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Tankus A, Rosenberg N, Ben-Hamo O, Stern E, Strauss I. Machine learning decoding of single neurons in the thalamus for speech brain-machine interfaces. J Neural Eng 2024; 21:036009. [PMID: 38648783 DOI: 10.1088/1741-2552/ad4179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/22/2024] [Indexed: 04/25/2024]
Abstract
Objective. Our goal is to decode firing patterns of single neurons in the left ventralis intermediate nucleus (Vim) of the thalamus, related to speech production, perception, and imagery. For realistic speech brain-machine interfaces (BMIs), we aim to characterize the amount of thalamic neurons necessary for high accuracy decoding.Approach. We intraoperatively recorded single neuron activity in the left Vim of eight neurosurgical patients undergoing implantation of deep brain stimulator or RF lesioning during production, perception and imagery of the five monophthongal vowel sounds. We utilized the Spade decoder, a machine learning algorithm that dynamically learns specific features of firing patterns and is based on sparse decomposition of the high dimensional feature space.Main results. Spade outperformed all algorithms compared with, for all three aspects of speech: production, perception and imagery, and obtained accuracies of 100%, 96%, and 92%, respectively (chance level: 20%) based on pooling together neurons across all patients. The accuracy was logarithmic in the amount of neurons for all three aspects of speech. Regardless of the amount of units employed, production gained highest accuracies, whereas perception and imagery equated with each other.Significance. Our research renders single neuron activity in the left Vim a promising source of inputs to BMIs for restoration of speech faculties for locked-in patients or patients with anarthria or dysarthria to allow them to communicate again. Our characterization of how many neurons are necessary to achieve a certain decoding accuracy is of utmost importance for planning BMI implantation.
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Affiliation(s)
- Ariel Tankus
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurology and Neurosurgery, School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Noam Rosenberg
- School of Electrical Engineering, Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Oz Ben-Hamo
- School of Electrical Engineering, Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Einat Stern
- Department of Neurology and Neurosurgery, School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurology and Neurosurgery, School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Strauss I, Gabay S, Roth J. Laser interstitial thermal therapy (LITT) for pediatric low-grade glioma-case presentations and lessons learned. Childs Nerv Syst 2024:10.1007/s00381-024-06419-3. [PMID: 38703238 DOI: 10.1007/s00381-024-06419-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The surgical treatment of brain tumors has developed over time, offering customized strategies for patients and their specific lesions. One of the most recent advances in pediatric neuro-oncological surgery is laser interstitial thermal therapy (LITT). However, its effectiveness and indications are still being evaluated. The aim of this work is to review the current literature on LITT for pediatric low-grade gliomas (pLGG) and evaluate our initial results in this context. METHODS We retrospectively reviewed our pediatric neurosurgery database for patients who received LITT treatment between November 2019 and December 2023. We collected data on the indications for LITT, technical issues during the procedure, and clinical and radiological follow-up. RESULTS Three patients underwent 5 LITT procedures for pLGG. The lesion was thalamo-peduncular in one patient, cingulate in one, and deep parietal in one patient. Two patients had a previous open resection done and were diagnosed with pLGG. One patient underwent a stereotaxic biopsy during the LITT procedure that was non-diagnostic. The same patient underwent a later open resection of the tumor in the cingulate gyrus. There were no surgical complications and all patients were discharged home on the first post-operative day. The follow-up period was between 20 and 40 months. Radiological follow-up showed a progressive reduction of the tumor in patients with LGG. CONCLUSION Laser interstitial thermal therapy is a minimally invasive treatment that shows promise in treating deep-seated pLGG in children. The treatment has demonstrated a reduction in tumor volume, and the positive results continue over time. LITT can be used as an alternative treatment for tumors located in areas that are difficult to access surgically or in cases where other standard treatment options have failed.
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Affiliation(s)
- Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Segev Gabay
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jonathan Roth
- Pediatric Neurosurgery and Pediatric Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tankus A, Lustig-Barzelay Y, Gurevitch G, Faust-Socher A, Strauss I. Neuronal Encoding of Speech Features in the Human Thalamus in Parkinson's Disease and Essential Tremor Patients. Neurosurgery 2024; 94:307-316. [PMID: 37695053 DOI: 10.1227/neu.0000000000002665] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/10/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The human thalamus is known, from stimulation studies and functional imaging, to participate in high-level language tasks. The goal of this study is to find whether and how speech features, in particular, vowel phonemes, are encoded in the neuronal activity of the thalamus, and specifically of the left ventralis intermediate nucleus (Vim), during speech production, perception, and imagery. METHODS In this cross-sectional study, we intraoperatively recorded single neuron activity in the left Vim of eight neurosurgical patients with Parkinson's disease (PD) (n = 4) or essential tremor (n = 4) undergoing implantation of deep brain stimulation (n = 3) or radiofrequency lesioning (n = 5) while patients articulated the five monophthongal vowel sounds. RESULTS In this article, we report that single neurons in the left Vim encode individual vowel phonemes mainly during speech production but also during perception and imagery. They mainly use one of two encoding schemes: broad or sharp tuning, with a similar percentage of units each. Sinusoidal tuning has been demonstrated in almost half of the broadly tuned units. Patients with PD had a lower percentage of speech-related units in each aspect of speech (production, perception, and imagery), a significantly lower percentage of broadly tuned units, and significantly lower median firing rates during speech production and perception, but significantly higher rates during imagery, than patients with essential tremor. CONCLUSION The results suggest that the left Vim uses mixed encoding schemes for speech features. Our findings explain, at the single neuron level, why deep brain stimulation and radiofrequency lesioning of the left Vim are likely to cause speech side effects. Moreover, they may indicate that speech-related units in the left Vim of patients with PD may be degraded even in the subclinical phase.
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Affiliation(s)
- Ariel Tankus
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
- Department of Neurology and Neurosurgery, Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv , Israel
| | - Yael Lustig-Barzelay
- Department of Neurology and Neurosurgery, Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Guy Gurevitch
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv , Israel
- Department of Physiology and Pharmacology, Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Achinoam Faust-Socher
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
- Department of Neurology and Neurosurgery, Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
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Gabay S, Sapir Y, Korn A, Hochberg U, Tellem R, Zegerman A, Brogan SE, Rahimpour S, Shofty B, Strauss I. Optimization of Radiofrequency Needle Placement in Percutaneous Cordotomy Using Electromyography in the Deeply Sedated Patient. Oper Neurosurg (Hagerstown) 2024; 26:22-27. [PMID: 37747336 DOI: 10.1227/ons.0000000000000907] [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: 04/19/2023] [Accepted: 07/14/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cordotomy, the selective disconnection of the nociceptive fibers in the spinothalamic tract, is used to provide pain palliation to oncological patients suffering from intractable cancer-related pain. Cordotomies are commonly performed using a cervical (C1-2) percutaneous approach under imaging guidance and require patients' cooperation to functionally localize the spinothalamic tract. This can be challenging in patients suffering from extreme pain. It has recently been demonstrated that intraoperative neurophysiology monitoring by electromyography may aid in safe lesion positioning. The aim of this study was to evaluate the role of compound muscle action potential (CMAP) in deeply sedated patients undergoing percutaneous cervical cordotomy (PCC). METHODS A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy while deeply sedated between January 2019 and November 2022 in 2 academic centers. The operative report, neuromonitoring logs, and clinical medical records were evaluated. RESULTS Eleven patients underwent PCC under deep sedation. In all patients, the final motor assessment prior to ablation was done using the electrophysiological criterion alone. The median threshold for evoking CMAP activity at the lesion site was 0.9 V ranging between 0.5 and 1.5 V (average 1 V ± 0.34 V SD). An immediate, substantial decrease in pain was observed in 9 patients. The median pain scores (Numeric Rating Scale) decreased from 10 preoperatively (range 8-10) to a median 0 (range 0-10) immediately after surgery. None of our patients developed motor deficits. CONCLUSION CMAP-guided PCC may be feasible in deeply sedated patients without added risk to postoperative motor function. This technique should be considered in a group of patients who are not able to undergo awake PCC.
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Affiliation(s)
- Segev Gabay
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
| | - Yechiam Sapir
- Surgical Monitoring Services, Beit Shemesh , Israel
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv , Israel
| | - Akiva Korn
- Surgical Monitoring Services, Beit Shemesh , Israel
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv , Israel
| | - Uri Hochberg
- Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Rotem Tellem
- Palliative Care Service, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
| | - Alex Zegerman
- Division of Anesthesia, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
| | - Shane E Brogan
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City , Utah , USA
| | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah, Salt Lake City , Utah , USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah, Salt Lake City , Utah , USA
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
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Giannotti A, Lo Vecchio S, Musco S, Pollina L, Vallone F, Strauss I, Paggi V, Bernini F, Gabisonia K, Carlucci L, Lenzi C, Pirone A, Giannessi E, Miragliotta V, Lacour S, Del Popolo G, Moccia S, Micera S. Decoding bladder state from pudendal intraneural signals in pigs. APL Bioeng 2023; 7:046101. [PMID: 37811476 PMCID: PMC10558243 DOI: 10.1063/5.0156484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Neuroprosthetic devices used for the treatment of lower urinary tract dysfunction, such as incontinence or urinary retention, apply a pre-set continuous, open-loop stimulation paradigm, which can cause voiding dysfunctions due to neural adaptation. In the literature, conditional, closed-loop stimulation paradigms have been shown to increase bladder capacity and voiding efficacy compared to continuous stimulation. Current limitations to the implementation of the closed-loop stimulation paradigm include the lack of robust and real-time decoding strategies for the bladder fullness state. We recorded intraneural pudendal nerve signals in five anesthetized pigs. Three bladder-filling states, corresponding to empty, full, and micturition, were decoded using the Random Forest classifier. The decoding algorithm showed a mean balanced accuracy above 86.67% among the three classes for all five animals. Our approach could represent an important step toward the implementation of an adaptive real-time closed-loop stimulation protocol for pudendal nerve modulation, paving the way for the design of an assisted-as-needed neuroprosthesis.
