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Roumengous T, Reutter AB, Peterson CL. Effect of low-cost transcranial magnetic stimulation navigation on hotspot targeting and motor evoked potential variability in the biceps brachii. Restor Neurol Neurosci 2021; 39:319-328. [PMID: 34657854 DOI: 10.3233/rnn-211207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) can monitor or modulate brain excitability. However, reliability of TMS outcomes depends on consistent coil placement during stimulation. Neuronavigated TMS systems can address this issue, but their cost limits their use outside of specialist research environments. OBJECTIVE The objective was to evaluate the performance of a low-cost navigated TMS approach in improving coil placement consistency and its effect on motor evoked potentials (MEPs) when targeting the biceps brachii at rest and during voluntary contractions. METHODS We implemented a navigated TMS system using a low-cost 3D camera system and open-source software environment programmed using the Unity 3D engine. MEPs were collected from the biceps brachii at rest and during voluntary contractions across two sessions in ten non-disabled individuals. Motor hotspots were recorded and targeted via two conditions: navigated and conventional. RESULTS The low-cost navigated TMS system reduced coil orientation error (pitch: 1.18°±1.2°, yaw: 1.99°±1.9°, roll: 1.18°±2.2° with navigation, versus pitch: 3.7°±5.7°, yaw: 3.11°±3.1°, roll: 3.8°±9.1° with conventional). The improvement in coil orientation had no effect on MEP amplitudes and variability. CONCLUSIONS The low-cost system is a suitable alternative to expensive systems in tracking the motor hotspot between sessions and quantifying the error in coil placement when delivering TMS. Biceps MEP variability reflects physiological variability across a range of voluntary efforts, that can be captured equally well with navigated or conventional approaches of coil locating.
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Affiliation(s)
- Thibault Roumengous
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alec B Reutter
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Carrie L Peterson
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
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Navigated transcranial magnetic stimulation of the supplementary motor cortex disrupts fine motor skills in healthy adults. Sci Rep 2019; 9:17744. [PMID: 31780823 PMCID: PMC6883055 DOI: 10.1038/s41598-019-54302-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022] Open
Abstract
Navigated transcranial magnetic stimulation (nTMS) over the supplementary motor area (SMA) may impact fine motor skills. This study evaluates different nTMS parameters in their capacity to affect fine motor performance on the way to develop an SMA mapping protocol. Twenty healthy volunteers performed a variety of fine motor tests during baseline and nTMS to the SMA using 5 Hz, 10 Hz, and theta-burst stimulation (TBS). Effects on performance were measured by test completion times (TCTs), standard deviation of inter-tap interval (SDIT), and visible coordination problems (VCPs). The predominant stimulation effect was slowing of TCTs, i.e. a slowdown of test performances during stimulation. Furthermore, participants exhibited VCPs like accidental use of contralateral limbs or inability to coordinate movements. More instances of significant differences between baseline and stimulation occurred during stimulation of the right hemisphere compared to left-hemispheric stimulation. In conclusion, nTMS to the SMA could enable new approaches in neuroscience and enable structured mapping approaches. Specifically, this study supports interhemispheric differences in motor control as right-hemispheric stimulation resulted in clearer impairments. The application of our nTMS-based setup to assess the function of the SMA should be applied in patients with changed anatomo-functional representations as the next step, e.g. among patients with eloquent brain tumors.
