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Liu Q, Lin Z, Shen Y, Zhu J, Song J, Zhang C, Lu Y, Xu J. Use of Compressed Sensing Accelerated, Low-Velocity Encoded, Isotropic Resolution, Phase Contrast Magnetic Resonance Angiography for SEEG Electrode Implantation. World Neurosurg 2024; 181:e18-e28. [PMID: 36791880 DOI: 10.1016/j.wneu.2023.02.030] [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: 12/06/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE We assessed the feasibility of using compressed sensing accelerated, low-velocity encoded, isotropic resolution phase contrast (CLIP) magnetic resonance angiography (MRA) for avascular trajectory planning of stereoelectroencephalography. METHODS Ten healthy subjects (1 woman and 9 men; age, 33.6 ± 9.0 years) and 20 consecutive patients (12 female patients; age, 22 ± 13.6 years) were enrolled in the present study. The healthy subjects underwent CLIP-MRA, and 3 other phase contrast MRA protocols with conventional parallel imaging (PI) acceleration, including low resolution with twofold PI (PI2), high resolution (HR) with fivefold PI (PI5), and HR-PI2. The patients underwent CLIP-MRA and computed tomography angiography (CTA). The image qualities were evaluated. The numbers and locations of trajectory-vessel conflict detected using CLIP-MRA were noted. RESULTS With similar scan durations, CLIP-MRA achieved higher spatial resolution compared with low resolution with PI2 and detected significantly more branches compared with HR-PI5. With the same spatial resolution, the signal/noise and contrast/noise ratios of CLIP-MRA were higher than those with HR-PI2 with a shorter scan duration. For the 12 adult patients (10 female patients; 28.8 ± 12.7 years), CLIP-MRA had better signal/noise and contrast/noise ratios than CTA. The trajectory had required modification for 14 of the 20 patients (70%), with a proportion of trajectory modification of 10.7% (23 of 215 electrodes). The middle meningeal artery, cortical vessel, and skull vessel were the main vessels with conflict (n = 11, n = 7, and n = 5, respectively). CONCLUSIONS In the present study, CLIP-MRA provided a clear cortical vascular display noninvasively without intravascular contrast and radiation. The middle meningeal artery and diploic and emissary veins were the main conflict vessels and could be clearly displayed using CLIP-MRA but not CTA.
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Affiliation(s)
- Qiangqiang Liu
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China; Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zengping Lin
- United Imaging Healthcare Group, Shanghai, People's Republic of China
| | - Yiwen Shen
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jiachen Zhu
- United Imaging Healthcare Group, Shanghai, People's Republic of China
| | - Jian Song
- Wuhan United Imaging Healthcare Surgical Technology Co., Ltd., Wuhan, People's Republic of China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yong Lu
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jiwen Xu
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China; Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
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Iqbal J, Mansour MNM, Saboor HA, Suyambu J, Lak MA, Zeeshan MH, Hafeez MH, Arain M, Mehmood M, Mehmood D, Ashraf M. Role of deep brain stimulation (DBS) in addiction disorders. Surg Neurol Int 2023; 14:434. [PMID: 38213452 PMCID: PMC10783698 DOI: 10.25259/sni_662_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/19/2023] [Indexed: 01/13/2024] Open
Abstract
Background Addiction disorders pose significant challenges to public health, necessitating innovative treatments. This assesses deep brain stimulation (DBS) as a potential intervention for addiction disorders. Methods A literature review was carried out with a focus on the role of DBS in addiction disorders and its future implications in neurosurgical research. Results The online literature shows that DBS precisely modulates certain brain regions to restore addiction-related neural circuits and promote behavioral control. Conclusion Preclinical evidence demonstrates DBS's potential to rebalance neural circuits associated with addiction, and early clinical trials provide encouraging outcomes in enhancing addiction-related outcomes. Ethical considerations, long-term safety, and personalized patient selection require further investigation.