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Affiliation(s)
- A. Giannotti
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S. Lo Vecchio
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S. Musco
- Neuro-Urology Department, Careggi University Hospital, Firenze, Italy
| | - L. Pollina
- Bertarelli Foundation Chair in Translational NeuroEngineering, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - F. Vallone
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - I. Strauss
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering–IMTEK, IMBIT//NeuroProbes BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - V. Paggi
- Bertarelli Foundation Chair in Microengineering and Bioengineering, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - F. Bernini
- BioMedLab, Scuola Superiore Sant'Anna, Pisa, Italy
| | - K. Gabisonia
- BioMedLab, Scuola Superiore Sant'Anna, Pisa, Italy
| | - L. Carlucci
- BioMedLab, Scuola Superiore Sant'Anna, Pisa, Italy
| | - C. Lenzi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - A. Pirone
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - E. Giannessi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - V. Miragliotta
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - S. Lacour
- Bertarelli Foundation Chair in Microengineering and Bioengineering, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - G. Del Popolo
- Neuro-Urology Department, Careggi University Hospital, Firenze, Italy
| | - S. Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S. Micera
- Author to whom correspondence should be addressed:
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Strauss I, Agnesi F, Zinno C, Giannotti A, Dushpanova A, Casieri V, Terlizzi D, Bernini F, Gabisonia K, Wu Y, Jiang D, Paggi V, Lacour S, Recchia F, Demosthenous A, Lionetti V, Micera S. Neural Stimulation Hardware for the Selective Intrafascicular Modulation of the Vagus Nerve. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4449-4458. [PMID: 37917519 DOI: 10.1109/tnsre.2023.3329735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
The neural stimulation of the vagus nerve is able to modulate various functions of the parasympathetic response in different organs. The stimulation of the vagus nerve is a promising approach to treating inflammatory diseases, obesity, diabetes, heart failure, and hypertension. The complexity of the vagus nerve requires highly selective stimulation, allowing the modulation of target-specific organs without side effects. Here, we address this issue by adapting a neural stimulator and developing an intraneural electrode for the particular modulation of the vagus nerve. The neurostimulator parameters such as amplitude, pulse width, and pulse shape were modulated. Single-, and multi-channel stimulation was performed at different amplitudes. For the first time, a polyimide thin-film neural electrode was designed for the specific stimulation of the vagus nerve. In vivo experiments were performed in the adult minipig to validate to elicit electrically evoked action potentials and to modulate physiological functions, validating the spatial selectivity of intraneural stimulation. Electrochemical tests of the electrode and the neurostimulator showed that the stimulation hardware was working correctly. Stimulating the porcine vagus nerve resulted in spatially selective modulation of the vagus nerve. ECAP belonging to alpha and beta fibers could be distinguished during single- and multi-channel stimulation. We have shown that the here presented system is able to activate the vagus nerve and can therefore modulate the heart rate, diastolic pressure, and systolic pressure. The here presented system may be used to restore the cardiac loop after denervation by implementing biomimetic stimulation patterns. Presented methods may be used to develop intraneural electrodes adapted for various applications.
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Roth J, Fried I, Constantini S, Kramer U, Strauss I, Uliel-Sibony S. [EPILEPSY SURGERY IN CHILDREN: A SUMMARY OF A DECADE AT THE SOURASKY TEL AVIV MEDICAL CENTER]. Harefuah 2023; 162:210-215. [PMID: 37120739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Drug-resistant epilepsy in children is associated with morbidity, developmental regression and mortality. Over recent years, there is an increase in awareness regarding the role of surgery in the treatment of refractory epilepsy, both in the diagnostic phase and for treatment, reducing the number and magnitude of seizures. Technological advancements have enabled a minimalization of surgery, with reduction in surgical associated morbidity. METHODS In this retrospective study, we review our experience with cranial surgery for epilepsy between the years 2011-2020. Collected data included information regarding the epileptic disorder, surgery, surgical-related complications and epilepsy outcome. RESULTS A total of 93 children underwent 110 cranial surgeries over a decade. The main etiologies included cortical dysplasia (29), Rasmussen encephalitis (10), genetic disorders (9), tumors (7) and tuberous sclerosis (7). The main surgeries included lobectomies (32), focal resections (26), hemispherotomies (25), and callosotomies (16). Two children underwent MRI-guided laser interstitial thermal treatment (LITT). The most significant improvements following surgery were following hemispherotomy or tumor resection (100% of children, each). Following resections for cortical dysplasia led to a significant improvement in 70%. In 83% of children undergoing callosotomy, there were no additional drop seizures; 14% of the entire group underwent additional epilepsy surgery; 23% of children had an unexpected complication, in the vast majority with no permanent sequela. There was not mortality. CONCLUSIONS Epilepsy surgery may lead to significant improvement and even cure of epilepsy. There is a wide span of epilepsy surgical procedures. Ealy referral of children with refractory epilepsy for surgical evaluation may significantly reduce the developmental injury, and improve functional outcomes.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University
| | - Itzhak Fried
- Functional Neurosurgery Unit, Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University
| | - Uri Kramer
- Department of Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University
| | - Ido Strauss
- Department of Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University
| | - Shimrit Uliel-Sibony
- Department of Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University
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Grossman R, Strauss I. [LASER INTERSTITIAL THERMAL THERAPY (LITT) IN NEUROSURGERY]. Harefuah 2023; 162:110-115. [PMID: 36916081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Laser interstitial thermal therapy (LITT) has emerged as a new treatment option for various conditions within the neurosurgery world, not only due to its minimal invasiveness but also because it has been shown to be safe and effective. Combined with magnetic resonance thermography, LITT gives surgeons the ability to estimate damage in real time and precisely ablate the target tissue while minimizing thermal damage to adjacent structures. In recent years, LITT has become a reality in epilepsy surgery and in neuro-oncology and is emerging as an option in other fields in neurosurgery.
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Affiliation(s)
- Rachel Grossman
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Jalon I, Berger A, Shofty B, Goldway N, Artzi M, Gurevitch G, Hochberg U, Tellem R, Hendler T, Gonen T, Strauss I. Lesions to both somatic and affective pain pathways lead to decreased salience network connectivity. Brain 2022; 146:2153-2162. [PMID: 36314058 DOI: 10.1093/brain/awac403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Human pain is a salient stimulus composed of two main components: a sensory\somatic component, carrying peripheral nociceptive sensation via the spino-thalamic tract and brainstem nuclei to the thalamus and then to sensory cortical regions, and an affective (suffering) component, where information from central thalamic nuclei is carried to the anterior insula, dorsal anterior cingulate cortex and other regions. While the sensory component processes information about stimulus location and intensity, the affective component processes information regarding pain-related expectations, motivation to reduce pain, and pain unpleasantness. Unlike investigations of acute pain that are based on the introduction of real-time stimulus during brain recordings, chronic pain investigations are usually based on longitudinal and case-control studies, which are limited in their ability to infer the functional network topology of chronic pain. In the current study, we utilized the unique opportunity to target the central nervous system’s pain pathways in two different hierarchical locations to establish causality between pain relief and specific connectivity changes seen within the salience and sensorimotor networks. We examined how lesions to the affective and somatic pain pathways affect resting-state network topology in cancer patients suffering from severe intractable pain. Two procedures have been employed: percutaneous cervical cordotomy (n = 15), hypothesized to disrupt the transmission of the sensory component of pain along the spino-thalamic tract, or stereotactic cingulotomy (n = 7), which refers to bilateral intra-cranial ablation of an area in the dorsal anterior cingulate cortex and is known to ameliorate the affective component of pain. Both procedures led to immediate significant alleviation of experienced pain and decreased functional connectivity within the salience network. However, only the sensory procedure (cordotomy) led to decreased connectivity within the sensorimotor network. Thus, our results support the existence of two converging systems relaying experienced pain, showing that pain-related suffering can be either directly influenced by interfering with the affective pathway, or indirectly influenced by interfering with the ascending spino-thalamic tract.
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Affiliation(s)
- Itamar Jalon
- Department of Psychology, Tel Aviv University , Tel Aviv , Israel
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Department of Neurosurgery, NYU Langone Medical Center, New York University , New York , USA
| | - Ben Shofty
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Department of Neurosurgery, Baylor College of Medicine , Houston, Texas , USA
| | - Noam Goldway
- Department of Psychology, New York University , New York, NY
| | - Moran Artzi
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Guy Gurevitch
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Uri Hochberg
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- Institute of Pain Medicine, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Rotem Tellem
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- The Palliative Care Service, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Talma Hendler
- Department of Psychology, Tel Aviv University , Tel Aviv , Israel
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- Sagol School of Neuroscience Tel Aviv University , Israel
| | - Tal Gonen
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
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Arafat T, Miron G, Strauss I, Fahoum F. Electrodiagnostic artifacts due to neurostimulation devices for drug resistant epilepsy. Epilepsy Behav Rep 2022; 20:100566. [PMID: 36276845 PMCID: PMC9583742 DOI: 10.1016/j.ebr.2022.100566] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/11/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022] Open
Abstract
Neurostimulation devices for epilepsy commonly induce EEG and/or ECG artifacts. Neurostimulation-related artifacts are intermittent and could mimic ictal EEG changes or cardiac rhythm abnormalities. Clinicians should be aware of different EEG and ECG artifact patterns to accurately interpret test findings and avoid unnecessary diagnostics and treatment.
Background Methods Results Conclusions
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Erdman HB, Kornilov E, Kahana E, Zarchi O, Reiner J, Socher A, Strauss I, Firman S, Israel Z, Bergman H, Tamir I. Asleep DBS under ketamine sedation: Proof of concept. Neurobiol Dis 2022; 170:105747. [PMID: 35550159 DOI: 10.1016/j.nbd.2022.105747] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to optimize brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS borders and subdomains based on electrophysiological properties like firing rates and patterns, intra-operative evaluation of therapeutic window, and improvement of lead placement accuracy. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties and interference with clinical testing, resulting in potential impact on surgical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. OBJECTIVE This open-label study investigates the use of low-dose ketamine for conscious sedation during microelectrode recordings and lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients. METHODS Three anesthetic regimens were retrospectively compared in 38 surgeries (74 MER trajectories, 5962 recording sites) across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA). RESULTS All anesthesia regimens achieved satisfactory MER. Detection of STN borders and subdomains by expert electrophysiologist was similar between the groups. Electrophysiological signature of the STN under ketamine was not inferior to either control group. All patients completed stimulation testing. CONCLUSIONS This study supports a low-dose ketamine anesthesia regimen for DBS which allows microelectrode recordings and stimulation testing that are not inferior to those conducted under awake and propofol-awake regimens and may optimize patient experience. A prospective double-blind study that would also compare patients' satisfaction level and clinical outcome should be performed to confirm these findings.
