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He Q, Yang Y, Ge P, Li S, Chai X, Luo Z, Zhao J. The brain nebula: minimally invasive brain-computer interface by endovascular neural recording and stimulation. J Neurointerv Surg 2024:jnis-2023-021296. [PMID: 38388478 DOI: 10.1136/jnis-2023-021296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
A brain-computer interface (BCI) serves as a direct communication channel between brain activity and external devices, typically a computer or robotic limb. Advances in technology have led to the increasing use of intracranial electrical recording or stimulation in the treatment of conditions such as epilepsy, depression, and movement disorders. This indicates that BCIs can offer clinical neurological rehabilitation for patients with disabilities and functional impairments. They also provide a means to restore consciousness and functionality for patients with sequelae from major brain diseases. Whether invasive or non-invasive, the collected cortical or deep signals can be decoded and translated for communication. This review aims to provide an overview of the advantages of endovascular BCIs compared with conventional BCIs, along with insights into the specific anatomical regions under study. Given the rapid progress, we also provide updates on ongoing clinical trials and the prospects for current research involving endovascular electrodes.
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Affiliation(s)
- Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Center for Neurological Disorders, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- National Research Center for Rehabilitation Technical Aids, Beijing, China
- Chinese Institute for Brain Research, Beijing, People's Republic of China
- Beijing Institute of Brain Disorders, Beijing, People's Republic of China
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sining Li
- Tianjin Key Laboratory of Brain Science and Intelligent Rehabilitation, College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Xiaoke Chai
- Brain Computer Interface Transitional Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongqiu Luo
- Department of Neurosurgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Center for Neurological Disorders, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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2
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Fujimoto A, Matsumaru Y, Masuda Y, Sato K, Hatano K, Numoto S, Hotta R, Marushima A, Hosoo H, Araki K, Okanishi T, Ishikawa E. Endovascular electroencephalography (eEEG) can detect the laterality of epileptogenic foci as accurately as subdural electrodes. Heliyon 2024; 10:e25567. [PMID: 38327423 PMCID: PMC10847992 DOI: 10.1016/j.heliyon.2024.e25567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/28/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Background Traditional brain activity monitoring via scalp electroencephalography (EEG) offers limited resolution and is susceptible to artifacts. Endovascular electroencephalography (eEEG) emerged in the 1990s. Despite early successes and potential for detecting epileptiform activity, eEEG has remained clinically unutilized. This study aimed to further test the capabilities of eEEG in detecting lateralized epileptic discharges in animal models. We hypothesized that eEEG would be able to detect lateralization. The purpose of this study was to measure epileptiform discharges with eEEG in animal models with lateralization in epileptogenicity. Materials and methods We inserted eEEG electrodes into the transverse sinuses of three pigs, and subdural electrodes (SDs) on the surfaces of the left and right hemispheres. We induced epileptogenicity with penicillin in the left brain of pigs F00001 and F00003, and in the right brain of pig F00002. The resulting epileptiform discharges were measured by eEEG electrodes placed in the left and right transverse sinuses, and conducted comparisons with epileptiform discharges from SDs. We also had 12 neurological physicians interpret measurement results from eEEG alone and determine the side (left or right) of epileptogenicity. Results Three pigs were evaluated for epileptiform discharge detection using eEEG: F00001 (7 months old, 14.0 kg), F00002 (8 months old, 15.6 kg), and F00003 (8 months old, 14.4 kg). The eEEG readings were compared with results from SDs, showing significant alignment across all subjects (p < 0.001). The sensitivity and positive predictive values (PPV) were as follows: F00001 had 0.93 and 0.96, F00002 had 0.99 and 1.00, and F00003 had 0.98 and 0.99. Even though one of the neurological physicians got all sides incorrect, all other assessments were correct. Upon post-experimental dissection, no abnormalities were observed in the brain tissue or in the vascular damage at the site where the eEEG was placed, based on pathological evaluation. Conclusion With eEEG, lateralization can be determined with high sensitivity (>0.93) and PPV (>0.95) that appear equivalent to those of subdural EEG in the three pigs. This lateralization was also discernible by neurological physicians on visual inspection.