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Affiliation(s)
- Javed Iqbal
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | | | - Jenisha Suyambu
- Department of Neurosurgery, Jonelta Foundation School of Medicine, University of Perpetual Help System Dalta, Las Pinas City, Philippines
| | - Muhammad Ali Lak
- School of Medicine, Combined Military Hospitals (CMH) Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | | | | | - Mustafa Arain
- School of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Maria Mehmood
- School of Medicine, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Dalia Mehmood
- School of Medicine, Fatima Jinnah Medical University, Sir Ganga Ram Hospital, Lahore, Pakistan
| | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
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Reese R, Kriesen T, Kersten M, Löhle M, Cantré D, Freiman TM, Storch A, Walter U. Combining ultrasound and microelectrode recordings for postoperative localization of subthalamic electrodes in Parkinson's disease. Clin Neurophysiol 2023; 156:196-206. [PMID: 37972531 DOI: 10.1016/j.clinph.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/10/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess transcranial sonography (TCS) as stand-alone tool and in combination with microelectrode recordings (MER) as a method for the postoperative localization of deep brain stimulation (DBS) electrodes in the subthalamic nucleus (STN). METHODS Individual dorsal and ventral boundaries of STN (n = 12) were determined on intraoperative MER. Postoperatively, a standardized TCS protocol was applied to measure medio-lateral, anterior-posterior and rostro-caudal electrode position using visualized reference structures (midline, substantia nigra). TCS and combined TCS-MER data were validated using fusion-imaging and clinical outcome data. RESULTS Test-retest reliability of standard TCS measures of electrode position was excellent. Computed tomography and TCS measures of distance between distal electrode contact and midline agreed well (Pearson correlation; r = 0.86; p < 0.001). Comparing our "gold standard" of rostro-caudal electrode localization relative to STN boundaries, i.e. combining MRI-based stereotaxy and MER data, with the combination of TCS and MER data, the measures differed by 0.32 ± 0.87 (range, -1.35 to 1.25) mm. Combined TCS-MER data identified the clinically preferred electrode contacts for STN-DBS with high accuracy (Coheńs kappa, 0.86). CONCLUSIONS Combined TCS-MER data allow for exact localization of STN-DBS electrodes. SIGNIFICANCE Our method provides a new option for monitoring of STN-DBS electrode location and guidance of DBS programming in Parkinson's disease.
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Affiliation(s)
- René Reese
- Department of Neurology, Rostock University Medical Center, Rostock, Germany.
| | - Thomas Kriesen
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Maxi Kersten
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany
| | - Matthias Löhle
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Alexander Storch
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany.
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Goel C, Manjunath A, Kozel OA, Baskaran AB, Gibson W, Jones MR, Rosenow JM. Pruritus and urticaria induced by neurostimulation: A case report and review of literature. Surg Neurol Int 2023; 14:241. [PMID: 37560573 PMCID: PMC10408599 DOI: 10.25259/sni_1145_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/19/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Spinal cord stimulation (SCS) consists of the implantation of neuromodulatory devices in the spinal cord to treat refractory neuropathic pain. Although SCS technology has been proven of immense clinical benefit, complications remain including refractory pain, infection risk, and electrode migration or displacement. Till date, there are minimal reports of allergic side effects following SCS implantation. CASE DESCRIPTION In the first case, a 36-year-old male with chronic axial and radicular neuropathic pain in underwent implantation of an open paddle lead and generator. Within 1-3 h of activating the SCS, he developed diffuse raised erythematous hives. Over time, the SCS had immense clinical benefit for his pain reduction; however, he continued to experience recurrent hives and various other allergic reactions including facial flushing and photosensitivity. Four years later, he ultimately opted to retain the device for its clinical pain benefits. In the second case, a 35-year-old female with acute, intractable bilateral occipital neuralgia and a past medical history of Type 1 Chiari Malformation status-post-posterior fossa decompression underwent implantation of an occipital nerve stimulator (ONS). At 1-month follow-up, she began to experience pruritus across the back of her head and along the subcutaneous course of the lead. At 8 months, she continued to experience persistent symptoms, ultimately opting for device removal. CONCLUSION Although allergic reactions to implanted neurostimulation systems are rare, and mechanisms not completely understood, existing studies posit multiple theories surrounding the pathophysiology of allergic reactions to these devices, such as delayed hypersensitivity reactions or contact dermatitis. Further research is needed to elucidate the cutaneous and immunologic side effects of SCS and ONS devices.