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Affiliation(s)
- Halen Baker Erdman
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel.
| | - Evgeniya Kornilov
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel; Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Eilat Kahana
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Omer Zarchi
- Intraoperative Neurophysiology Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Johnathan Reiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Achinoam Socher
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shimon Firman
- Department of Anesthesiology, Critical Care Medicine, and Pain Management, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel; Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, Hebrew University, Jerusalem, Israel
| | - Idit Tamir
- Department of Neurosurgery, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
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12
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Berger A, Jalon I, Gonen T, Shofty B, Tellem R, Hochberg U, Artzi M, Ben-Bashat D, Hendler T, Strauss I. 831 Pain Networks Connectivity Changes Following the Relief of Prolonged Cancer Pain. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_831] [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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13
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Miron G, Strauss I, Fried I, Fahoum F. Anterior thalamic deep brain stimulation in epilepsy patients refractory to vagus nerve stimulation: A single center observational study. Epilepsy Behav Rep 2022; 20:100563. [PMID: 36119948 PMCID: PMC9471437 DOI: 10.1016/j.ebr.2022.100563] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022] Open
Abstract
Patients with drug resistant epilepsy refractory to treatment with vagal nerve stimulation benefited from anterior thalamic deep brain stimulation. We report a combined neuromodulation approach of simultaneous vagal nerve and deep brain stimulation. Additional studies are needed to assess safety and efficacy of simultaneous VNS and DBS treatment.
Anterior thalamic deep brain stimulation (DBS) is a palliative treatment that may be considered in patients with drug resistant epilepsy (DRE) that fail treatment with vagus nerve stimulation (VNS). Combining VNS and DBS treatment is a therapeutic approach rarely reported. This single center observational study aims to describe response to DBS treatment in 11 epilepsy patients resistant to medications and VNS. Patients either had inactivated VNS (DBS only) or were treated with simultaneous DBS and VNS (DBS-VNS). Focal impaired awareness (FIA) and most disabling seizure rates were examined pre-DBS implantation, 3 months following implantation, and last follow up. Overall, a decrease in FIA (47.0 ± 30.7 %, p = 0.02) and most disabling seizure rate (54.8 ± 34.2 %, p = 0.03) was seen at last follow-up (average follow-up 28.5 ± 13.5 months). Eight of 11 patients were DBS responders (most disabling seizure rate reduction above 50%). No difference in seizure control was found between seven DBS only and four DBS-VNS patients. Our results argue that patients who have failed antiseizure medication and VNS therapies, could benefit from better seizure control if treated with adjunctive DBS. Larger prospective studies are needed to assess the efficacy and safety of combined neurostimulation treatments in DRE.
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14
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Treister R, Honigman L, Berger A, Cohen B, Asaad I, Kuperman P, Tellem R, Hochberg U, Strauss I. Temporal Summation Predicts De Novo Contralateral Pain After Cordotomy in Patients With Refractory Cancer Pain. Neurosurgery 2022; 90:59-65. [PMID: 34982871 DOI: 10.1227/neu.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Percutaneous cervical cordotomy (PCC), which selectively interrupts ascending nociceptive pathways in the spinal cord, can mitigate severe refractory cancer pain. It has an impressive success rate, with most patients emerging pain-free. Aside from the usual complications of neurosurgical procedures, the risks of PCC include development of contralateral pain, which is less understood. OBJECTIVE To evaluate whether sensory and pain sensitivity, as measured by quantitative sensory testing (QST), are associated with PCC clinical outcomes. METHODS Fourteen palliative care cancer patients with severe chronic refractory pain limited mainly to one side of the body underwent comprehensive quantitative sensory testing assessment pre-PPC and post-PCC. They were also queried about maximal pain during the 24 h precordotomy (0-10 numerical pain scale). RESULTS All 14 patients reported reduced pain postcordotomy, with 7 reporting complete resolution. Four patients reported de novo contralateral pain. Reduced sensitivity in sensory and pain thresholds to heat and mechanical stimuli was recorded on the operated side (P = .028). Sensitivity to mechanical pressure increased on the unaffected side (P = .023), whereas other sensory thresholds were unchanged. The presurgical temporal summation values predicted postoperative contralateral pain (r = 0.582, P = .037). CONCLUSION The development of contralateral pain in patients postcordotomy for cancer pain might be due to central sensitization. Temporal summation could serve as a potential screening tool to identify those who are most likely at risk to develop contralateral pain. Analysis of PCC affords a unique opportunity to investigate how a specific lesion to the nociceptive system affects pain processes.
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Affiliation(s)
- Roi Treister
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Liat Honigman
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Assaf Berger
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Cohen
- Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Israa Asaad
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Pora Kuperman
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rotem Tellem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Palliative Medicine Care Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Uri Hochberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Strauss
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Tankus A, Solomon L, Aharony Y, Faust-Socher A, Strauss I. Machine learning algorithm for decoding multiple subthalamic spike trains for speech brain-machine interfaces. J Neural Eng 2021; 18. [PMID: 34695815 DOI: 10.1088/1741-2552/ac3315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
Objective. The goal of this study is to decode the electrical activity of single neurons in the human subthalamic nucleus (STN) to infer the speech features that a person articulated, heard or imagined. We also aim to evaluate the amount of subthalamic neurons required for high accuracy decoding suitable for real-life speech brain-machine interfaces (BMI).Approach. We intraoperatively recorded single-neuron activity in the STN of 21 neurosurgical patients with Parkinson's disease undergoing implantation of deep brain stimulator while patients produced, perceived or imagined the five monophthongal vowel sounds. Our decoder is based on machine learning algorithms that dynamically learn specific features of the speech-related firing patterns.Main results. In an extensive comparison of algorithms, our sparse decoder ('SpaDe'), based on sparse decomposition of the high dimensional neuronal feature space, outperformed the other algorithms in all three conditions: production, perception and imagery. For speech production, our algorithm, Spade, predicted all vowels correctly (accuracy: 100%; chance level: 20%). For perception accuracy was 96%, and for imagery: 88%. The accuracy of Spade showed a linear behavior in the amount of neurons for the perception data, and even faster for production or imagery.Significance. Our study demonstrates that the information encoded by single neurons in the STN about the production, perception and imagery of speech is suitable for high-accuracy decoding. It is therefore an important step towards BMIs for restoration of speech faculties that bears an enormous potential to alleviate the suffering of completely paralyzed ('locked-in') patients and allow them to communicate again with their environment. Moreover, our research indicates how many subthalamic neurons may be necessary to achieve each level of decoding accuracy, which is of supreme importance for a neurosurgeon planning the implantation of a speech BMI.
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Affiliation(s)
- Ariel Tankus
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lior Solomon
- School of Electrical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yotam Aharony
- School of Electrical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Achinoam Faust-Socher
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Limon D, Ferro L, Kohen T, Grossman R, Strauss I. Cystic Brain Metastases: Characteristics and Optimal Management. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1544] [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: 11/16/2022]
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17
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Shofty B, Bergman L, Berger A, Aizenstein O, Ben-Valid S, Gurovich D, Tankus A, Attias M, Fahoum F, Strauss I. Adopting MR-guided stereotactic laser ablations for epileptic lesions: initial clinical experience and lessons learned. Acta Neurochir (Wien) 2021; 163:2797-2803. [PMID: 34269876 DOI: 10.1007/s00701-021-04903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive technique for ablating brain lesions under real-time MRI feedback and control of the ablation process. The Medtronic Visualase system was recently approved for use in Europe and Israel. We report our initial technical experience using the system in the first 16 cases in which the system was used to ablate focal epileptogenic lesions. METHODS We included all consecutive patients with intractable epilepsy who underwent MRgLITT procedures between 2018 and 2020. We reviewed medical charts and imaging studies of patients. Post-ablation MRIs were used to calculate ablation volumes. RESULTS Seventeen MRgLITT procedures were performed in 16 patients. One cooling catheter/laser fiber assemblies were placed per patient. Indications for surgery were intractable epilepsy due to TLE (n = 7), suspected low-grade glioma (n = 4), radiological cortical dysplasia (n = 1), hypothalamic hamartoma (n = 1), and MR-negative foci (n = 3). Ablations were made using 30 to 70% of the maximal energy of the Visualase system. We used serial ablations as needed along the tract of the catheter by pulling back the optic fiber; the length of the lesion ranged between 7.4 and 38.1 mm. Ablation volume ranged between 0.27 and 6.78 mm3. Immediate post-ablation MRI demonstrated good ablation of the epileptic lesion in 16/17 cases. In one case with mesial temporal sclerosis, no ablation was performed due to suboptimal position of the catheter. That patient was successfully reoperated at a later date. Mean follow-up was 14.9 months (± 11.6 months). Eleven patients had follow-up longer than 12 months. Good seizure control (Engel I, A) was achieved in 7/11 patients (63%) and 1/11 (9%) had significant improvement in seizure frequency (Angle IIIa). Three patients (27%) did not experience improvement in their seizure frequency (Engel IV, B), and one of these patients died during the follow-up period from sudden unexpected death of epilepsy (SUDEP). No immediate or delayed neurological complications were documented in any of the cases during the follow-up period. CONCLUSIONS MRgLITT is a promising technique and can be used safely as an alternative to open resection in both lesional and non-lesional intractable epilepsy cases. In our local series, the success rate of epilepsy surgery was comparable to recent publications.
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18
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Tankus A, Lustig Y, Fried I, Strauss I. Impaired Timing of Speech-Related Neurons in the Subthalamic Nucleus of Parkinson Disease Patients Suffering Speech Disorders. Neurosurgery 2021; 89:800-809. [PMID: 34392374 DOI: 10.1093/neuros/nyab293] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our previous study found degradation to subthalamic neuronal encoding of speech features in Parkinson disease (PD) patients suffering from speech disorders. OBJECTIVE To find how timing of speech-related neuronal firing changes in PD patients with speech disorders compared to PD patients without speech disorders. METHODS During the implantation of deep brain stimulator (DBS), we recorded the activity of single neurons in the subthalamic nucleus (STN) of 18 neurosurgical patients with PD while they articulated, listened to, or imagined articulation of 5 vowel sounds, each following a beep. We compared subthalamic activity of PD patients with (n = 10) vs without speech disorders. RESULTS In this comparison, patients with speech disorders had longer reaction times and shorter lengths of articulation. Their speech-related neuronal activity preceding speech onset (planning) was delayed relative to the beep, but the time between this activity and the emission of speech sound was similar. Notwithstanding, speech-related neuronal activity following the onset of speech (feedback) was delayed when computed relative to the onset. Only in these patients was the time lag of planning neurons significantly correlated with the reaction time. Neuronal activity in patients with speech disorders was delayed during imagined articulation of vowel sounds but earlier during speech perception. CONCLUSION Our findings indicate that longer reaction times in patients with speech disorders are due to STN or earlier activity of the speech control network. This is a first step in locating the source(s) of PD delays within this network and is therefore of utmost importance for future treatment of speech disorders.
