pipeline-for-planning-execution-transcranial-ultrasound

Pipeline for Planning and Execution of Transcranial Ultrasound Neuromodulation Experiments in Humans

Transcranial ultrasound stimulation (TUS) is an emerging non-invasive neuromodulation technique capable of manipulating both cortical and subcortical ...

University of Calgary

Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF). Treatment is directed at sealing the site of leak, which is often difficult to localize. We present a case of near fatal SIH that was treated with thoracic epidural blood patching. A 47-year old male presented with orthostatic headache and bilateral cranial nerve VI palsies progressing over several weeks. Brain magnetic resonance (MR) imaging showed features typical of SIH and identified an epidural collection stretching from spinal levels C6 to T4, but further imaging with MR myelography and radionuclide cisternography failed to identify a precise site of leak. The patient worsened in the hospital requiring craniotomy for evacuation of an evolving subdural hematoma (SDH). Epidural blood patch was performed at the T1-2 level, the presumed location of the leak due to presence of a bone spur on computed tomography and the large corresponding CSF collection. This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his SDH. Through this case and review of the literature, we aim to demonstrate that directed cervical or thoracic blood patching should be considered for SIH as an alternative to the conventional lumbar blood patch.

Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature.

Cranioplasty encompasses various cranial reconstruction techniques that are used following craniectomy due to stroke or trauma. Despite classical infectious signs, symptoms, and radiologic findings, however, the diagnosis of infection following cranioplasty can be elusive, with the potential to result in definitive treatment delay. We sought to determine if fever or leukocytosis at presentation were indicative of infection, as well as to identify any factors that may limit its applicability.

The Absence of Fever or Leukocytosis Does Not Exclude Infection Following Cranioplasty.

The emphasis regarding intracranial neuroendoscopy has been traditionally advocated and focused on the role in pediatric patients, although a significant usage has developed in adult patients. In this study, we examine and contrast the role of predominantly intracranial neuroendoscopy in both a pediatric and adult population with a minimum postprocedure follow-up of 5 years.

Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults.

Patient satisfaction with therapeutic interventions is an important outcome of care. Although generic measures of patient satisfaction exist, there is no validated scale for measuring patient satisfaction with epilepsy surgery. We aimed to systematically obtain patient-identified factors related to satisfaction with epilepsy surgery as a means of informing clinicians about the ways that patients evaluate outcomes of their treatment and as a conceptual basis for the future development of epilepsy surgery patient satisfaction scales. Focus group discussions with epilepsy surgery patients (n=9) were conducted to identify themes relevant to patient satisfaction with epilepsy surgery and to draft initial items of importance. Consensus methodology (Delphi technique) was used to obtain expert opinion (n=13) to refine the items. Member-checking with focus group participants was performed to ensure the identified items were relevant, clear, and inclusive. A list of 31 items embodied 12 themes related to patient-reported satisfaction with epilepsy surgery. These included adverse effects, medical care or rehabilitation, seizure control, post-operative recovery, anti-seizure medication, independence, seizure worry, ability to drive, social relationships, self-confidence, improved cognitive function, and improved physical health. This study used a systematic approach to identify factors that are important to patients when assessing satisfaction with epilepsy surgery. This knowledge can assist clinicians caring for these patients and is also a critical step towards the validation of a formal scale to assess satisfaction with epilepsy surgery.

Patient satisfaction with epilepsy surgery: what is important to patients?

One in three patients with epilepsy are medication-refractory and may benefit from investigations and operative treatment at a comprehensive epilepsy center. However, while these centers have capabilities for advanced seizure monitoring and surgical intervention, they are not required to have a functional neurosurgeon who is primarily focused in epilepsy surgery. Therefore, the objective of this study is to determine the impact of having a sub-specialized, epilepsy-focused functional neurosurgeon on patient outcomes.

The impact of sub specialization within functional neurosurgery on patient outcomes in a comprehensive epilepsy center.

Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). While the success of DBS is dependent on careful patient selection and accurate lead placement, programming parameters play a pivotal role in tailoring therapy on the individual level. Various algorithms have been developed to streamline the initial programming process, but the relationship between pre-operative patient characteristics and post-operative device settings is unclear. In this study, we investigated how PD severity correlates with DBS settings.

Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson's disease severity.

Deep brain stimulation is a common treatment for Parkinson's disease (PD). Despite strong efficacy in well-selected patients, complications can occur. Intraoperative micro-electrode recording (MER) can enhance efficacy by improving lead accuracy. However, there is controversy as to whether MER increases risk of hemorrhage.

Complications of Deep Brain Stimulation for Parkinson Disease and Relationship between Micro-electrode tracks and hemorrhage: Systematic Review and Meta-Analysis.

Flexible behavior requires gating mechanisms that encode only task-relevant information in working memory. Extant literature supports a theoretical division of labor whereby lateral frontoparietal interactions underlie information maintenance and the striatum enacts the gate. Here, we reveal neocortical gating mechanisms in intracranial EEG patients by identifying rapid, within-trial changes in regional and inter-regional activities that predict subsequent behavioral outputs. Results first demonstrate information accumulation mechanisms that extend prior fMRI (i.e., regional high-frequency activity) and EEG evidence (inter-regional theta synchrony) of distributed neocortical networks in working memory. Second, results demonstrate that rapid changes in theta synchrony, reflected in changing patterns of default mode network connectivity, support filtering. Graph theoretical analyses further linked filtering in task-relevant information and filtering out irrelevant information to dorsal and ventral attention networks, respectively. Results establish a rapid neocortical theta network mechanism for flexible information encoding, a role previously attributed to the striatum.

A rapid theta network mechanism for flexible information encoding.

Trigeminal autonomic cephalalgias (TACs) are a group of highly disabling primary headache disorders. Although pharmacological treatments exist, they are not always effective or well tolerated. Occipital nerve stimulation (ONS) is a potentially effective surgical treatment.

Efficacy of Occipital Nerve Stimulation in Trigeminal Autonomic Cephalalgias: A Systematic Review.

Non-literal expressions such as sarcasm, metaphor and simile refer to words and sentences that convey meanings or intentions that are different and more abstract than literal expressions. Neuroimaging studies have shown activations in a variety of frontal, parietal and temporal brain regions implicated in non-literal language processing. However, neurophysiological correlates of these brain areas underlying non-literal processing remain underexplored.

Article	Year
Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature. Turkish neurosurgery\| PubMed ID: 26014022	2015
The Absence of Fever or Leukocytosis Does Not Exclude Infection Following Cranioplasty. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques\| PubMed ID: 26062405	2015
Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques\| PubMed ID: 26347500	2015
Patient satisfaction with epilepsy surgery: what is important to patients? Epileptic disorders : international epilepsy journal with videotape\| PubMed ID: 30361186	2018
The impact of sub specialization within functional neurosurgery on patient outcomes in a comprehensive epilepsy center. Clinical neurology and neurosurgery\| PubMed ID: 33984798	2021
Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson's disease severity. Acta neurochirurgica\| PubMed ID: 35751700	2022
Complications of Deep Brain Stimulation for Parkinson Disease and Relationship between Micro-electrode tracks and hemorrhage: Systematic Review and Meta-Analysis. World neurosurgery\| PubMed ID: 36244666	2023
A rapid theta network mechanism for flexible information encoding. Nature communications\| PubMed ID: 37208373	2023
Efficacy of Occipital Nerve Stimulation in Trigeminal Autonomic Cephalalgias: A Systematic Review. Neurosurgery\| PubMed ID: 37712710	2023
Intracranial recordings reveal high-frequency activity in the human temporal-parietal cortex supporting non-literal language processing. Frontiers in neuroscience\| PubMed ID: 38260011	2023

Fady Girgis

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