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Yoon K, Lee W, Lee JE, Xu L, Croce P, Foley L, Yoo SS. Effects of sonication parameters on transcranial focused ultrasound brain stimulation in an ovine model. PLoS One 2019; 14:e0224311. [PMID: 31648261 PMCID: PMC6812789 DOI: 10.1371/journal.pone.0224311] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/10/2019] [Indexed: 01/01/2023] Open
Abstract
Low-intensity focused ultrasound (FUS) has significant potential as a non-invasive brain stimulation modality and novel technique for functional brain mapping, particularly with its advantage of greater spatial selectivity and depth penetration compared to existing non-invasive brain stimulation techniques. As previous studies, primarily carried out in small animals, have demonstrated that sonication parameters affect the stimulation efficiency, further investigation in large animals is necessary to translate this technique into clinical practice. In the present study, we examined the effects of sonication parameters on the transient modification of excitability of cortical and thalamic areas in an ovine model. Guided by anatomical and functional neuroimaging data specific to each animal, 250 kHz FUS was transcranially applied to the primary sensorimotor area associated with the right hind limb and its thalamic projection in sheep (n = 10) across multiple sessions using various combinations of sonication parameters. The degree of effect from FUS was assessed through electrophysiological responses, through analysis of electromyogram and electroencephalographic somatosensory evoked potentials for evaluation of excitatory and suppressive effects, respectively. We found that the modulatory effects were transient and reversible, with specific sonication parameters outperforming others in modulating regional brain activity. Magnetic resonance imaging and histological analysis conducted at different time points after the final sonication session, as well as behavioral observations, showed that repeated exposure to FUS did not damage the underlying brain tissue. Our results suggest that FUS-mediated, non-invasive, region-specific bimodal neuromodulation can be safely achieved in an ovine model, indicating its potential for translation into human studies.
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Affiliation(s)
- Kyungho Yoon
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Wonhye Lee
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ji Eun Lee
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Linda Xu
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Phillip Croce
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lori Foley
- Translational Discovery Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Koponen LM, Nieminen JO, Ilmoniemi RJ. Multi-locus transcranial magnetic stimulation-theory and implementation. Brain Stimul 2018; 11:849-855. [PMID: 29627272 DOI: 10.1016/j.brs.2018.03.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/09/2018] [Accepted: 03/20/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation method: a magnetic field pulse from a TMS coil can excite neurons in a desired location of the cortex. Conventional TMS coils cause focal stimulation underneath the coil centre; to change the location of the stimulated spot, the coil must be moved over the new target. This physical movement is inherently slow, which limits, for example, feedback-controlled stimulation. OBJECTIVE To overcome the limitations of physical TMS-coil movement by introducing electronic targeting. METHODS We propose electronic stimulation targeting using a set of large overlapping coils and introduce a matrix-factorisation-based method to design such sets of coils. We built one such device and demonstrated the electronic stimulation targeting in vivo. RESULTS The demonstrated two-coil transducer allows translating the stimulated spot along a 30-mm-long line segment in the cortex; with five coils, a target can be selected from within a region of the cortex and stimulated in any direction. Thus, far fewer coils are required by our approach than by previously suggested ones, none of which have resulted in practical devices. CONCLUSION Already with two coils, we can adjust the location of the induced electric field maximum along one dimension, which is sufficient to study, for example, the primary motor cortex.
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Affiliation(s)
- Lari M Koponen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko O Nieminen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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5
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Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, Di Lazzaro V, Ferreri F, Fitzgerald PB, George MS, Hallett M, Lefaucheur JP, Langguth B, Matsumoto H, Miniussi C, Nitsche MA, Pascual-Leone A, Paulus W, Rossi S, Rothwell JC, Siebner HR, Ugawa Y, Walsh V, Ziemann U. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol 2015; 126:1071-1107. [PMID: 25797650 PMCID: PMC6350257 DOI: 10.1016/j.clinph.2015.02.001] [Citation(s) in RCA: 1736] [Impact Index Per Article: 192.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/22/2015] [Accepted: 02/01/2015] [Indexed: 12/14/2022]
Abstract
These guidelines provide an up-date of previous IFCN report on “Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application” (Rossini et al., 1994). A new Committee, composed of international experts, some of whom were in the panel of the 1994 “Report”, was selected to produce a current state-of-the-art review of non-invasive stimulation both for clinical application and research in neuroscience. Since 1994, the international scientific community has seen a rapid increase in non-invasive brain stimulation in studying cognition, brain–behavior relationship and pathophysiology of various neurologic and psychiatric disorders. New paradigms of stimulation and new techniques have been developed. Furthermore, a large number of studies and clinical trials have demonstrated potential therapeutic applications of non-invasive brain stimulation, especially for TMS. Recent guidelines can be found in the literature covering specific aspects of non-invasive brain stimulation, such as safety (Rossi et al., 2009), methodology (Groppa et al., 2012) and therapeutic applications (Lefaucheur et al., 2014). This up-dated review covers theoretical, physiological and practical aspects of non-invasive stimulation of brain, spinal cord, nerve roots and peripheral nerves in the light of more updated knowledge, and include some recent extensions and developments.