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Affiliation(s)
- Chirag Goel
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Anusha Manjunath
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Olivia A. Kozel
- Department of Neurosurgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, United States
| | | | - William Gibson
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Michael R. Jones
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Joshua M. Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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Wu Y, Meng YJ, Shi YF, Li JM, Xu YY, Zhang SX, Tian R, He JJ, Ding Y, Wang W. Stereotactic neurosurgery as a symptomatic treatment for autism spectrum disorders: A systematic review. Asian J Psychiatr 2023; 83:103541. [PMID: 36958138 DOI: 10.1016/j.ajp.2023.103541] [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: 11/29/2022] [Revised: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
Stereotactic neurosurgery has been employed in autism spectrum disorders (ASD). However, its safety and effectiveness remain unclear owing to limited sample size and other methodological limitations. We aimed to systematically investigate the safety and efficacy of stereotactic neurosurgery for ASD. Eleven studies with 36 patients were included. Stereotactic neurosurgery alleviated the obsessive-compulsive disorder and aggressive behavior symptoms in ASD, with a mean improvement of 42.74% and 59.59% in the Yale-Brown Obsessive Compulsive Scale and Overt Aggression Scale scores, respectively. Systematic studies are necessary to explore the role of deep brain stimulation for social and communication difficulties in ASD.
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Affiliation(s)
- Yang Wu
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Ya-Jing Meng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yi-Feng Shi
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Jia-Ming Li
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Yang-Yang Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Shu-Xin Zhang
- Department of Histoembryology and Neurobiology, West China College of Basic Medicine and Forensic Medicine, Sichuan University, Chengdu, Sichuan Province, China
| | - Rui Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Jiao-Jiang He
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Yi Ding
- University of Electronic Science and Technology, Chengdu, Sichuan Province, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan Province, China.
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Chiu TL, Lin SZ, Ahmed T, Huang CY, Chen CH. Pilot study of a new type of machine vision-assisted stereotactic neurosurgery for EVD placement. Acta Neurochir (Wien) 2022; 164:2385-93. [PMID: 35788905 DOI: 10.1007/s00701-022-05287-7] [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: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The usage of machine vision technologies for image-based analysis and inspection is increasing. With the advent of the ability to process high-dimension data instantly, the possibilities of machine vision multiply exponentially. Robots now use this technology to assist in surgery. OBJECTIVE The aim of this study is to explore the efficacy of Surgical Navigation Robot NaoTrac (Brain Navi Biotechnology Co., Ltd.), which utilizes machine vision-inspired technology for patient registration and stereotactic external ventricular drainage (EVD) by the robotic arm. METHODS Preoperative and postoperative computed tomography (CT) scans were acquired for each case. The surgeons planned the targets and trajectories with the preoperative CT images. The postoperative CT images were utilized in the accuracy measurements. RESULTS All 14 cases had cerebrospinal fluid drained through the catheter. The NaoTrac placed the catheter into the frontal horn in one attempt in 13 cases and was able to drain CSF in 12 cases. Not a single case had any bleeding or intraoperative complications. The average time spent on the patient registration was 142.8 s. The mean target deviation was 1.68 mm, and the mean angular deviation was 1.99°, all within the accepted tolerance for minimal tissue damage. CONCLUSION The results of this report demonstrate that machine vision-inspired patient registration is feasible and fast. NaoTrac has demonstrated its accuracy and safety in performing frameless catheter placement in 13 clinical cases. Other stereotactic neurosurgical operations such as stereotactic biopsy, depth electrode placement, deep brain stimulation electrode positioning, and neuroendoscopy may also be benefited from the assistance of NaoTrac.