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Affiliation(s)
- Ariel Tankus
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lustig
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Fried
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Berger A, Artzi M, Aizenstein O, Gonen T, Tellem R, Hochberg U, Ben-Bashat D, Strauss I. Cervical Cordotomy for Intractable Pain: Do Postoperative Imaging Features Correlate with Pain Outcomes and Mirror Pain? AJNR Am J Neuroradiol 2021; 42:794-800. [PMID: 33632733 DOI: 10.3174/ajnr.a6999] [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: 08/06/2020] [Accepted: 10/28/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Percutaneous cervical cordotomy offers relief of unilateral intractable oncologic pain. We aimed to find anatomic and postoperative imaging features that may correlate with clinical outcomes, including pain relief and postoperative contralateral pain. MATERIALS AND METHODS We prospectively followed 15 patients with cancer who underwent cervical cordotomy for intractable pain during 2018 and 2019 and underwent preoperative and up to 1-month postoperative cervical MR imaging. Lesion volume and diameter were measured on T2-weighted imaging and diffusion tensor imaging (DTI). Lesion mean diffusivity and fractional anisotropy values were extracted. Pain improvement up to 1 month after surgery was assessed by the Numeric Rating Scale and Brief Pain Inventory. RESULTS All patients reported pain relief from 8 (7-10) to 0 (0-4) immediately after surgery (P = .001), and 5 patients (33%) developed contralateral pain. The minimal percentages of the cord lesion volume required for pain relief were 10.0% on T2-weighted imaging and 6.2% on DTI. Smaller lesions on DWI correlated with pain improvement on the Brief Pain Inventory scale (r = 0.705, P = .023). Mean diffusivity and fractional anisotropy were significantly lower in the ablated tissue than contralateral nonlesioned tissue (P = .003 and P = .001, respectively), compatible with acute-phase tissue changes after injury. Minimal postoperative mean diffusivity values correlated with an improvement of Brief Pain Inventory severity scores (r = -0.821, P = .004). The average lesion mean diffusivity was lower among patients with postoperative contralateral pain (P = .037). CONCLUSIONS Although a minimal ablation size is required during cordotomy, larger lesions do not indicate better outcomes. DWI metrics changes represent tissue damage after ablation and may correlate with pain outcomes.
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Affiliation(s)
- A Berger
- From the Department of Neurosurgery (A.B., I.S.)
- Sackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
| | - M Artzi
- Sagol Brain Institute (M.A., T.G, D.B.-B.)
- Sackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
| | - O Aizenstein
- Department of Radiology (O.A.)
- Sackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
| | - T Gonen
- Sagol Brain Institute (M.A., T.G, D.B.-B.)
- Sackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
| | - R Tellem
- The Palliative Care Service (R.T.)
- Sackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
| | - U Hochberg
- Institute of Pain Medicine (U.H.)
- Division of Anesthesiology, Tel Aviv Medical Center (U.H.), Tel Aviv, Israel
- Sackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
| | - D Ben-Bashat
- Sagol Brain Institute (M.A., T.G, D.B.-B.)
- Sackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
| | - I Strauss
- From the Department of Neurosurgery (A.B., I.S.)
- Sackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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20
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Andelman-Gur MM, Gazit T, Strauss I, Fried I, Fahoum F. Stimulating the inferior fronto-occipital fasciculus elicits complex visual hallucinations. Brain Stimul 2020; 13:1577-1579. [PMID: 32927093 DOI: 10.1016/j.brs.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - Tomer Gazit
- Sagol Brain Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Fried
- Sagol Brain Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Firas Fahoum
- Epilepsy and EEG Unit, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Granata G, Valle G, Di Iorio R, Iodice F, Petrini FM, Strauss I, D'anna E, Iberite F, Lauretti L, Fernandez E, Romanello R, Stieglitz T, Raspopovic S, Calabresi P, Micera S, Rossini PM. Cortical plasticity after hand prostheses use: Is the hypothesis of deafferented cortex "invasion" always true? Clin Neurophysiol 2020; 131:2341-2348. [PMID: 32828036 DOI: 10.1016/j.clinph.2020.06.023] [Citation(s) in RCA: 2] [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: 03/23/2020] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study motor cortex plasticity after a period of training with a new prototype of bidirectional hand prosthesis in three left trans-radial amputees, correlating these changes with the modification of Phantom Limb Pain (PLP) in the same period. METHODS Each subject underwent a brain motor mapping with Transcranial Magnetic Stimulation (TMS) and PLP evaluation with questionnaires during a six-month training with a prototype of bidirectional hand prosthesis. RESULTS The baseline motor maps showed in all three amputees a smaller area of muscles representation of the amputated side compared to the intact limb. After training, there was a partial reversal of the baseline asymmetry. The two subjects affected by PLP experienced a statistically significant reduction of pain. CONCLUSIONS Two apparently opposite findings, the invasion of the "deafferented" cortex by neighbouring areas and the "persistence" of neural structures after amputation, could vary according to different target used for measurement. Our results do not support a correlation between PLP and motor cortical changes. SIGNIFICANCE The selection of the target and of the task is essential for studies investigating motor brain plasticity. This study boosts against a direct and unique role of motor cortical changes on PLP genesis.
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Affiliation(s)
- G Granata
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - G Valle
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - R Di Iorio
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Iodice
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Neuroscience, San Raffaele Pisana IRCCS, Rome, Italy
| | - F M Petrini
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - I Strauss
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - E D'anna
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - F Iberite
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - L Lauretti
- Institute of Neurosurgery, Catholic University of The Sacred Heart, Roma, Italy
| | - E Fernandez
- Institute of Neurosurgery, Catholic University of The Sacred Heart, Roma, Italy
| | - R Romanello
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - T Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg and BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany
| | - S Raspopovic
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - P Calabresi
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Micera
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - P M Rossini
- Department of Neuroscience, San Raffaele Pisana IRCCS, Rome, Italy
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22
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Gazit T, Gonen T, Gurevitch G, Cohen N, Strauss I, Zeevi Y, Yamin H, Fahoum F, Hendler T, Fried I. Author Correction: The role of mPFC and MTL neurons in human choice under goal-conflict. Nat Commun 2020; 11:4047. [PMID: 32778724 PMCID: PMC7417735 DOI: 10.1038/s41467-020-17982-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Tomer Gazit
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Gonen
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Guy Gurevitch
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Noa Cohen
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Strauss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yoav Zeevi
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Statistics and Operation Research, Tel Aviv University, Tel Aviv, Israel
| | - Hagar Yamin
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Firas Fahoum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Epilepsy Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Talma Hendler
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel. .,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Itzhak Fried
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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23
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Sapir Y, Korn A, Bitan-Talmor Y, Vendrov I, Berger A, Shofty B, Zegerman A, Strauss I. Intraoperative Neurophysiology for Optimization of Percutaneous Spinothalamic Cordotomy for Intractable Cancer Pain. Oper Neurosurg (Hagerstown) 2020; 19:E566-E572. [PMID: 32710768 DOI: 10.1093/ons/opaa209] [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: 01/14/2020] [Accepted: 04/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Percutaneous ablation of the cervical spinothalamic tract (STT) remains a therapeutic remedy for intractable cancer pain. However, it is accompanied by the risk of collateral damage to essential spinal cord circuitry, including the corticospinal tract (CST). Recent studies describe threshold-based mapping of the CST with the objective of motor bundle preservation during intramedullary spinal cord and supratentorial surgery. OBJECTIVE To assess the possibility that application of spinal cord mapping using intraoperative neuromonitoring in percutaneous cordotomy procedures may aid in minimizing iatrogenic motor tract injury. METHODS We retrospectively reviewed the files of 11 patients who underwent percutaneous cervical cordotomy for intractable oncological pain. We performed quantitative electromyogram (EMG) recordings to stimulation of the ablation needle prior to the STT-ablative stage. We compared evoked motor and sensory electrical thresholds, and the electrical span between them as a reliable method to confirm safe electrode location inside the STT. RESULTS Quantified EMG data were collected in 11 patients suffering from intractable cancer pain. The threshold range for evoking motor activity was 0.3 to 1.2 V. Stimulation artifacts were detected from trapezius muscles even at the lowest stimulation intensity, while thenar muscles were found to be maximally sensitive and specific. The minimal stimulation intensity difference between the motor and the sensory threshold, set as "Δ-threshold," was 0.26 V, with no new motor deficit at 3 days or 1 month postoperatively. CONCLUSION Selective STT ablation is an effective procedure for treating intractable pain. It can be aided by quantitative evoked EMG recordings, with tailored parameters and thresholds.
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Affiliation(s)
| | - Akiva Korn
- Surgical Monitoring Services, Beit Shemesh, Israel.,Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yifat Bitan-Talmor
- Surgical Monitoring Services, Beit Shemesh, Israel.,Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Irina Vendrov
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Shofty
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Zegerman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Anesthesia and Critical Care, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Hochberg U, Berger A, Atias M, Tellem R, Strauss I. Tailoring of neurosurgical ablative procedures in the management of refractory cancer pain. Reg Anesth Pain Med 2020; 45:696-701. [PMID: 32699105 DOI: 10.1136/rapm-2020-101566] [Citation(s) in RCA: 2] [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: 04/18/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Neurosurgical ablative procedures can offer immediate and effective pain relief for patients suffering from refractory cancer pain. However, choosing the appropriate procedure for each patient may not be straightforward and warrants an interdisciplinary approach. The purpose of the current study was to evaluate the outcome of patients with cancer who were carefully selected for neurosurgical intervention by a dedicated interdisciplinary team composed of a palliative physician and nurse practitioner, a pain specialist and a neurosurgeon. METHODS A retrospective review was carried out on all patients who underwent neurosurgical ablative procedures in our institute between March 2015 and September 2019. All patients had advanced metastatic cancer with unfavorable prognosis and suffered from intractable oncological pain. Each treatment plan was devised to address the patients' specific pain syndromes. RESULTS A total of 204 patients were examined by our service during the study period. Sixty-four patients with localized pain and nineteen patients with diffuse pain syndromes were selected for neurosurgical interventions, either targeted disconnection of the spinothalamic tract or stereotactic cingulotomy. Substantial pain relief was reported by both groups immediately (cordotomy: Numerical Rating Scale (NRS) 9 ≥1, p=0.001, cingulotomy: NRS 9 ≥2, p=0.001) and maintained along the next 3-month follow-up visits. CONCLUSIONS An interdisciplinary collaboration designated to provide neurosurgical ablative procedures among carefully selected patients could culminate in substantial relief of intractable cancer pain. TRIAL REGISTRATION NUMBER IR0354-17.