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Affiliation(s)
- P M Rossini
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy
| | - D Burke
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - R Chen
- Division of Neurology, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - Z Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - R Di Iorio
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy.
| | - V Di Lazzaro
- Department of Neurology, University Campus Bio-medico, Rome, Italy
| | - F Ferreri
- Department of Neurology, University Campus Bio-medico, Rome, Italy; Department of Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland
| | - P B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, Australia
| | - M S George
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - M Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD, USA
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - H Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - C Miniussi
- Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy; IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M A Nitsche
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - A Pascual-Leone
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - S Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - J C Rothwell
- Institute of Neurology, University College London, London, United Kingdom
| | - H R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Y Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - V Walsh
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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Kim H, Chiu A, Lee SD, Fischer K, Yoo SS. Focused ultrasound-mediated non-invasive brain stimulation: examination of sonication parameters. Brain Stimul 2014; 7:748-56. [PMID: 25088462 DOI: 10.1016/j.brs.2014.06.011] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/20/2014] [Accepted: 06/25/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transcranial focused ultrasound (FUS) has emerged as a new brain stimulation modality. The range of sonication parameters for successful brain stimulation warrants further investigation. OBJECTIVE The objective of this study was to examine the range of FUS sonication parameters that minimize the acoustic intensity/energy deposition while successfully stimulating the motor brain area in Sprague-Dawley rats. METHODS We transcranially administered FUS to the somatomotor area of the rat brain and measured the acoustic intensity that caused excitatory effects with respect to different pulsing parameters (tone-burst duration, pulse-repetition frequency, duty cycle, and sonication duration) at 350 and 650 kHz of fundamental frequency. RESULTS We observed that motor responses were elicited at minimum threshold acoustic intensities (4.9-5.6 W/cm(2) in spatial-peak pulse-average intensity; 2.5-2.8 W/cm(2) in spatial-peak temporal-average intensity) in a limited range of sonication parameters, i.e. 1-5 ms of tone-burst duration, 50% of duty cycle, and 300 ms of sonication duration, at 350 kHz fundamental frequency. We also found that the pulsed sonication elicited motor responses at lower acoustic intensities than its equivalent continuous sonication. CONCLUSION Our results suggest that the pulsed application of FUS selectively stimulates specific brain areas-of-interest at an acoustic intensity that is compatible with regulatory safety limits on biological tissue, thus allowing for potential applications in neurotherapeutics.
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Affiliation(s)
- Hyungmin Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Mechanical Engineering, Korea University, Anam-dong, Sungbuk-gu, Seoul 136-713, Korea; Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-Gu, Incheon 403-720, Korea
| | - Alan Chiu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Stephanie D Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Krisztina Fischer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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7
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Linte CA, Davenport KP, Cleary K, Peters C, Vosburgh KG, Navab N, Edwards PE, Jannin P, Peters TM, Holmes DR, Robb RA. On mixed reality environments for minimally invasive therapy guidance: systems architecture, successes and challenges in their implementation from laboratory to clinic. Comput Med Imaging Graph 2013; 37:83-97. [PMID: 23632059 PMCID: PMC3796657 DOI: 10.1016/j.compmedimag.2012.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 11/16/2012] [Accepted: 12/24/2012] [Indexed: 11/21/2022]
Abstract
Mixed reality environments for medical applications have been explored and developed over the past three decades in an effort to enhance the clinician's view of anatomy and facilitate the performance of minimally invasive procedures. These environments must faithfully represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical instrument tracking, and display technology into a common framework centered around and registered to the patient. However, in spite of their reported benefits, few mixed reality environments have been successfully translated into clinical use. Several challenges that contribute to the difficulty in integrating such environments into clinical practice are presented here and discussed in terms of both technical and clinical limitations. This article should raise awareness among both developers and end-users toward facilitating a greater application of such environments in the surgical practice of the future.