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Mallereau CH, Chibbaro S, Ganau M, Benmekhbi M, Cebula H, Dannhoff G, Santin MDN, Ollivier I, Chaussemy D, Hugo Coca A, Proust F, Todeschi J. Pushing the boundaries of accuracy and reliability during stereotactic procedures: A prospective study on 526 biopsies comparing the frameless robotic and Image-Guided Surgery systems. J Clin Neurosci 2021; 95:203-212. [PMID: 34933231 DOI: 10.1016/j.jocn.2021.11.034] [Citation(s) in RCA: 7] [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: 03/26/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION A 12-year long, prospective, single center study was conducted, comparing two frameless systems for brain biopsies: ROSA robotic-assisted stereotaxy and BrainLab Varioguide image-guided stereotaxy (Image Guided Surgery, IGS). METHOD All consecutive adult and pediatric patients undergoing frameless brain biopsies were included. Successfully achieving diagnosis was the primary endpoint, analysis of all periprocedural complications was the secondary endpoint, and the tertiary endpoint was the length of the procedure, with the aim of assessing of the learning curve for each operator over time. The results for the ROSA robot and the Varioguide system were compared and benchmarked to data from the literature. RESULTS We performed 526 on 516 patients, 314 with the ROSA robot (Group A) and 212 with the IGS Varioguide (Group B). Histological diagnosis was achieved in 97.4% of cases in Group A, versus 93.3% in Group B (p < 0.05). No statistically significant difference was found for secondary and tertiary endpoints. The complication rate appeared similar between the 2 frameless systems, with a hemorrhagic complications rate of 3.5% in Group A and 4.7% in Group B. Permanent neurological deterioration was only recorded in 0.8% of cases from Group B. Mortality was recorded in 0.3% in Group A and 0.4% in Group B. CONCLUSION This study provides evidence to confirm that robotic surgery lives up to its promises of increased safety, accuracy, and reliability.
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Affiliation(s)
| | - Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Mario Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Mustapha Benmekhbi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Helene Cebula
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Guillaume Dannhoff
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Irène Ollivier
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Chaussemy
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Andres Hugo Coca
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - François Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Julien Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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Bichsel O, Oertel MF, Stieglitz LH. Mobile intraoperative CT-assisted frameless stereotactic biopsies achieved single-millimeter trajectory accuracy for deep-seated brain lesions in a sample of 7 patients. BMC Neurol 2021; 21:285. [PMID: 34294075 PMCID: PMC8296727 DOI: 10.1186/s12883-021-02322-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background Brain biopsies are crucial diagnostic interventions, providing valuable information for treatment and prognosis, but largely depend on a high accuracy and precision. We hypothesized that through the combination of neuronavigation-based frameless stereotaxy and MRI-guided trajectory planning with intraoperative CT examination using a mobile unit, one can achieve a seamlessly integrated approach yielding optimal target accuracy. Methods We analyzed a total of 7 stereotactic biopsy trajectories for a variety of deep-seated locations and different patient positions. After rigid head fixation, an intraoperative pre-procedural scan using a mobile CT unit was performed for automatic image fusion with the planning MRI images and a peri-procedural scan with the biopsy cannula in situ for verification of the definite target position. We then evaluated the radial trajectory error. Results Intraoperative scanning, surgery, computerized merging of MRI and CT images as well as trajectory planning were feasible without difficulties and safe in all cases. We achieved a radial trajectory deviation of 0.97 ± 0.39 mm at a trajectory length of 60 ± 12.3 mm (mean ± standard deviation). Repositioning of the biopsy cannula due to inaccurate targeting was not required. Conclusion Intraoperative verification using a mobile CT unit in combination with frameless neuronavigation-guided stereotaxy and pre-operative MRI-based trajectory planning was feasible, safe and highly accurate. The setting enabled single-millimeter accuracy for deep-seated brain lesions and direct detection of intraoperative complications, did not depend on a dedicated operating room and was seamlessly integrated into common stereotactic procedures.
