in regions of highest Cho/Cr was greater than minimum ADC and did not correlate with the Cho/Cr ratio. ADC and ATC were not significantly different between oligodendroglial subtypes or grades. Tumors with intact 1p/19q had higher maximum (P = 0.021) and histogram ADC (P = 0.015), and greater ATC (P = 0.001) compared to those with 1p/19q loss, which may reflect differences in edema and cellularity. CONCLUSION This preliminary study identified differences in ADC and ATC between oligodendroglial tumor genotypes that may reflect underlying biology. Confirmation in a larger series is warranted.
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Affiliation(s)
- Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
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Reed JE, Dunn JR, du Plessis DG, Shaw EJ, Reeves P, Gee AL, Warnke PC, Sellar GC, Moss DJ, Walker C. Expression of cellular adhesion molecule 'OPCML' is down-regulated in gliomas and other brain tumours. Neuropathol Appl Neurobiol 2007; 33:77-85. [PMID: 17239010 DOI: 10.1111/j.1365-2990.2006.00786.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The four GPI-anchored cell adhesion molecules that exemplify the IgLON family are most highly expressed in the nervous system and associate to form up to six different heterodimeric 'Diglons' that can modify cell adhesion and inhibit axon migration. Recently, two members, OPCML and LSAMP, were identified as putative tumour suppressor genes in ovarian and renal carcinomas respectively. In this study, we investigated OPCML expression in nonneoplastic brain tissue and 35 brain tumours (18 glioblastoma multiformes, five anaplastic gliomas, five meningiomas, six metastases and one medulloblastoma) and four glioma cell lines using quantitative reverse transcriptase polymerase chain reaction (RT-PCR). OPCML was highly expressed in cerebellum, less so in cerebral cortex, frontal lobe and meninges and was significantly reduced or absent in 83% of brain tumours and all cell lines compared with nonneoplastic whole brain. Two OPCML splice variants have been identified in humans, termed alpha1 and alpha2, but the latter has not been demonstrated in human neural tissues. Using PCR with specific primers, nonneoplastic brain and 3/6 of tested brain tumours expressed both splice variants, whereas the remaining brain tumours only expressed the alpha2 variant. Hypermethylation of the alpha1 OPCML promoter, associated with down-regulation of expression in ovarian tumours, did not correlate with expression levels in the subset of brain tumours tested, implying transcription of OPCML from an alternative promoter or a different mechanism of down-regulation. This study demonstrates that OPCML down-regulation occurs in the majority of brain tumours tested, warranting further investigation of OPCML and other IgLONs in the development and progression of brain tumours.
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Affiliation(s)
- J E Reed
- JK Douglas Laboratories, Clatterbridge Hospital, Wirral, UK
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