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Affiliation(s)
- Uri Hochberg
- Institute of Pain Medicine, Division of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel .,Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Asaf Berger
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.,Deparment of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miri Atias
- Deparment of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rotem Tellem
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.,The Palliative Care Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Strauss
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.,Department of Neurosurgery, Neuromodulation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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25
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Krom AJ, Marmelshtein A, Gelbard-Sagiv H, Tankus A, Hayat H, Hayat D, Matot I, Strauss I, Fahoum F, Soehle M, Boström J, Mormann F, Fried I, Nir Y. Anesthesia-induced loss of consciousness disrupts auditory responses beyond primary cortex. Proc Natl Acad Sci U S A 2020; 117:11770-11780. [PMID: 32398367 PMCID: PMC7261054 DOI: 10.1073/pnas.1917251117] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 12/14/2022] Open
Abstract
Despite its ubiquitous use in medicine, and extensive knowledge of its molecular and cellular effects, how anesthesia induces loss of consciousness (LOC) and affects sensory processing remains poorly understood. Specifically, it is unclear whether anesthesia primarily disrupts thalamocortical relay or intercortical signaling. Here we recorded intracranial electroencephalogram (iEEG), local field potentials (LFPs), and single-unit activity in patients during wakefulness and light anesthesia. Propofol infusion was gradually increased while auditory stimuli were presented and patients responded to a target stimulus until they became unresponsive. We found widespread iEEG responses in association cortices during wakefulness, which were attenuated and restricted to auditory regions upon LOC. Neuronal spiking and LFP responses in primary auditory cortex (PAC) persisted after LOC, while responses in higher-order auditory regions were variable, with neuronal spiking largely attenuated. Gamma power induced by word stimuli increased after LOC while its frequency profile slowed, thus differing from local spiking activity. In summary, anesthesia-induced LOC disrupts auditory processing in association cortices while relatively sparing responses in PAC, opening new avenues for future research into mechanisms of LOC and the design of anesthetic monitoring devices.
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Affiliation(s)
- Aaron J Krom
- Department of Physiology & Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
- Hadassah School of Medicine, Hebrew University, Jerusalem 91120, Israel
| | - Amit Marmelshtein
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hagar Gelbard-Sagiv
- Department of Physiology & Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ariel Tankus
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurology & Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hanna Hayat
- Department of Physiology & Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Daniel Hayat
- Department of Anesthesia, Intensive Care and Pain, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Idit Matot
- Department of Anesthesia, Intensive Care and Pain, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurology & Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Firas Fahoum
- Department of Neurology & Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- EEG and Epilepsy Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Martin Soehle
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Jan Boström
- Department of Neurosurgery, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Florian Mormann
- Department of Epileptology, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Itzhak Fried
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel;
- Department of Neurology & Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Neurosurgery, University of California, Los Angeles, CA 90095
| | - Yuval Nir
- Department of Physiology & Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
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26
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Berger A, Cohen N, Fahoum F, Medvedovsky M, Meller A, Ekstein D, Benifla M, Aizenstein O, Fried I, Gazit T, Strauss I. Preoperative localization of seizure onset zones by magnetic source imaging, EEG-correlated functional MRI, and their combination. J Neurosurg 2020; 134:1037-1043. [PMID: 32413858 DOI: 10.3171/2020.3.jns192794] [Citation(s) in RCA: 2] [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: 10/13/2019] [Accepted: 03/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Preoperative localization of seizure onset zones (SOZs) is an evolving field in the treatment of refractory epilepsy. Both magnetic source imaging (MSI), and the more recent EEG-correlated functional MRI (EEG-fMRI), have shown applicability in assisting surgical planning. The purpose of this study was to evaluate the capability of each method and their combination in localizing the seizure onset lobe (SL). METHODS The study included 14 patients who underwent both MSI and EEG-fMRI before undergoing implantation of intracranial EEG (icEEG) as part of the presurgical planning of the resection of an epileptogenic zone (EZ) during the years 2012-2018. The estimated location of the SL by each method was compared with the location determined by icEEG. Identification rates of the SL were compared between the different methods. RESULTS MSI and EEG-fMRI showed similar identification rates of SL locations in relation to icEEG results (88% ± 31% and 73% ± 42%, respectively; p = 0.281). The additive use of the coverage lobes of both methods correctly identified 100% of the SL, significantly higher than EEG-fMRI alone (p = 0.039) and nonsignificantly higher than MSI (p = 0.180). False-identification rates of the additive coverage lobes were significantly higher than MSI (p = 0.026) and EEG-fMRI (p = 0.027). The intersecting lobes of both methods showed the lowest false identification rate (13% ± 6%, p = 0.01). CONCLUSIONS Both MSI and EEG-fMRI can assist in the presurgical evaluation of patients with refractory epilepsy. The additive use of both tests confers a high identification rate in finding the SL. This combination can help in focusing implantation of icEEG electrodes targeting the SOZ.
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Affiliation(s)
- Assaf Berger
- 1Department of Neurosurgery.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Noa Cohen
- 2Sagol Brain Institute.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Firas Fahoum
- 3Department of Neurology, and.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Mordekhay Medvedovsky
- 4Department of Neurology, Hadassah Medical Center, Jerusalem.,8Hebrew University Hadassah Medical School, Jerusalem; and
| | - Aaron Meller
- 2Sagol Brain Institute.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Dana Ekstein
- 4Department of Neurology, Hadassah Medical Center, Jerusalem.,8Hebrew University Hadassah Medical School, Jerusalem; and
| | - Mony Benifla
- 5Department of Neurosurgery, Rambam Health Care Campus, Haifa.,9Rappaport Faculty of Medicine-Technion, Haifa, Israel
| | - Orna Aizenstein
- 6Department of Radiology, Tel Aviv Medical Center, Tel Aviv.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Itzhak Fried
- 1Department of Neurosurgery.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Tomer Gazit
- 2Sagol Brain Institute.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Ido Strauss
- 1Department of Neurosurgery.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
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27
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Strauss I, Valle G, Artoni F, D'Anna E, Granata G, Di Iorio R, Guiraud D, Stieglitz T, Rossini PM, Raspopovic S, Petrini FM, Micera S. Characterization of multi-channel intraneural stimulation in transradial amputees. Sci Rep 2019; 9:19258. [PMID: 31848384 PMCID: PMC6917705 DOI: 10.1038/s41598-019-55591-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022] Open
Abstract
Although peripheral nerve stimulation using intraneural electrodes has been shown to be an effective and reliable solution to restore sensory feedback after hand loss, there have been no reports on the characterization of multi-channel stimulation. A deeper understanding of how the simultaneous stimulation of multiple electrode channels affects the evoked sensations should help in improving the definition of encoding strategies for bidirectional prostheses. We characterized the sensations evoked by simultaneous stimulation of median and ulnar nerves (multi-channel configuration) in four transradial amputees who had been implanted with four TIMEs (Transverse Intrafascicular Multichannel Electrodes). The results were compared with the characterization of single-channel stimulation. The sensations were characterized in terms of location, extent, type, and intensity. Combining two or more single-channel configurations caused a linear combination of the sensation locations and types perceived with such single-channel stimulations. Interestingly, this was also true when two active sites from the same nerve were stimulated. When stimulating in multi-channel configuration, the charge needed from each electrode channel to evoke a sensation was significantly lower than the one needed in single-channel configuration (sensory facilitation). This result was also supported by electroencephalography (EEG) recordings during nerve stimulation. Somatosensory potentials evoked by multi-channel stimulation confirmed that sensations in the amputated hand were perceived by the subjects and that a perceptual sensory facilitation occurred. Our results should help the future development of more efficient bidirectional prostheses by providing guidelines for the development of more complex stimulation approaches to effectively restore multiple sensations at the same time.
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Affiliation(s)
- I Strauss
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - G Valle
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - F Artoni
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - E D'Anna
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - G Granata
- Fondazione Policlinico Agostino Gemelli-IRCCS, Roma, Italy
| | - R Di Iorio
- Institute of Neurology, Catholic University of The Sacred Heart, Policlinic A. Gemelli Foundation, Roma, Italy
| | - D Guiraud
- University of Montpellier, INRIA, CAMIN team, 860 Rue St Priest, 34090, Montpellier, France
| | - T Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center, BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, D-79110, Germany
| | - P M Rossini
- Fondazione Policlinico Agostino Gemelli-IRCCS, Roma, Italy
- Institute of Neurology, Catholic University of The Sacred Heart, Policlinic A. Gemelli Foundation, Roma, Italy
| | - S Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich (ETH), Zürich, 8092, Switzerland
| | - F M Petrini
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich (ETH), Zürich, 8092, Switzerland.
| | - S Micera
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
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28
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Risso G, Valle G, Iberite F, Strauss I, Stieglitz T, Controzzi M, Clemente F, Granata G, Rossini PM, Micera S, Baud-Bovy G. Optimal integration of intraneural somatosensory feedback with visual information: a single-case study. Sci Rep 2019; 9:7916. [PMID: 31133637 PMCID: PMC6536542 DOI: 10.1038/s41598-019-43815-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/23/2019] [Indexed: 02/05/2023] Open
Abstract
Providing somatosensory feedback to amputees is a long-standing objective in prosthesis research. Recently, implantable neural interfaces have yielded promising results in this direction. There is now considerable evidence that the nervous system integrates redundant signals optimally, weighting each signal according to its reliability. One question of interest is whether artificial sensory feedback is combined with other sensory information in a natural manner. In this single-case study, we show that an amputee with a bidirectional prosthesis integrated artificial somatosensory feedback and blurred visual information in a statistically optimal fashion when estimating the size of a hand-held object. The patient controlled the opening and closing of the prosthetic hand through surface electromyography, and received intraneural stimulation proportional to the object's size in the ulnar nerve when closing the robotic hand on the object. The intraneural stimulation elicited a vibration sensation in the phantom hand that substituted the missing haptic feedback. This result indicates that sensory substitution based on intraneural feedback can be integrated with visual feedback and make way for a promising method to investigate multimodal integration processes.
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Affiliation(s)
- G Risso
- Robotics, Brain and Cognitive Sciences (RBCS), Istituto Italiano di Tecnologia, Genoa, Italy
- DIBRIS, Università degli studi di Genova, Genoa, Italy
| | - G Valle
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - F Iberite
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - I Strauss
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - T Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK & Bernstein Center, University of Freiburg, Freiburg, D-79110, Germany
| | - M Controzzi
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - F Clemente
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - G Granata
- Institute of Neurology, Catholic University of The Sacred Heart, Policlinic A. Gemelli Foundation, Roma, Italy
| | - P M Rossini
- Institute of Neurology, Catholic University of The Sacred Heart, Policlinic A. Gemelli Foundation, Roma, Italy
| | - S Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - G Baud-Bovy
- Robotics, Brain and Cognitive Sciences (RBCS), Istituto Italiano di Tecnologia, Genoa, Italy.