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Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- Seirei Christopher University, Shizuoka, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- E.P. Medical Inc., Tokyo, Japan
| | - Yosuke Masuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Keisuke Hatano
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Shingo Numoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Ryuya Hotta
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kota Araki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Brannigan JFM, Fry A, Opie NL, Campbell BCV, Mitchell PJ, Oxley TJ. Endovascular Brain-Computer Interfaces in Poststroke Paralysis. Stroke 2024; 55:474-483. [PMID: 38018832 DOI: 10.1161/strokeaha.123.037719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Stroke is a leading cause of paralysis, most frequently affecting the upper limbs and vocal folds. Despite recent advances in care, stroke recovery invariably reaches a plateau, after which there are permanent neurological impairments. Implantable brain-computer interface devices offer the potential to bypass permanent neurological lesions. They function by (1) recording neural activity, (2) decoding the neural signal occurring in response to volitional motor intentions, and (3) generating digital control signals that may be used to control external devices. While brain-computer interface technology has the potential to revolutionize neurological care, clinical translation has been limited. Endovascular arrays present a novel form of minimally invasive brain-computer interface devices that have been deployed in human subjects during early feasibility studies. This article provides an overview of endovascular brain-computer interface devices and critically evaluates the patient with stroke as an implant candidate. Future opportunities are mapped, along with the challenges arising when decoding neural activity following infarction. Limitations arise when considering intracerebral hemorrhage and motor cortex lesions; however, future directions are outlined that aim to address these challenges.
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Affiliation(s)
- Jamie F M Brannigan
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (J.F.M.B.)
| | - Adam Fry
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
| | - Nicholas L Opie
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
- Vascular Bionics Laboratory, Department of Medicine, The University of Melbourne, Victoria, Australia (N.L.O., T.J.O.)
| | - Bruce C V Campbell
- Department of Neurology (B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
- Melbourne Brain Centre (B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | - Peter J Mitchell
- Department of Radiology (P.J.M.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | - Thomas J Oxley
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
- Vascular Bionics Laboratory, Department of Medicine, The University of Melbourne, Victoria, Australia (N.L.O., T.J.O.)
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4
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Li L, Ibayashi K, Piscopo A, Deifelt Streese C, Chen H, Greenlee JDW, Hasan DM. Intraarterial encephalography from an acutely implanted aneurysm embolization device in awake humans. J Neurosurg 2023; 138:785-792. [PMID: 35932270 DOI: 10.3171/2022.6.jns22932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endovascular electroencephalography (evEEG) uses the cerebrovascular system to record electrical activity from adjacent neural structures. The safety, feasibility, and efficacy of using the Woven EndoBridge Aneurysm Embolization System (WEB) for evEEG has not been investigated. METHODS Seventeen participants undergoing awake WEB endovascular treatment of unruptured cerebral aneurysms were included. After WEB deployment and before detachment, its distal deployment wire was connected to an EEG receiver, and participants performed a decision-making task for 10 minutes. WEB and scalp recordings were captured. RESULTS All patients underwent successful embolization and evEEG with no complications. Event-related potentials were detected on scalp EEG in 9/17 (53%) patients. Of these 9 patients, a task-related low-gamma (30-70 Hz) response on WEB channels was captured in 8/9 (89%) cases. In these 8 patients, the WEB was deployed in 2 middle cerebral arteries, 3 anterior communicating arteries, the terminal internal carotid artery, and 2 basilar tip aneurysms. Electrocardiogram artifact on WEB channels was present in 12/17 cases. CONCLUSIONS The WEB implanted within cerebral aneurysms of awake patients is capable of capturing task-specific brain electrical activities. Future studies are warranted to establish the efficacy of and support for evEEG as a tool for brain recording, brain stimulation, and brain-machine interface applications.