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Romero JR, Ramirez DM, Aglio LS, Gugino LD. Brain mapping using transcranial magnetic stimulation. Neurosurg Clin N Am 2011; 22:141-52, vii. [PMID: 21435567 DOI: 10.1016/j.nec.2010.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a novel brain stimulation technique that has advanced the understanding of brain physiology, and has diagnostic value as well as therapeutic potential for several neuropsychiatric disorders. The stimulation involves restricted cortical and subcortical regions, and, when used in combination with a visually guided technique, results in improved accuracy to target specific areas, which may also influence the outcome desired. This article reviews the principles underlying the mechanism of action of TMS, and discusses its use to obtain functional maps of the motor and visual cortex, including technical considerations for accuracy and reproducibility of mapping procedures.
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Affiliation(s)
- José Rafael Romero
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA.
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Jung NH, Delvendahl I, Kuhnke NG, Hauschke D, Stolle S, Mall V. Navigated transcranial magnetic stimulation does not decrease the variability of motor-evoked potentials. Brain Stimul 2010; 3:87-94. [DOI: 10.1016/j.brs.2009.10.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 10/07/2009] [Accepted: 10/07/2009] [Indexed: 10/20/2022] Open
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Picht T, Mularski S, Kuehn B, Vajkoczy P, Kombos T, Suess O. Navigated transcranial magnetic stimulation for preoperative functional diagnostics in brain tumor surgery. Neurosurgery 2010; 65:93-8; discussion 98-9. [PMID: 19935007 DOI: 10.1227/01.neu.0000348009.22750.59] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Transcranial magnetic stimulation (TMS) is a noninvasive method for analyzing cortical function. To utilize TMS for presurgical functional diagnostics, the magnetic impulse must be precisely targeted by stereotactically positioning the coil. The aim of this study was to evaluate the usefulness of TMS for operation planning when combined with a sensor-based electromagnetic navigation system (nTMS). METHODS Preoperative functional mapping with nTMS was performed in 10 patients with rolandic tumors. Intraoperative mapping was performed with the "gold standard" of direct cortical stimulation. Stimulation was performed in the same predefined 5-mm raster for both modalities, and the results were compared. RESULTS In regard to the 5-mm mapping raster, the centers of gravity of nTMS and direct cortical stimulation were located at the same spot in 4 cases and at neighboring spots in the remaining 6 cases. The mean distance between the tumor and the nearest motor response ("safety margin") was 7.9 mm (range, 5-15 mm; standard deviation, 3.2 mm) for nTMS and 6.6 mm (range, 0-12 mm; standard deviation, 3.4 mm) for direct cortical stimulation. CONCLUSION nTMS allowed for reliable, precise application of the magnetic impulse, and the peritumoral somatotopy corresponded well between the 2 modalities in all 10 cases. nTMS is a promising method for preoperative functional mapping in motor cortex tumor surgery.
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Affiliation(s)
- Thomas Picht
- Department of Neurosurgery, Charité-Universitaetsmedizin, Berlin, Germany.
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Linte CA, White J, Eagleson R, Guiraudon GM, Peters TM. Virtual and Augmented Medical Imaging Environments: Enabling Technology for Minimally Invasive Cardiac Interventional Guidance. IEEE Rev Biomed Eng 2010; 3:25-47. [DOI: 10.1109/rbme.2010.2082522] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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The value of neuronavigated rTMS for the treatment of depression. Neurophysiol Clin 2009; 40:37-43. [PMID: 20230934 DOI: 10.1016/j.neucli.2009.06.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 06/21/2009] [Indexed: 01/18/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been increasingly evaluated as a therapeutic tool for the treatment of depression, using various stimulation parameters and protocols. Heterogeneous results have been reported with regard to clinical outcome, at least partly due to the variety of procedures for coil placement above the desired site of stimulation. This article reviews the strategies for coil positioning in the treatment of depression. Considering preliminary clinical evidence, neuronavigated rTMS appears desirable to treat depression, compared to the standard targeting procedure (5cm anterior to the motor cortex). Coil positioning strategy might improve in the future by taking into consideration the individual abnormalities revealed by functional neuroimaging data.