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Affiliation(s)
- Oliver Bichsel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Markus F Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lennart H Stieglitz
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Stoecklein VM, Kellert L, Patzig M, Küpper C, Giese A, Ruf V, Weller J, Kreth FW, Schöberl F. Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety. J Neurol 2021; 268:367-376. [PMID: 32813052 PMCID: PMC7815620 DOI: 10.1007/s00415-020-10157-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy and safety of extended stereotactic brain biopsy (ESBB) in a single center cohort with suspected primary angiitis of the central nervous system (PACNS). METHODS A standardized stereotactic biopsy targeting MRI-positive lesions and collecting samples from the meninges and the cortex as well as from the white matter was performed in 23 patients with clinically suspected PACNS between 2010 and 2017. The relationship between biopsy yield and clinical characteristics, cerebrospinal fluid parameters, MR-imaging, time point of biopsy and exact localization of biopsy as well as number of tissue samples were examined. RESULTS PACNS was confirmed in 7 of 23 patients (30.4%). Alternative diagnoses were identified in 7 patients (30%). A shorter time period between the onset or worsening of symptoms (p = 0.018) and ESBB significantly increased the diagnostic yield. We observed only minor and transient postoperative complications in 3 patients (13.0%). ESBB led to a direct change of the therapeutic regime in 13 of 23 patients (56.5%). Careful neuropathological analysis furthermore revealed that cortical samples were crucial in obtaining a diagnosis. CONCLUSION ESBB is a safe approach with good feasibility, even in critically ill patients, and high diagnostic accuracy in patients with suspected PACNS changing future therapies in 13 of 23 patients (56.5%). Early biopsy after symptom onset/worsening is crucial and (sub)acute MRI-lesions should be targeted with a particular need for biopsy samples from the cortical layer.
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Affiliation(s)
| | - Lars Kellert
- Department of Neurology, Ludwig-Maximilians-University Munich, Marchioninistr.15, 81377, Munich, Germany
| | - Maximilian Patzig
- Department of Neuroradiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Clemens Küpper
- Department of Neurology, Ludwig-Maximilians-University Munich, Marchioninistr.15, 81377, Munich, Germany
| | - Armin Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Viktoria Ruf
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Florian Schöberl
- Department of Neurology, Ludwig-Maximilians-University Munich, Marchioninistr.15, 81377, Munich, Germany.
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Pistol C, Daneasa A, Ciurea J, Rasina A, Barborica A, Oane I, Mindruta I. Accuracy and Safety of Customized Stereotactic Fixtures for Stereoelectroencephalography in Pediatric Patients. Stereotact Funct Neurosurg 2020; 99:17-24. [PMID: 33227801 DOI: 10.1159/000510063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
Stereoelectroencephalography (SEEG) in children with intractable epilepsy presents particular challenges. Their thin and partially ossified cranium, specifically in the temporal area, is prone to fracture while attaching stereotactic systems to the head or stabilizing the head in robot's field of action. Postponing SEEG in this special population of patients can have serious consequences, reducing their chances of becoming seizure-free and impacting their social and cognitive development. This study demonstrates the safety and accuracy offered by a frameless personalized 3D printed stereotactic implantation system for SEEG investigations in children under 4 years of age. SEEG was carried out in a 3-year-old patient with drug-resistant focal epilepsy, based on a right temporal-perisylvian epileptogenic zone hypothesis. Fifteen intracerebral electrodes were placed using a StarFix patient-customized stereotactic fixture. The median lateral entry point localization error of the electrodes was 0.90 mm, median lateral target point localization error was 1.86 mm, median target depth error was 0.83 mm, and median target point localization error was 1.96 mm. There were no perioperative complications. SEEG data led to a tailored right temporal-insular-opercular resection, with resulting seizure freedom (Engel IA). In conclusion, patient-customized stereotactic fixtures are a safe and accurate option for SEEG exploration in young children.
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Affiliation(s)
| | - Andrei Daneasa
- Neurology Department, University Emergency Hospital, Bucharest, Romania
| | - Jean Ciurea
- Neurosurgery Department, Bagdasar-Arseni Hospital, Bucharest, Romania
| | - Alin Rasina
- Neurosurgery Department, Bagdasar-Arseni Hospital, Bucharest, Romania
| | - Andrei Barborica
- Physics Department, University of Bucharest, Bucharest, Romania.,FHC Inc., Bowdoin, Maine, USA
| | - Irina Oane
- Neurology Department, University Emergency Hospital, Bucharest, Romania
| | - Ioana Mindruta
- Neurology Department, University Emergency Hospital, Bucharest, Romania, .,Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,
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Patel S, Fitzgerald JJ, Antoniades CA. Oculomotor effects of medical and surgical treatments of Parkinson's disease. Prog Brain Res 2019; 249:297-305. [PMID: 31325988 DOI: 10.1016/bs.pbr.2019.04.020] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Oculomotor abnormalities are fast becoming a proxy for disease diagnosis and progression. Saccades-ballistic eye movements-are known to be affected by dopaminergic cell loss in the basal ganglia, caused by Parkinson's disease. Pharmaceutical and neurosurgical interventions such as deep brain stimulation and functional neurosurgery have both been noted to have an effect on saccades. Comparing and contrasting these effects may yield insights into Parkinson's disease pathophysiology, and the mechanisms of pharmacological and neurosurgical treatments. Computational models of saccadic control, such as the LATER model, can help to interpret the distribution of saccadic latencies, providing a framework for objectively comparing the effects of pharmaceutical interventions and deep brain stimulation.