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Affiliation(s)
- Luyuan Li
- 1Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Kenji Ibayashi
- 2Department of Neurosurgery, Jichi Medical University, Tochigi, Japan; and
| | - Anthony Piscopo
- 1Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | | | - Haiming Chen
- 1Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | | | - David M Hasan
- 3Department of Neurosurgery, Duke University, Durham, North Carolina
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Thielen B, Xu H, Fujii T, Rangwala SD, Jiang W, Lin M, Kammen A, Liu C, Selvan P, Song D, Mack WJ, Meng E. Making a case for endovascular approaches for neural recording and stimulation. J Neural Eng 2023; 20:10.1088/1741-2552/acb086. [PMID: 36603221 PMCID: PMC9928900 DOI: 10.1088/1741-2552/acb086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/05/2023] [Indexed: 01/06/2023]
Abstract
There are many electrode types for recording and stimulating neural tissue, most of which necessitate direct contact with the target tissue. These electrodes range from large, scalp electrodes which are used to non-invasively record averaged, low frequency electrical signals from large areas/volumes of the brain, to penetrating microelectrodes which are implanted directly into neural tissue and interface with one or a few neurons. With the exception of scalp electrodes (which provide very low-resolution recordings), each of these electrodes requires a highly invasive, open brain surgical procedure for implantation, which is accompanied by significant risk to the patient. To mitigate this risk, a minimally invasive endovascular approach can be used. Several types of endovascular electrodes have been developed to be delivered into the blood vessels in the brain via a standard catheterization procedure. In this review, the existing body of research on the development and application of endovascular electrodes is presented. The capabilities of each of these endovascular electrodes is compared to commonly used direct-contact electrodes to demonstrate the relative efficacy of the devices. Potential clinical applications of endovascular recording and stimulation and the advantages of endovascular versus direct-contact approaches are presented.
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Affiliation(s)
- Brianna Thielen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Huijing Xu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Tatsuhiro Fujii
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shivani D. Rangwala
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wenxuan Jiang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Michelle Lin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexandra Kammen
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charles Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Neurorestoration Center, University of Southern California, Los Angeles, CA, USA
| | - Pradeep Selvan
- The Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Dong Song
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - William J. Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ellis Meng
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
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Fujimoto A, Matsumaru Y, Masuda Y, Marushima A, Hosoo H, Araki K, Ishikawa E. Endovascular Electroencephalogram Records Simultaneous Subdural Electrode-Detectable, Scalp Electrode-Undetectable Interictal Epileptiform Discharges. Brain Sci 2022; 12:brainsci12030309. [PMID: 35326265 PMCID: PMC8946704 DOI: 10.3390/brainsci12030309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: We hypothesized that an endovascular electroencephalogram (eEEG) can detect subdural electrode (SDE)-detectable, scalp EEG-undetectable epileptiform discharges. The purpose of this study is, therefore, to measure SDE-detectable, scalp EEG-undetectable epileptiform discharges by an eEEG on a pig. Methods: A pig under general anesthesia was utilized to measure an artificially generated epileptic field by an eEEG that was able to be detected by an SDE, but not a scalp EEG as a primary outcome. We also compared the phase lag of each epileptiform discharge that was detected by the eEEG and SDE as a secondary outcome. Results: The eEEG electrode detected 113 (97%) epileptiform discharges (97% sensitivity). Epileptiform discharges that were localized within the three contacts (contacts two, three and four), but not spread to other parts, were detected by the eEEG with a 92% sensitivity. The latency between peaks of the eEEG and right SDE earliest epileptiform discharge ranged from 0 to 48 ms (mean, 13.3 ms; median, 11 ms; standard deviation, 9.0 ms). Conclusion: In a pig, an eEEG could detect epileptiform discharges that an SDE could detect, but that a scalp EEG could not.