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Finke M, Fadini T, Kantelhardt S, Giese A, Matthaus L, Schweikard A. Brain-mapping using robotized TMS. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:3929-32. [PMID: 19163572 DOI: 10.1109/iembs.2008.4650069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present first results of brain-mapping using robotic Transcranial Magnetic Stimulation. This non-invasive procedure enables the reliable detection of the representation of individual muscles or muscle groups in the motor-cortex. The accuracy is only exceeded by direct electrical stimulation of the brain during surgery. Brain-mapping using robotic TMS can also be used to detect displacements of brain regions caused by tumors. The advantage of TMS is that it is non-invasive. In this study, we compare results from statistical mapping with robotic TMS to results achieved from direct stimulation done during tumor surgery. To our knowledge this is the first study of this type. We mapped the representation of three muscle groups (forearm, pinky and thumb) in tumor patients with the robot-aided TMS protocol and with direct stimulation. The resulting maps agree within 5mm.
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Affiliation(s)
- M Finke
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, Luebeck, Germany.
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Sack AT, Cohen Kadosh R, Schuhmann T, Moerel M, Walsh V, Goebel R. Optimizing functional accuracy of TMS in cognitive studies: a comparison of methods. J Cogn Neurosci 2009; 21:207-21. [PMID: 18823235 DOI: 10.1162/jocn.2009.21126] [Citation(s) in RCA: 279] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a tool for inducing transient disruptions of neural activity noninvasively in conscious human volunteers. In recent years, the investigative domain of TMS has expanded and now encompasses causal structure-function relationships across the whole gamut of cognitive functions and associated cortical brain regions. Consequently, the importance of how to determine the target stimulation site has increased and a number of alternative methods have emerged. Comparison across studies is precluded because different studies necessarily use different tasks, sites, TMS conditions, and have different goals. Here, therefore, we systematically compare four commonly used TMS coil positioning approaches by using them to induce behavioral change in a single cognitive study. Specifically, we investigated the behavioral impact of right parietal TMS during a number comparison task, while basing TMS localization either on (i) individual fMRI-guided TMS neuronavigation, (ii) individual MRI-guided TMS neuronavigation, (iii) group functional Talairach coordinates, or (iv) 10-20 EEG position P4. We quantified the exact behavioral effects induced by TMS using each approach, calculated the standardized experimental effect sizes, and conducted a statistical power analysis in order to calculate the optimal sample size required to reveal statistical significance. Our findings revealed a systematic difference between the four approaches, with the individual fMRI-guided TMS neuronavigation yielding the strongest and the P4 stimulation approach yielding the smallest behavioral effect size. Accordingly, power analyses revealed that although in the fMRI-guided neuronavigation approach five participants were sufficient to reveal a significant behavioral effect, the number of necessary participants increased to n = 9 when employing MRI-guided neuronavigation, to n = 13 in case of TMS based on group Talairach coordinates, and to n = 47 when applying TMS over P4. We discuss these graded effect size differences in light of the revealed interindividual variances in the actual target stimulation site within and between approaches.
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15
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Weiduschat N, Habedank B, Lampe B, Poggenborg J, Schuster A, Haupt WF, Heiss WD, Thiel A. Localizing Broca's area for transcranial magnetic stimulation: Comparison of surface distance measurements and stereotaxic positioning. Brain Stimul 2009; 2:93-102. [DOI: 10.1016/j.brs.2008.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 09/08/2008] [Accepted: 09/10/2008] [Indexed: 11/24/2022] Open
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Matthäus L, Trillenberg P, Fadini T, Finke M, Schweikard A. Brain mapping with transcranial magnetic stimulation using a refined correlation ratio and Kendall's tau. Stat Med 2009; 27:5252-70. [PMID: 18693298 DOI: 10.1002/sim.3353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Transcranial magnetic stimulation provides a mean to stimulate the brain non-invasively and painlessly. The effect of the stimulation hereby depends on the stimulation coil used and on its placement. This paper presents a mapping algorithm based on the assumption of a monotonous functional relationship between the applied electric field strength at the representation point of a muscle and the evoked motor potential. We combine data from coil characteristics, coil placement, and stimulation outcome to calculate a likelihood map for the representation of stimulated muscles in the brain. Hereby, correlation ratio (CR) and Kendall's rank coefficient tau are used to find areas in the brain where there is most likely a functional or monotonous relationship between electric field strength applied to this area and the muscle response. First results show a good accordance of our method with mapping from functional magnetic resonance imaging. In our case, classical evaluation of CR with binning is impossible, because sample data sets are too small and data are continuous. We therefore introduce a refined CR formula based on a Parzen windowing of the X-data to solve the problem. In contrast to usual windowing approaches, which require numeric integration, it can be evaluated directly in O(n2) time. Hence, its advantage lies in fast evaluation while maintaining robust applicability to small sample sets. We suggest that the presented formula can generally be used in CR-related problems where sample size is small and data range is continuous.