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Gouveia FV, Hamani C, Fonoff ET, Brentani H, Alho EJL, de Morais RMCB, de Souza AL, Rigonatti SP, Martinez RCR. Amygdala and Hypothalamus: Historical Overview With Focus on Aggression. Neurosurgery 2019; 85:11-30. [PMID: 30690521 PMCID: PMC6565484 DOI: 10.1093/neuros/nyy635] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 03/12/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
Aggressiveness has a high prevalence in psychiatric patients and is a major health problem. Two brain areas involved in the neural network of aggressive behavior are the amygdala and the hypothalamus. While pharmacological treatments are effective in most patients, some do not properly respond to conventional therapies and are considered medically refractory. In this population, surgical procedures (ie, stereotactic lesions and deep brain stimulation) have been performed in an attempt to improve symptomatology and quality of life. Clinical results obtained after surgery are difficult to interpret, and the mechanisms responsible for postoperative reductions in aggressive behavior are unknown. We review the rationale and neurobiological characteristics that may help to explain why functional neurosurgery has been proposed to control aggressive behavior.
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Affiliation(s)
| | - Clement Hamani
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Erich Talamoni Fonoff
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
| | - Helena Brentani
- Department of Psychiatry, University of Sao Paulo, Medical School, Sao Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil
| | - Eduardo Joaquim Lopes Alho
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
| | | | - Aline Luz de Souza
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
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Chen Y, Godage I, Su H, Song A, Yu H. Stereotactic Systems for MRI-Guided Neurosurgeries: A State-of-the-Art Review. Ann Biomed Eng 2018; 47:335-353. [PMID: 30377898 DOI: 10.1007/s10439-018-02158-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/25/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
Recent technological developments in magnetic resonance imaging (MRI) and stereotactic techniques have significantly improved surgical outcomes. Despite the advantages offered by the conventional MRI-guided stereotactic neurosurgery, the robotic-assisted stereotactic approach has potential to further improve the safety and accuracy of neurosurgeries. This review aims to provide an update on the potential and continued growth of the MRI-guided stereotactic neurosurgical techniques by describing the state of the art in MR conditional stereotactic devices including manual and robotic-assisted. The paper also presents a detailed overview of MRI-guided stereotactic devices, MR conditional actuators and encoders used in MR conditional robotic-assisted stereotactic devices. The review concludes with several research challenges and future perspectives, including actuator and sensor technique, MR image guidance, and robot design issues.
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Affiliation(s)
- Yue Chen
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA.
| | - Isuru Godage
- School of Computing, DePaul University, Chicago, IL, USA
| | - Hao Su
- Department of Mechanical Engineering, City College of New York, New York, NY, USA
| | - Aiguo Song
- School of Instrument Science and Engineering, Southeast University, Nanjing, People's Republic of China
| | - Hong Yu
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA
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Southwell DG, Rutkowski MJ, San Luciano M, Racine C, Ostrem J, Starr PA, Larson PS. Before and after the veterans affairs cooperative program 468 study: Deep brain stimulator target selection for treatment of Parkinson's disease. Parkinsonism Relat Disord 2017; 48:40-44. [PMID: 29249683 DOI: 10.1016/j.parkreldis.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Veterans Affairs Cooperative Study Program 468 study (CSP 468) produced significant findings regarding deep brain stimulation (DBS) target selection for Parkinson's Disease (PD) treatment, yet its impact on clinical practices has not been described. Here we assess how CSP 468 influenced target selection at a high-volume movement disorders treatment center. METHODS We compared DBS target site selection between 4-year periods that immediately preceded and followed CSP 468 publication. Additionally, we examined how baseline clinical features influenced target selection following CSP 468. RESULTS The STN was the predominant site of DBS implantation before and after CSP 468 publication (93.2% of cases, and 60.4%, respectively), but GPi targeting increased significantly following CSP 468 publication (from 5.3% to 37.4%; p < .001). Patients who underwent GPi stimulation following CSP 468 exhibited worse indices of depression (p < .001), less responsiveness to medications (p < .05), and a trend towards worse pre-operative cognitive performance (p = .06). In multi-variate analysis, advanced patient age and depression were independent predictors of GPi targeting (p < .01). CONCLUSIONS Key findings of CSP 468 were reflected in our target selection of DBS for Parkinson's Disease. Following CSP 468, GPi targeting increased, and it was selected for patients with poorer cognitive and mood indices.