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Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka 988-056, Japan;
- School of Rehabilitation Sciences, Seirei Christopher University, Shizuoka 988-056, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
- E.P. Medical Inc., 403 Nihonbashi-Life-Science Building, 2-3-11, Honcho, Nihonbashi, Chuo-ku, Tokyo 103-0023, Japan
- Correspondence: ; Tel.: +81-29-853-3900; Fax: +81-29-853-3214
| | - Yosuke Masuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Kota Araki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
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7
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Soldozy S, Young S, Kumar JS, Capek S, Felbaum DR, Jean WC, Park MS, Syed HR. A systematic review of endovascular stent-electrode arrays, a minimally invasive approach to brain-machine interfaces. Neurosurg Focus 2020; 49:E3. [PMID: 32610291 DOI: 10.3171/2020.4.focus20186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to systematically review the feasibility and safety of minimally invasive neurovascular approaches to brain-machine interfaces (BMIs). METHODS A systematic literature review was performed using the PubMed database for studies published between 1986 and 2019. All studies assessing endovascular neural interfaces were included. Additional studies were selected based on review of references of selected articles and review articles. RESULTS Of the 53 total articles identified in the original literature search, 12 studies were ultimately selected. An additional 10 articles were included from other sources, resulting in a total of 22 studies included in this systematic review. This includes primarily preclinical studies comparing endovascular electrode recordings with subdural and epidural electrodes, as well as studies evaluating stent-electrode gauge and material type. In addition, several clinical studies are also included. CONCLUSIONS Endovascular stent-electrode arrays provide a minimally invasive approach to BMIs. Stent-electrode placement has been shown to be both efficacious and safe, although further data are necessary to draw comparisons between subdural and epidural electrode measurements given the heterogeneity of the studies included. Greater access to deep-seated brain regions is now more feasible with stent-electrode arrays; however, further validation is needed in large clinical trials to optimize this neural interface. This includes the determination of ideal electrode material type, venous versus arterial approaches, the feasibility of deep brain stimulation, and more streamlined computational decoding techniques.
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Affiliation(s)
- Sauson Soldozy
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Steven Young
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jeyan S Kumar
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Stepan Capek
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Daniel R Felbaum
- 2Department of Neurosurgery, Georgetown University, Washington, DC; and
| | - Walter C Jean
- 3Department of Neurosurgery, George Washington University, Washington, DC
| | - Min S Park
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Hasan R Syed
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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8
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Affiliation(s)
- Robert S Fisher
- Department of Neurology & Neurological Sciences, and Neurosurgery by Courtesy, Stanford University School of Medicine, Palo Alto, CA, USA.
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9
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Gerboni G, John SE, Rind GS, Ronayne SM, May CN, Oxley TJ, Grayden DB, Opie NL, Wong YT. Visual evoked potentials determine chronic signal quality in a stent-electrode endovascular neural interface. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aad714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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John SE, Opie NL, Wong YT, Rind GS, Ronayne SM, Gerboni G, Bauquier SH, O'Brien TJ, May CN, Grayden DB, Oxley TJ. Signal quality of simultaneously recorded endovascular, subdural and epidural signals are comparable. Sci Rep 2018; 8:8427. [PMID: 29849104 PMCID: PMC5976775 DOI: 10.1038/s41598-018-26457-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/10/2018] [Indexed: 02/07/2023] Open
Abstract
Recent work has demonstrated the feasibility of minimally-invasive implantation of electrodes into a cortical blood vessel. However, the effect of the dura and blood vessel on recording signal quality is not understood and may be a critical factor impacting implementation of a closed-loop endovascular neuromodulation system. The present work compares the performance and recording signal quality of a minimally-invasive endovascular neural interface with conventional subdural and epidural interfaces. We compared bandwidth, signal-to-noise ratio, and spatial resolution of recorded cortical signals using subdural, epidural and endovascular arrays four weeks after implantation in sheep. We show that the quality of the signals (bandwidth and signal-to-noise ratio) of the endovascular neural interface is not significantly different from conventional neural sensors. However, the spatial resolution depends on the array location and the frequency of recording. We also show that there is a direct correlation between the signal-noise-ratio and classification accuracy, and that decoding accuracy is comparable between electrode arrays. These results support the consideration for use of an endovascular neural interface in a clinical trial of a novel closed-loop neuromodulation technology.