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Affiliation(s)
- L Matthäus
- Institute for Robotics and Cognitive Systems, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Moisa M, Pohmann R, Ewald L, Thielscher A. New coil positioning method for interleaved transcranial magnetic stimulation (TMS)/functional MRI (fMRI) and its validation in a motor cortex study. J Magn Reson Imaging 2009; 29:189-97. [DOI: 10.1002/jmri.21611] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Sparing R, Buelte D, Meister IG, Paus T, Fink GR. Transcranial magnetic stimulation and the challenge of coil placement: a comparison of conventional and stereotaxic neuronavigational strategies. Hum Brain Mapp 2008; 29:82-96. [PMID: 17318831 PMCID: PMC6871049 DOI: 10.1002/hbm.20360] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 11/13/2006] [Accepted: 12/07/2006] [Indexed: 11/07/2022] Open
Abstract
The combination of transcranial magnetic stimulation (TMS) with functional neuroimaging has expanded the potential of TMS for human brain mapping. The precise and reliable positioning of the TMS coil is not a simple task, however. Modern frameless stereotaxic systems allow investigators to base navigation either on the subject's structural magnetic resonance imaging (MRI), functional MRI data, or the use of functional neuroimaging data from the literature, so-called "probabilistic approach." The latter assumes consistency across individuals in the location of task-related "activations" in standardized stereotaxic space. Conventional nonstereotaxic localization of brain areas is also a common method for defining the coil position. Our aim was to evaluate the accuracy of five different localization strategies in one single study. The left primary motor cortex (left M1-Hand) was used as target region. Three approaches were based on real-time frameless stereotaxy using information based on either anatomical or functional MRI. The remaining two strategies relied either on standard cranial landmarks (i.e., the International 10-20 EEG system) or a standardized function-guided procedure (i.e., the spatial relationship between the left and right M1-Hand). The results were compared to a TMS-based mapping of the primary motor cortex; center of gravity of motor-evoked potentials (MEP-CoG) was calculated for each subject (n = 10). Our findings suggest that highest precision can be achieved with fMRI-guided stimulation, which was accurate within the range of millimeters. Very consistent results were also obtained with the "probabilistic" approach. In view of these findings, we discuss the methods and special characteristics of each localization strategy.
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Affiliation(s)
- Roland Sparing
- Department of Medicine, Institute of Neuroscience and Biophysics, Research Center Juelich, Juelich, Germany.
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Julkunen P, Pääkkönen A, Hukkanen T, Könönen M, Tiihonen P, Vanhatalo S, Karhu J. Efficient reduction of stimulus artefact in TMS-EEG by epithelial short-circuiting by mini-punctures. Clin Neurophysiol 2007; 119:475-81. [PMID: 18063410 DOI: 10.1016/j.clinph.2007.09.139] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 08/06/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed at comparing the effects of two different electrode-to-skin contact preparation techniques on the stimulus artefact induced by transcranial magnetic stimulation (TMS) in electroencephalography (EEG) signals. METHODS Six healthy subjects participated in a combined navigated brain stimulation (NBS) and EEG study. Electrode contacts were first prepared in the standard way of rubbing the skin using a wooden stick with a cotton tip. The location of hand motor area and the motor threshold (MT) was determined for each subject. Then, the TMS-induced artefact was measured at 60%, 80%, 100% and 120% of the MT. Subsequently, the epithelium under the electrode contacts was electrically short-circuited by puncturing with custom-made needles and the stimulation sequences were replicated. The artefact was compared between the preparation techniques. RESULTS The TMS-induced artefact was significantly reduced after puncturing. In addition, the size and duration of the artefact depended on the applied stimulation intensity. The reduction of the artefact was largest in electrodes at and close to the stimulation site. CONCLUSIONS Mini-puncturing technique enables more accurate analysis of TMS-induced short-latency phenomena in EEG during NBS, and it may aid in the examination of the short distance neural connectivity beneath and close to the stimulation site. SIGNIFICANCE This study describes a practical skin preparation method that significantly improves the utility of TMS-EEG method in studying short-latency cortical connectivity.