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Affiliation(s)
- Derek G Southwell
- Department of Neurological Surgery, University of California, San Francisco, USA.
| | - Martin J Rutkowski
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Marta San Luciano
- Department of Neurology, University of California, San Francisco, USA
| | - Caroline Racine
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Jill Ostrem
- Department of Neurology, University of California, San Francisco, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, USA
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Reinacher PC, Coenen VA, Kraeutle R, Scheiwe C, Jabbarli R, Roelz R. Feasibility of stereotactic catheter ventriculocisternostomy for cisternal lavage therapy in patients with subarachnoid hemorrhage. Clin Neurol Neurosurg 2017; 163:94-102. [PMID: 29096139 DOI: 10.1016/j.clineuro.2017.10.012] [Citation(s) in RCA: 4] [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: 08/04/2017] [Revised: 10/11/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Delayed cerebral infarction (DCI) confers considerable morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Available prevention strategies are insufficient. Cisternal blood clearance by stereotactic catheter ventriculocisternostomy (STX-VCS) and cisternal lavage therapy is a novel concept for DCI prevention. Here, we assess the general feasibility, pitfalls and imaging requirements of STX-VCS after aSAH. PATIENTS AND METHODS 73 aSAH patients admitted between 2008 and 2015 with appropriate imaging for simulation of stereotactic procedures were included. Surgical feasibility of a transventricular trajectory to the basal cisterns was assessed. RESULTS Transventricular catheter access to the basal cisterns was feasible in 94% of cases. In 6% vascular obstacles precluded a transventricular approach and access to the basal cisterns could be simulated via a transparenchymal trajectory. CT-artifacts that interfered with stereotactic planning were observed in 58% after coiling and 5% after clipping. In these cases stereotactic planning was enabled by MRI. Logistic regression of aneurysm size and distance-to-target allowed for precise prediction whether MRI was required for stereotactic planning of STX-VCS after coiling. CONCLUSIONS Stereotactic catheter access to the basal cisterns after aSAH appears to be generally feasible. Coil artifacts compromising CT-based planning can be precisely anticipated and planning enabled by MRI.
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Affiliation(s)
- Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Rainer Kraeutle
- Department of Nursing-IT, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, 45147, Germany
| | - Roland Roelz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
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Bot M, van den Munckhof P, Bakay R, Stebbins G, Verhagen Metman L. Accuracy of Intraoperative Computed Tomography during Deep Brain Stimulation Procedures: Comparison with Postoperative Magnetic Resonance Imaging. Stereotact Funct Neurosurg 2017; 95:183-188. [PMID: 28601874 DOI: 10.1159/000475672] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 10/18/2016] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the accuracy of intraoperative computed tomography (iCT) in localizing deep brain stimulation (DBS) electrodes by comparing this modality with postoperative magnetic resonance imaging (MRI). BACKGROUND Optimal lead placement is a critical factor for the outcome of DBS procedures and preferably confirmed during surgery. iCT offers 3-dimensional verification of both microelectrode and lead location during DBS surgery. However, accurate electrode representation on iCT has not been extensively studied. METHODS DBS surgery was performed using the Leksell stereotactic G frame. Stereotactic coordinates of 52 DBS leads were determined on both iCT and postoperative MRI and compared with intended final target coordinates. The resulting absolute differences in X (medial-lateral), Y (anterior-posterior), and Z (dorsal-ventral) coordinates (ΔX, ΔY, and ΔZ) for both modalities were then used to calculate the euclidean distance. RESULTS Euclidean distances were 2.7 ± 1.1 and 2.5 ± 1.2 mm for MRI and iCT, respectively (p = 0.2). CONCLUSION Postoperative MRI and iCT show equivalent DBS lead representation. Intraoperative localization of both microelectrode and DBS lead in stereotactic space enables direct adjustments. Verification of lead placement with postoperative MRI, considered to be the gold standard, is unnecessary.