- Vita-Salute San Raffaele University & Unit of Experimental Psychology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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29
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Berger A, Hochberg U, Zegerman A, Tellem R, Strauss I. Neurosurgical ablative procedures for intractable cancer pain. J Neurosurg 2019; 133:144-151. [PMID: 31075782 DOI: 10.3171/2019.2.jns183159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cancer patients suffering from severe refractory pain may benefit from targeted ablative neurosurgical procedures aimed to disconnect pain pathways in the spinal cord or the brain. These patients often present with a plethora of medical problems requiring careful consideration before surgical interventions. The authors present their experience at an interdisciplinary clinic aimed to facilitate appropriate patient selection for neurosurgical procedures, and the outcome of these interventions. METHODS This study was a retrospective review of all patients who underwent neurosurgical interventions for cancer pain in the authors' hospital between March 2015 and April 2018. All patients had advanced metastatic cancer with limited life expectancy and suffered from intractable oncological pain. RESULTS Sixty patients underwent surgery during the study period. Forty-three patients with localized pain underwent disconnection of the spinal pain pathways: 34 percutaneous-cervical and 5 open-thoracic cordotomies, 2 stereotactic mesencephalotomies, and 2 midline myelotomies. Thirty-nine of 42 patients (93%) who completed these procedures had excellent immediate postoperative pain relief. At 1 month the improvement was maintained in 30/36 patients (83%) available for follow-up. There was 1 case of hemiparesis.Twenty patients with diffuse pain underwent stereotactic cingulotomy. Nineteen of these patients reported substantial pain relief immediately after the operation. At 1 month good pain relief was maintained in 13/17 patients (76%) available for follow-up, and good pain relief was also found at 3 months in 7/11 patients (64%). There was no major morbidity or mortality. CONCLUSIONS With careful patient selection and tailoring of the appropriate procedure to the patient's pain syndrome, the authors' experience indicates that neurosurgical procedures are safe and effective in alleviating suffering in patients with intractable cancer pain.
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Affiliation(s)
- Assaf Berger
- 1Department of Neurosurgery
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Hochberg
- 4Institute of Pain Medicine; and
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Zegerman
- 5Division of Anesthesiology, Tel Aviv Medical Center; and
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rotem Tellem
- 3The Palliative Care Service
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Strauss
- 1Department of Neurosurgery
- 2Neuromodulation Unit
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Valle G, Petrini FM, Strauss I, Iberite F, D'Anna E, Granata G, Controzzi M, Cipriani C, Stieglitz T, Rossini PM, Mazzoni A, Raspopovic S, Micera S. Comparison of linear frequency and amplitude modulation for intraneural sensory feedback in bidirectional hand prostheses. Sci Rep 2018; 8:16666. [PMID: 30420739 PMCID: PMC6232130 DOI: 10.1038/s41598-018-34910-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/28/2018] [Indexed: 11/09/2022] Open
Abstract
Recent studies have shown that direct nerve stimulation can be used to provide sensory feedback to hand amputees. The intensity of the elicited sensations can be modulated using the amplitude or frequency of the injected stimuli. However, a comprehensive comparison of the effects of these two encoding strategies on the amputees' ability to control a prosthesis has not been performed. In this paper, we assessed the performance of two trans-radial amputees controlling a myoelectric hand prosthesis while receiving grip force sensory feedback encoded using either linear modulation of amplitude (LAM) or linear modulation of frequency (LFM) of direct nerve stimulation (namely, bidirectional prostheses). Both subjects achieved similar and significantly above-chance performance when they were asked to exploit LAM or LFM in different tasks. The feedbacks allowed them to discriminate, during manipulation through the robotic hand, objects of different compliances and shapes or different placements on the prosthesis. Similar high performances were obtained when they were asked to apply different levels of force in a random order on a dynamometer using LAM or LFM. In contrast, only the LAM strategy allowed the subjects to continuously modulate the grip pressure on the dynamometer. Furthermore, when long-lasting trains of stimulation were delivered, LFM strategy generated a very fast adaptation phenomenon in the subjects, which caused them to stop perceiving the restored sensations. Both encoding approaches were perceived as very different from the touch feelings of the healthy limb (natural). These results suggest that the choice of specific sensory feedback encodings can have an effect on user performance while grasping. In addition, our results invite the development of new approaches to provide more natural sensory feelings to the users, which could be addressed by a more biomimetic strategy in the future.
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Affiliation(s)
- G Valle
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - F M Petrini
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zürich, Switzerland
| | - I Strauss
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - F Iberite
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - E D'Anna
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - G Granata
- Institute of Neurology, Catholic University of The Sacred Heart, Policlinic A. Gemelli Foundation, Roma, Italy
| | - M Controzzi
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - C Cipriani
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - T Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center, BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, D-79110, Germany
| | - P M Rossini
- Institute of Neurology, Catholic University of The Sacred Heart, Policlinic A. Gemelli Foundation, Roma, Italy
| | - A Mazzoni
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S Raspopovic
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zürich, Switzerland
| | - S Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
- Center for Neuroscience, Neurotechnology, and Bioelectronic Medicine and BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
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Kanner A, Berger A, Moshe SB, Corn BW, Limon D, Shtraus N, Strauss I, Shahar T. NCOG-13. NEUROCOGNITIVE EVALUATION OF BRAIN METASTASES PATIENTS TREATED WITH POST-RESECTION STEREOTACTIC RADIOSURGERY: A PROSPECTIVE SINGLE ARM CLINICAL TRIAL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew Kanner
- Rabin Medical Center, Beilinson Campus, Petah Tikva, Tel Aviv, Israel
| | - Assaf Berger
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Dror Limon
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Ido Strauss
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tal Shahar
- Shaare Zedek Medical Center, Jerusalem, Israel
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32
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Shapira-Lichter I, Strauss I, Oren N, Gazit T, Sammartino F, Giacobbe P, Kennedy S, Hutchison WD, Fried I, Hendler T, Lozano AM. Conflict monitoring mechanism at the single-neuron level in the human ventral anterior cingulate cortex. Neuroimage 2018; 175:45-55. [DOI: 10.1016/j.neuroimage.2018.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 01/26/2023] Open
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33
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Berger A, Tellem R, Arad M, Hochberg U, Gonen T, Strauss I. [NEUROSURGICAL INTERVENTIONS FOR INTRACTABLE ONCOLOGICAL PAIN]. Harefuah 2018; 157:108-111. [PMID: 29484867] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pain is one of the most common symptoms among cancer patients, and particularly in those who suffer from metastatic or terminal disease. There is great importance in delivering good pain management to these patients in order to alleviate their suffering, improve their functional status and their overall quality of life. In most cases, pain management is based on pharmacotherapy with opioids and other medications. However, there are selected patients for whom pharmacotherapy does not achieve acceptable pain relief or is associated with marked side effects. These patients, who suffer from refractory cancer pain, may benefit from neurosurgical procedures selectively intervening in different locations along the pain signaling pathways. This article summarizes several of these neurosurgical procedures: percutaneous cordotomy for unilateral pain, punctuate midline myelotomy for visceral pain and stereotactic cingulotomy for diffuse pain syndromes. This article demonstrates the use of careful patient selection by an interdisciplinary team which is critical for the success of these procedures. The team consists of palliative care specialists, pain specialists and a neurosurgeon. These neurosurgical interventions are presented through representative clinical cases, followed by a discussion of the clinical considerations that guided the choice of the therapeutic approach for each case.
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Affiliation(s)
- Assaf Berger
- The Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv
- Sackler Faculty of Medicine, Tel Aviv University
| | - Rotem Tellem
- The Palliative Care Service, Tel Aviv Medical Center, Tel Aviv
- Sackler Faculty of Medicine, Tel Aviv University
| | - Michal Arad
- The Palliative Care Service, Tel Aviv Medical Center, Tel Aviv
- Sackler Faculty of Medicine, Tel Aviv University
| | - Uri Hochberg
- Institute of Pain Medicine, Tel Aviv Medical Center, Tel Aviv
- Sackler Faculty of Medicine, Tel Aviv University
| | - Tal Gonen
- The Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv
- Functional Brain Center, Tel Aviv Medical Center, Tel Aviv
- Sackler Faculty of Medicine, Tel Aviv University
| | - Ido Strauss
- The Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv
- Functional Neurosurgery Unit, Tel Aviv Medical Center, Tel Aviv
- Sackler Faculty of Medicine, Tel Aviv University
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34
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Strauss I, Berger A, Arad M, Hochberg U, Tellem R. O-Arm-Guided Percutaneous Radiofrequency Cordotomy. Stereotact Funct Neurosurg 2018; 95:409-416. [DOI: 10.1159/000484614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/18/2017] [Indexed: 12/11/2022]
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35
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Strauss I, Berger A, Ben Moshe S, Arad M, Hochberg U, Gonen T, Tellem R. Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain. Stereotact Funct Neurosurg 2018; 95:400-408. [PMID: 29316566 DOI: 10.1159/000484613] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/18/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stereotactic anterior cingulotomy has been used in the treatment of patients suffering from refractory oncological pain due to its effects on pain perception. However, the optimal targets as well as suitable candidates and outcome measures have not been well defined. We report our initial experience in the ablation of 2 cingulotomy targets on each side and the use of the Brief Pain Inventory (BPI) as a perioperative assessment tool. METHODS A retrospective review of all patients who underwent stereotactic anterior cingulotomy in our Department between November 2015 and February 2017 was performed. All patients had advanced metastatic cancer with limited prognosis and suffered from intractable oncological pain. RESULTS Thirteen patients (10 women and 3 men) underwent 14 cingulotomy procedures. Their mean age was 54 ± 14 years. All patients reported substantial pain relief immediately after the operation. Out of the 6 preoperatively bedridden patients, 3 started ambulating shortly after. At the 1-month follow-up, the mean preoperative Visual Analogue Scale score decreased from 9 ± 0.9 to 4 ± 2.7 (p = 0.003). Mean BPI pain severity and interference scores decreased from levels of 29 ± 4 and 55 ± 12 to 16 ± 12 (p = 0.028) and 37 ± 15 (p = 0.043), respectively. During the 1- and 3-month follow-up visits, 9/11 patients (82%) and 5/7 patients (71%) available for follow-up reported substantial pain relief. No patient reported worsening of pain during the study period. Neuropsychological analyses of 6 patients showed stable cognitive functions with a mild nonsignificant decline in focused attention and executive functions. Adverse events included transient confusion or mild apathy in 5 patients (38%) lasting 1-4 weeks. CONCLUSIONS Our initial experience indicates that double stereotactic cingulotomy is safe and effective in alleviating refractory oncological pain.