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Affiliation(s)
- P Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland.
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Laycock R, Crewther DP, Fitzgerald PB, Crewther SG. Evidence for Fast Signals and Later Processing in Human V1/V2 and V5/MT+: A TMS Study of Motion Perception. J Neurophysiol 2007; 98:1253-62. [PMID: 17634339 DOI: 10.1152/jn.00416.2007] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Evidence from human and primate studies suggests that fast visual processing may utilize signals projecting from primary visual cortex (V1) through the dorsal stream, to area V5/MT+ or beyond and subsequently back into V1. This coincides with the arrival of parvocellular signals en route to the ventral pathway and infero-temporal cortex. Such evidence suggests that the dorsal stream region V5/MT+ is activated rapidly through the traditional hierarchical pathway and also via a less-well-established direct signal to V5/MT+ bypassing V1. To test this, 16 healthy humans underwent transcranial magnetic stimulation (TMS) of V1/V2 and V5/MT+ while performing a motion-direction detection task. A three-alternate forced-choice design (left/right motion, stationary) allowed analysis of the quality of errors made, in addition to the more usual performance measures. Transient disruption of V1/V2 and V5/MT+ significantly reduced accuracy when TMS was applied at or near motion onset. Most participants also showed disrupted performance with TMS application over V1/V2 ∼125 ms post motion onset, and significantly reduced accuracy at 158 ms with V5/MT+ stimulation. The two periods of disruption with V1/V2 TMS are suggestive of feedforward/feedback models, although the earlier period of disruption has not been reported in previous TMS studies. Very early activation of V5/MT+, evidenced by diminished accuracy and reduced perception of motion after TMS may be indicative of a thalamic-extrastriate pathway in addition to the traditionally expected later period of processing. A profound disruption of performance prestimulus onset is more likely to reflect disruption of top-down expectancy than disruption of visual processing.
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Affiliation(s)
- Robin Laycock
- School of Psychological Science, La Trobe University, Bundoora, Victoria 3086, Australia.
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Hiwaki O, Inoue T, Wada Y. A method for accurate estimation of stimulating sites based on cerebral cortex structure in transcranial magnetic stimulation. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2005:5302-5. [PMID: 17281447 DOI: 10.1109/iembs.2005.1615677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive and painless method to stimulate the cortex. Accurate estimation of stimulating points is much important to evaluate cortical functions such as cortical motor output maps. However, most studies using TMS have not achieved to estimate the stimulating points exactly. This study proposed the novel method to provide the accurate estimation of stimulating points of the cortex in TMS taking account of the individual cortical anatomy and property of nerve excitation. We conducted TMS mapping of the motor cortex to confirm the validity of this method. The cortex sites which innervate muscles of the upper limb and hand were successfully delineated in primary motor area.