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Affiliation(s)
- Maarten Bot
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Lau JC, MacDougall KW, Arango MF, Peters TM, Parrent AG, Khan AR. Ultra-High Field Template-Assisted Target Selection for Deep Brain Stimulation Surgery. World Neurosurg 2017; 103:531-537. [PMID: 28427973 DOI: 10.1016/j.wneu.2017.04.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Template and atlas guidance are fundamental aspects of stereotactic neurosurgery. The recent availability of ultra-high field (7 Tesla) magnetic resonance imaging has enabled in vivo visualization at the submillimeter scale. In this Doing More with Less article, we describe our experiences with integrating ultra-high field template data into the clinical workflow to assist with target selection in deep brain stimulation (DBS) surgical planning. METHODS The creation of a high-resolution 7T template is described, generated from group data acquired at our center. A computational workflow was developed for spatially aligning the 7T template with standard clinical data and furthermore, integrating the derived imaging volumes into the surgical planning workstation. RESULTS We demonstrate that our methodology can be effective for assisting with target selection in 2 cases: unilateral internal pallidum DBS for painful dystonia and bilateral subthalamic nucleus DBS for Parkinson's disease. CONCLUSIONS In this article, we have described a workflow for the integration of high-resolution in vivo ultra-high field templates into the surgical navigation system as a means to assist with DBS planning. The method does not require any additional cost or time to the patient. Future work will include prospectively evaluating different templates and their impact on target selection.
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Affiliation(s)
- Jonathan C Lau
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada; Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, University Hospital, Western University, London, Ontario, Canada.
| | - Keith W MacDougall
- Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, University Hospital, Western University, London, Ontario, Canada
| | - Miguel F Arango
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University Hospital, Western University, London, Ontario, Canada
| | - Terry M Peters
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada; Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew G Parrent
- Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, University Hospital, Western University, London, Ontario, Canada
| | - Ali R Khan
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada; Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Abstract
The history of epilepsy surgery is generally noted to have begun in 1886 with Victor Horsley's first report of craniotomies for posttraumatic epilepsy. With increased understanding of brain function and development of electroencephalographic methods, nonlesional epilepsy began to be treated with resection in the 1950s. Methodological improvements and increased understanding of pathophysiology followed, and the advent of stereotaxy and ablative technology in the 1960s and 1970s heralded a new era of minimally invasive, targeted procedures for lesional and nonlesional epilepsy. Current techniques combine stereotactic methods, improved ablative technologies, and electroencephalographic methods for a multidisciplinary approach to the neurosurgical treatment of epilepsy.
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Affiliation(s)
- Saurabh Sinha
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Shabbar F Danish
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA.
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Abstract
The development of modern neurosurgery was, and remains, intimately associated with developments in radiology. Neuroimaging advances have been instrumental in improving patient care and reducing both morbidity and mortality for neurosurgical patients. The purpose of this narrative review is to provide the contemporary neurosurgeon with an overview of the history of the development of radiology as applied to neurosurgery. The focus is on cranial imaging but the spine is also discussed. This article demonstrates the remarkable advancements that have shaped our modern surgical specialty. Today, almost 120 years after the discovery of the X-ray, the neurosurgeon has a wide array of neuroimaging tools at their disposal, that have led to better knowledge to inform diagnosis and management, selection of appropriate patients and surgical targets, as well as optimal surgical approaches. Modern neurosurgery is based on the appropriate use of these investigations. The pace of neuroimaging and neurosurgical advances continues and the future promises to be as, if not more, exciting as the past and present described in this paper.
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Affiliation(s)
- Matthew A Kirkman
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK.
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