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Affiliation(s)
- Ido Strauss
- Department of Neurosurgery, Division of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
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36
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Tankus A, Strauss I, Gurevich T, Mirelman A, Giladi N, Fried I, Hausdorff JM. Subthalamic Neurons Encode Both Single- and Multi-Limb Movements in Parkinson's Disease Patients. Sci Rep 2017; 7:42467. [PMID: 28211850 PMCID: PMC5304178 DOI: 10.1038/srep42467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022] Open
Abstract
The subthalamic nucleus (STN) is the main target for neurosurgical treatment of motor signs of Parkinson’s disease (PD). Despite the therapeutic effect on both upper and lower extremities, its role in motor control and coordination and its changes in Parkinson’s disease are not fully clear. We intraoperatively recorded single unit activity in ten patients with PD who performed repetitive feet or hand movements while undergoing implantation of a deep brain stimulator. We found both distinct and overlapping representations of upper and lower extremity movement kinematics in subthalamic units and observed evidence for re-routing to a multi-limb representation that participates in limb coordination. The well-known subthalamic somatotopy showed a large overlap of feet and hand representations in the PD patients. This overlap and excessive amounts of kinematics or coordination units may reflect pathophysiology or compensatory mechanisms. Our findings thus explain, at the single neuron level, the important subthalamic role in motor control and coordination and indicate the effect of PD on the neuronal representation of movement.
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Affiliation(s)
- Ariel Tankus
- Center for study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel.,Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Tanya Gurevich
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel.,Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Anat Mirelman
- Center for study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nir Giladi
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel.,Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel.,Sieratzki Chair in Neurology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Itzhak Fried
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Department of Neurosurgery, University of California, Los Angeles, CA 90095, USA
| | - Jeffrey M Hausdorff
- Center for study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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37
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Gelerstein E, Berger A, Jonas-Kimchi T, Strauss I, Kanner AA, Blumenthal DT, Gottfried M, Margalit N, Ram Z, Shahar T. Regression of intracranial meningioma following treatment with nivolumab: Case report and review of the literature. J Clin Neurosci 2017; 37:51-53. [PMID: 28089420 DOI: 10.1016/j.jocn.2016.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 10/02/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
The treatment of refractory meningiomas remains a challenge for both neurosurgeons and neuro-oncologists. There have been no clinical reports of the use or effects of anti-PD-1 therapy in patients with meningioma. We describe a patient whose intracranial meningioma decreased significantly in size after treatment with nivolumab, a monoclonal antibody targeting PD-1, for a concomitant advanced lung cancer. This is the first clinical report suggesting that antibodies targeting PD-1 are effective in treating meningioma. It should encourage further research into the use of checkpoint inhibitors in meningioma.
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Affiliation(s)
- Efrat Gelerstein
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Assaf Berger
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Tali Jonas-Kimchi
- Imaging Division, Neuroradiology Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Andrew A Kanner
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Deborah T Blumenthal
- Neuro-oncology Service, Division of Oncology, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Maya Gottfried
- Oncology Department, Meir Medical Center, Kfar Saba, Israel
| | - Nevo Margalit
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Zvi Ram
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Tal Shahar
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel.
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38
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Hadanny A, Rozovski U, Nossek E, Shapira Y, Strauss I, Kanner AA, Sitt R, Ram Z, Shahar T. Craniectomy Versus Craniotomy for Posterior Fossa Metastases: Complication Profile. World Neurosurg 2016; 89:193-8. [DOI: 10.1016/j.wneu.2016.01.076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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39
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Krishna V, King NKK, Sammartino F, Strauss I, Andrade DM, Wennberg RA, Lozano AM. Anterior Nucleus Deep Brain Stimulation for Refractory Epilepsy. Neurosurgery 2016; 78:802-11. [DOI: 10.1227/neu.0000000000001197] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Abstract
BACKGROUND:
Anterior nucleus (AN) deep brain stimulation (DBS) is a palliative treatment for medically refractory epilepsy. The long-term efficacy and the optimal target localization for AN DBS are not well understood.
OBJECTIVE:
To analyze the long-term efficacy of AN DBS and its predictors.
METHODS:
We performed a retrospective review of 16 patients who underwent AN DBS. We selected only patients with reliable seizure frequency data and at least a 1-year follow-up. We studied the duration of the seizure reduction after DBS insertion and before stimulation (the insertional effect) and its association with long-term outcome. We modeled the volume of activation using the active contacts, stimulation parameters, and postoperative imaging. The overlap of this volume was plotted in Montreal Neurological Institute 152 space in 7 patients with significant clinical efficacy.
RESULTS:
Nine patients reported a decrease in seizure frequency immediately after electrode insertion (insertional or microthalamotomy effect). The duration of insertional effect varied from 2 to 4 months. However, 1 patient had a long-term insertional effect of 36 months. Altogether, 11 patients reported >50% decrease in seizure frequency with long-term stimulation. The most common pattern of seizure control was immediate and sustained stimulation benefit (n = 8). In patients with long-term stimulation benefit, the efficacious target was localized in the anteroventral AN in close proximity to the mammillothalamic tract.
CONCLUSION:
AN DBS is efficacious in the control of seizure frequency in selected patients. An insertional effect is commonly observed (56%). The most efficacious site of stimulation appears to be the anteroventral AN.
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Affiliation(s)
| | | | | | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Danielle M. Andrade
- Department of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Richard A. Wennberg
- Department of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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40
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Abstract
Spinal dural arteriovenous fistula (SDAVF) is a rare disease, the etiology of which is not entirely clear. It is the most common vascular malformation of the spinal cord, comprising 60-80 % of the cases. The clinical presentation and imaging findings may be nonspecific and misleading, often mistaking it for other entities like demyelinating or degenerative diseases of the spine.This chapter describes the imaging findings, clinical signs, and symptoms of this disease and also the available treatment options according to the current literature.Angiography is still considered the gold standard for diagnosis; however, MRI/MRA is increasingly used as a screening tool. Modern endovascular techniques are becoming increasingly more effective in treating SDAVF offering a less invasive treatment option; however, they still lag behind surgical success rates which approach 100 %. The outcome of both treatment options is similar if complete obliteration of the fistula is obtained and depends mainly on the severity of neurological dysfunction before treatment.Heightened awareness by radiologists and clinicians to this rare entity is essential to make a timely diagnosis of this treatable disease. A multidisciplinary treatment approach is required in order to make appropriate treatment decisions.
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Affiliation(s)
- Shimon Maimon
- Department of Neurosurgery, Sourasky Hospital Tel Aviv Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yehudit Luckman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neuroradiology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Ido Strauss
- Department of Neurosurgery, Sourasky Hospital Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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41
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Hadanny A, Nossek E, Shapira Y, Strauss I, Kanner AA, Rozovski U, Sitt R, Ram Z, Shahar T. SURG-26COMPLICATION PROFILE: COMPARING CRANIECTOMY AND CRANIOTOMY FOR POSTERIOR FOSSA METASTASES. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov235.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Srejic LR, Prescott IA, Zhang P, Strauss I, Dostrovsky JO, Giacobbe P, Kennedy SH, Lozano AM, Hamani C, Hutchison WD. Paired Pulse Depression in the Subcallosal Cingulate Region of Depression Patients. Biol Psychiatry 2015; 78:e3-e4. [PMID: 25582268 DOI: 10.1016/j.biopsych.2014.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Luka R Srejic
- Institute of Medical Science, University of Toronto, Toronto Western Hospital, Ontario
| | - Ian A Prescott
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto Western Hospital, Ontario
| | - Pauline Zhang
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto Western Hospital, Ontario
| | - Ido Strauss
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Ontario
| | - Jonathan O Dostrovsky
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto Western Hospital, Ontario
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto Western Hospital & Toronto General Hospital, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto Western Hospital & Toronto General Hospital, Ontario, Canada
| | - Andres M Lozano
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Ontario
| | - Clement Hamani
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Ontario
| | - William D Hutchison
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto Western Hospital, Ontario; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Ontario.
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43
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Strauss I. Experiences with Isoxyl in the treatment of kidney tuberculosis. Antibiot Chemother 2015; 16:182-6. [PMID: 4108886 DOI: 10.1159/000386820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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44
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Chen DQ, Strauss I, Hayes DJ, Davis KD, Hodaie M. Age-related changes in diffusion tensor imaging metrics of fornix subregions in healthy humans. Stereotact Funct Neurosurg 2015; 93:151-9. [PMID: 25790958 DOI: 10.1159/000368442] [Citation(s) in RCA: 18] [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: 06/25/2014] [Accepted: 09/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE White matter diffusivity measures of the fornix change with aging, which likely relates to changes in memory and cognition in older adults. Subregional variations in forniceal diffusivity may exist, given its heterogeneous anatomy and connectivity; however, these have not been closely examined in vivo. We examined diffusivity parameters (fractional anisotropy, FA; radial diffusivity, RD; axial diffusivity, AD) in forniceal subregions of healthy subjects and correlated them with age and hippocampal volume. METHODS Diffusion-weighted imaging and streamline tractography of the fornix were performed on 20 healthy, right-handed females (23-66 years). Six anatomical subregions were defined: midline (body, column, precommissural fornix) or lateral (fimbria, crura, postcommissural fornix). Regression analysis was performed comparing diffusivities against age. Hippocampal and ventricular volumes were also compared. RESULTS Diffusivity values revealed statistical changes with age in both midline and lateralized subregions. The fornix body and left crus showed age-related alterations in all metrics (FA, RD, AD), whereas only right crus FA was altered. There was no significant change in hippocampal volumes, suggesting that forniceal changes may precede hippocampal age-related changes. CONCLUSIONS Age-related changes in fornix diffusivity measures appear subregion dependent and asymmetrical. Specific subregion diffusivity measures may be a more sensitive aging marker than hippocampal volume change.