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Affiliation(s)
- O Hiwaki
- Hiroshima City University, Hiroshima, 731-3194 Japan
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Denslow S, Bohning DE, Bohning PA, Lomarev MP, George MS. An increased precision comparison of TMS-induced motor cortex BOLD fMRI response for image-guided versus function-guided coil placement. Cogn Behav Neurol 2005; 18:119-26. [PMID: 15970732 DOI: 10.1097/01.wnn.0000160821.15459.68] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine with high precision the differences between function-guided and image-guided transcranial magnetic stimulation (TMS). METHOD Using a calibrated TMS coil holder/positioner, interleaved TMS/functional magnetic resonance imaging (fMRI), and individualized anatomy-based regional normalization, we conducted a two-phase study of TMS coil positioning guided by either function (elicited thumb motion) or image-based targeting of the "hand knob," the anatomy associated with fMRI activation during thumb motion. RESULTS In every case, image-guided TMS coil placement produced a thumb movement response at thresholds similar to those found under function guidance. Unexpectedly, function-guided coil locations clustered bimodally over central and precentral sulci. Image-guided locations clustered as anticipated toward the targeted gyral crown. Despite these differences, blood oxygenation level-dependent (BOLD) activation locations and magnitude for the two methods displayed no consistent differences in mean or variance between or within subjects. Image guidance produced more consistent coil placement from subject to subject relative to targeted anatomy. Surprisingly, BOLD time courses from image-guided experiments showed significantly slower return to baseline after TMS than was observed under function guidance. CONCLUSIONS The results demonstrate the effectiveness and precision of image-guided positioning of TMS coils combined with a precisely adjustable holder/positioner and regional normalization. Image guidance provides an accurate TMS placement relative to individual anatomy when no external sign is available.
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Affiliation(s)
- Stewart Denslow
- Department of Radiology, Center for Advanced Imaging Research and Brain Stimulation Laboratories, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Bohning DE, Denslow S, Bohning PA, Walker JA, George MS. A TMS coil positioning/holding system for MR image-guided TMS interleaved with fMRI. Clin Neurophysiol 2004; 114:2210-9. [PMID: 14580621 DOI: 10.1016/s1388-2457(03)00232-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Transcranial magnetic stimulation (TMS) can be interleaved with fMRI to visualize regional brain activity in response to direct, non-invasive, cortical stimulation, making it a promising tool for studying brain function. A major practical difficulty is accurately positioning the TMS coil within the MRI scanner for stimulating a particular area of brain cortex. The objective of this work was to design and build a self-contained hardware/software system for MR-guided TMS coil positioning in interleaved TMS/fMRI studies. METHODS A compact, manually operated, articulated TMS coil positioner/holder with 6 calibrated degrees of freedom was developed for use inside a cylindrical RF head coil, along with a software package for transforming between MR image coordinates, MR scanner space coordinates, and positioner/holder settings. RESULTS Phantom calibration studies gave an accuracy for positioning within setups of dx=+/-1.9 mm, dy=+/-1.4 mm, dz=+/-0.8 mm and a precision for multiple setups of dx=+/-0.8 mm, dy=+/-0.1 mm, dz=+/-0.1 mm. CONCLUSIONS This self-contained, integrated MR-guided TMS system for interleaved TMS/fMRI studies provides fast, accurate location of motor cortex stimulation sites traditionally located functionally, and a means of consistent, anatomy-based TMS coil positioning for stimulation of brain areas without overt response.
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Affiliation(s)
- Daryl E Bohning
- Center for Advanced Imaging Research, Department of Radiology, Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC 29425, USA.
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Herwig U, Schönfeldt-Lecuona C, Wunderlich AP, von Tiesenhausen C, Thielscher A, Walter H, Spitzer M. The navigation of transcranial magnetic stimulation. Psychiatry Res 2001; 108:123-31. [PMID: 11738546 DOI: 10.1016/s0925-4927(01)00121-4] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a new method for investigating cortical information processing and for investigating therapeutic applications in psychiatry and neurology. A common problem of most studies in this field regards the localization of the magnetic coil with respect to the cortex. This article reviews the currently used methods and proposes a neuronavigational approach. The method of neuronavigated TMS is described and discussed in detail. It is used to guide the magnetic coil on an individual basis to a structurally or functionally predetermined cortical area while monitoring the location of the coil in relation to the subject's head in real time. Possible applications of TMS in combination with functional neuroimaging in clinical research within a cognitive neuroscience framework are discussed. Future applications of TMS should take individual anatomy into account, and neuronavigation provides the means to do so.
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Affiliation(s)
- U Herwig
- Department of Psychiatry, University of Ulm, Leimgrubenweg 12, D-89070 Ulm, Germany.
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Grimson E, Leventon M, Ettinger G, Chabrerie A, Ozlen F, Nakajima S, Atsumi H, Kikinis R, Black P. Clinical experience with a high precision image-guided neurosurgery system. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION — MICCAI’98 1998. [DOI: 10.1007/bfb0056188] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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