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Affiliation(s)
- David Qixiang Chen
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ont., Canada
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45
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Cherniak M, Etlin A, Strauss I, Anglister L, Lev-Tov A. The sacral networks and neural pathways used to elicit lumbar motor rhythm in the rodent spinal cord. Front Neural Circuits 2014; 8:143. [PMID: 25520624 PMCID: PMC4253665 DOI: 10.3389/fncir.2014.00143] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/11/2014] [Indexed: 01/17/2023] Open
Abstract
Identification of neural networks and pathways involved in activation and modulation of spinal central pattern generators (CPGs) in the absence of the descending control from the brain is important for further understanding of neural control of movement and for developing innovative therapeutic approaches to improve the mobility of spinal cord injury patients. Activation of the hindlimb innervating segments by sacrocaudal (SC) afferent input and by specific application of neurochemicals to the sacral networks is feasible in the isolated spinal cord preparation of the newborn rat. Here we review our recent studies of sacral relay neurons with lumbar projections and evaluate their role in linking the sacral and thoracolumbar (TL) networks during different motor behaviors. Our major findings show that: (1) heterogeneous groups of dorsal, intermediate and ventral sacral-neurons with ventral and lateral ascending funicular projections mediate the activation of the locomotor CPGs through sacral sensory input; and (2) rhythmic excitation of lumbar flexor motoneurons, produced by bath application of alpha-1 adrenoceptor agonists to the sacral segments is mediated exclusively by ventral clusters of sacral-neurons with lumbar projections through the ventral funiculus.
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Affiliation(s)
- Meir Cherniak
- Department of Medical Neurobiology, Institute for Medical Research-Israel-Canada, IMRIC, The Hebrew University Medical School Jerusalem, Israel
| | - Alex Etlin
- Department of Medical Neurobiology, Institute for Medical Research-Israel-Canada, IMRIC, The Hebrew University Medical School Jerusalem, Israel
| | - Ido Strauss
- Department of Medical Neurobiology, Institute for Medical Research-Israel-Canada, IMRIC, The Hebrew University Medical School Jerusalem, Israel
| | - Lili Anglister
- Department of Medical Neurobiology, Institute for Medical Research-Israel-Canada, IMRIC, The Hebrew University Medical School Jerusalem, Israel
| | - Aharon Lev-Tov
- Department of Medical Neurobiology, Institute for Medical Research-Israel-Canada, IMRIC, The Hebrew University Medical School Jerusalem, Israel
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46
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Rochkind S, Strauss I, Shlitner Z, Alon M, Reider E, Graif M. Clinical aspects of ballistic peripheral nerve injury: shrapnel versus gunshot. Acta Neurochir (Wien) 2014; 156:1567-75. [PMID: 24898760 DOI: 10.1007/s00701-014-2139-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 01/15/2014] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Ballistic injuries to peripheral nerves pose special challenges in terms of indications, timing and type of surgical intervention. The aim of the present work was to analyze our experience in the surgical treatment of peripheral nerve ballistic injuries with respect to the mechanism of injury (gunshot versus shrapnel), and identify common and dissimilar prognostic factors in both types of injury. METHODS This study was conducted on 42 patients totaling 58 nerves. Twenty-two patients (32 nerves) were injured by gunshot and 20 patients (26 nerves) by shrapnel. Median postoperative follow-up was 33 months (range 12 months to 14 years). RESULTS Overall postoperative outcome appears to be more favorable for gunshot-wound (GSW) patients than shrapnel-injured patients, especially in terms of neuropathic pain relief (75 % vs. 58 % respectively, p < 0.05). Presence of foreign particles in shrapnel injured patients has a negative impact on the surgical outcome in terms of rate of pain improvement (28 % compared to 67 % in patients with and without foreign particles, respectively). Nerve graft reconstruction, rather than neurolysis, seems to be the more beneficial treatment for shrapnel-induced neuropathic pain (100 % vs. 47 % in improvement rate, respectively). Early surgical intervention (median 2 months after injury) significantly relieved neuropathic pain in 83 % of shrapnel-injured patients compared to 58 % in patients operated later. CONCLUSIONS This study suggests that shrapnel injury is more destructive for nerve tissue than gunshot injury. Our impression is that early surgical intervention in shrapnel injuries and split nerve grafting (especially when small fragments are recognized in the nerve) significantly improve the patient's functional activity and quality of life.
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Affiliation(s)
- Shimon Rochkind
- Division of Peripheral Nerve Reconstruction, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, 64239, Israel,
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Strauss I, Jonas-Kimchi T, Lidar Z, Buchbut D, Shtraus N, Corn BW, Kanner AA. Synergy-S stereotactic radiosurgery for spinal tumors. Isr Med Assoc J 2013; 15:678-681. [PMID: 24511647] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Radiation treatment of spinal and paraspinal tumors has been limited by the tolerance of the spinal cord. As such, therapeutic options are restricted to surgically accessible lesions or the use of suboptimal dosing of external beam irradiation. OBJECTIVES To evaluate the safety and applicability of the Elekta Synergy-S radiation unit for the treatment of spinal tumors. METHODS We retrospectively reviewed all patients treated with stereotactic radiosurgery for spinal tumors between November 2007 and June 2011. RESULTS Thirty-four patients were treated for 41 lesions. Treatment indications were local tumor control and pain palliation. The mean follow-up was 10.8 +/- 11.6 months (range 0.5-38 months). No acute radiation toxicity or new neurological deficits occurred during the follow-up period. Local tumor control was achieved in 21 of the 24 lesions (87.5%) available for radiological follow-up at a median of 9.8 months (range 3-32 months). Good analgesia was achieved in 24/30 lesions (80%) that presented with intractable pain. CONCLUSIONS The safety and feasibility of delivering single and multiple-fraction stereotactic spinal irradiation was demonstrated and became a standard treatment option in our institution.
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Affiliation(s)
- Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tali Jonas-Kimchi
- Diagnostic Neuroradiology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zvi Lidar
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dana Buchbut
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Natan Shtraus
- Department of Radiation Therapy, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Benjamin W Corn
- Department of Radiation Therapy, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Andrew A Kanner
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Strauss I, Carmi-Oren N, Hassner A, Shapiro M, Giladi M, Lidar Z. Spinal epidural abscess: in search of reasons for an increased incidence. Isr Med Assoc J 2013; 15:493-496. [PMID: 24340840] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Spinal epidural abscess (SEA) is a rare disease with a potentially devastating outcome, and a reported incidence traditionally estimated at 0.2-2 cases/10,000 hospital admissions. Since the implementation in October 2007 of a program to increase medical personnel's awareness of SEA, we have documented a sharp increase in the incidence of SEA at our medical center OBJECTIVES To investigate the cause of the increased incidence of SEA. METHODS All cases diagnosed with SEA during the period 1998-2010 were retrospectively reviewed. Cases diagnosed before 2007 were compared with those diagnosed thereafter. RESULTS From January 1998 to October 2007 SEA was diagnosed in 22 patients (group A), giving an annual incidence of 0.14-0.6 cases per 10,000 admissions. During the period November 2007 to April 2010, 26 additional patients were diagnosed (group B), yielding an incidence of 0.81-1.7 cases per 10,000 admissions (P < 0.01). The two groups did not differ significantly in epidemiological, clinical or laboratory characteristics, or in the causative bacteria isolated. CONCLUSIONS The threefold rise in the incidence of SEA observed at a tertiary medical center in Tel Aviv since November 2007 was not explained by different host characteristics or by more virulent bacterial isolates. We suggest that heightened awareness of the clinical presentation and timely utilization of MR imaging has resulted in more cases being identified.
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Affiliation(s)
- Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Noga Carmi-Oren
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Avi Hassner
- Quality Control and Risk Management, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Mervyn Shapiro
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Michael Giladi
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Zvi Lidar
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Strauss I, Jonas-Kimchi T, Bokstein F, Blumenthal D, Roth J, Sitt R, Wilson J, Ram Z. Gliomas of the posterior fossa in adults. J Neurooncol 2013; 115:401-9. [PMID: 23979683 DOI: 10.1007/s11060-013-1231-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 08/18/2013] [Indexed: 11/25/2022]
Abstract
Infratentorial gliomas are relatively rare tumors compared to their supratentorial counterparts. As such they have not been extensively characterized as a group and are usually excluded from clinical studies. Using our database we aimed to characterize adult gliomas involving the posterior fossa with respect to their clinical behavior and prognostic factors. We reviewed our neurosurgical and neuro-oncological data bases for adult patients diagnosed with gliomas involving the posterior fossa between 1996 and 2010. Of 1,283 glioma patients, 57 patients with gliomas involving the posterior fossa were identified (4.4 %). Tumors were further classified by location as primary brainstem (n = 21) and primary cerebellar (n = 18) tumors. On univariate analysis survival was correlated to tumor grade and KPS. In addition we have identified a unique group of patients (n = 18) with previously diagnosed supratentorial gliomas who subsequently developed noncontiguous secondary infratentorial extension of their tumors with subsequent rapid clinical deterioration. Gliomas of the posterior fossa comprise a heterogeneous group of tumors. Histological grade of the tumor was found to be the main prognostic factor. Survival of primary cerebellar gliomas is comparable to supra-tentorial gliomas, while brainstem gliomas in adults fare better than in the pediatric population. Secondary extension of supratentorial gliomas to the posterior fossa signifies a grave prognosis.
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Affiliation(s)
- Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
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Strauss I, Frolov V, Buchbut D, Gonen L, Maimon S. Critical appraisal of endovascular treatment of brain arteriovenous malformation using Onyx in a series of 92 consecutive patients. Acta Neurochir (Wien) 2013; 155:611-7. [PMID: 23430232 DOI: 10.1007/s00701-013-1633-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/24/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The introduction of Onyx has led us to adopt a new treatment approach for brain arteriovenous malformation (AVM), using endovascular embolization with Onyx as the first line treatment with a curative intent. The aim of the present report is to evaluate our results using this strategy, with special emphasis on angiographic characteristics affecting treatment risks and success rates. METHODS From October 2006 to December 2009, 92 consecutive patients harboring brain AVM were treated with Onyx during 177 procedures. RESULTS Endovascular treatments were completed in 68 out of 92 patients. Median number of procedures was two. Complete obliteration using embolization exclusively was achieved in 25 patients, resulting in a 37 % cure rate in patients who concluded treatments (25/68), and 27 % in the cohort. In Spetzler-Martin grades 1 & 2 AVMs, complete obliteration was achieved in 48 % of the cases. Complete obliteration rates were significantly higher in lesions with superficial big feeding arteries. There were 15 bleeding complications during 177 embolization sessions (8.4 % per procedure); seven cases resolved in less than 3 months. Permanent disability rate was 6.5 %; mortality rate was 2.2 %. Bleeding was related to the use of the microcatheter/guidewire in six cases and to the use of the embolization material in nine, the amount of Onyx injected was significantly higher in those nine cases. CONCLUSIONS Embolization of brain AVM using Onyx and detachable tip microcatheters results in a relatively high rate of complete obliteration. Angioarchitecture of the lesion can predict treatment success. Higher amounts of Onyx injected per session increase the bleeding risk.
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