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Affiliation(s)
- Sam E John
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia. .,Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, (RMH), The University of Melbourne, Parkville, Australia. .,Florey Institute of Neuroscience and Mental Health, Parkville, Australia. .,SmartStent Pty Ltd, Parkville, Australia.
| | - Nicholas L Opie
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, (RMH), The University of Melbourne, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,SmartStent Pty Ltd, Parkville, Australia
| | - Yan T Wong
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia.,Department of Physiology and Department of Electrical and Computer Systems Engineering, Monash University, Clayton, Australia
| | - Gil S Rind
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, (RMH), The University of Melbourne, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,SmartStent Pty Ltd, Parkville, Australia
| | - Stephen M Ronayne
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, (RMH), The University of Melbourne, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,SmartStent Pty Ltd, Parkville, Australia
| | - Giulia Gerboni
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia.,Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, (RMH), The University of Melbourne, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Sebastien H Bauquier
- Department of Veterinary Science, The University of Melbourne, Werribee, Australia
| | - Terence J O'Brien
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, (RMH), The University of Melbourne, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Clive N May
- Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - David B Grayden
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia.,Centre for Neural Engineering, The University of Melbourne, Carlton, Australia
| | - Thomas J Oxley
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, (RMH), The University of Melbourne, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,SmartStent Pty Ltd, Parkville, Australia
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11
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Sefcik RK, Opie NL, John SE, Kellner CP, Mocco J, Oxley TJ. The evolution of endovascular electroencephalography: historical perspective and future applications. Neurosurg Focus 2017; 40:E7. [PMID: 27132528 DOI: 10.3171/2016.3.focus15635] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current standard practice requires an invasive approach to the recording of electroencephalography (EEG) for epilepsy surgery, deep brain stimulation (DBS), and brain-machine interfaces (BMIs). The development of endovascular techniques offers a minimally invasive route to recording EEG from deep brain structures. This historical perspective aims to describe the technical progress in endovascular EEG by reviewing the first endovascular recordings made using a wire electrode, which was followed by the development of nanowire and catheter recordings and, finally, the most recent progress in stent-electrode recordings. The technical progress in device technology over time and the development of the ability to record chronic intravenous EEG from electrode arrays is described. Future applications for the use of endovascular EEG in the preoperative and operative management of epilepsy surgery are then discussed, followed by the possibility of the technique's future application in minimally invasive operative approaches to DBS and BMI.
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Affiliation(s)
| | - Nicholas L Opie
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Sam E John
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | | | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Thomas J Oxley
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and.,Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
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12
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García-Asensio S, Guelbenzu S, Barrena R, Valero P. Technical Aspects of Intra-Arterial Electroencephalogram Recording. Interv Neuroradiol 2016; 5:289-300. [DOI: 10.1177/159101999900500405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/1999] [Accepted: 10/25/1999] [Indexed: 11/17/2022] Open
Abstract
The purpose of this prospective study is to show a technique for recording electroencephalographic activity via an endovascular approach in presurgical evaluation of epileptic patients. Technical aspects and insertion strategy are outlined. Advantages of intra-arterial electroencephalography have been demonstrated. It is a semi-invasive procedure that provides information in temporal lobe and extratemporal epilepsy. It allows a dynamic electroencephalographic recording and patient tolerance is excellent. Risks are practically absent. Disadvantages are: in comparison to ovale electrodes, chronic and multicontact recording is not possible and the recording is only intercritical.
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Affiliation(s)
- S. García-Asensio
- Neuroradiology Section, Radiology Department, Miguel Servet Hospital; Zaragoza
| | - S. Guelbenzu
- Neuroradiology Section, Radiology Department, Miguel Servet Hospital; Zaragoza
| | - R. Barrena
- Neuroradiology Section, Radiology Department, Miguel Servet Hospital; Zaragoza
| | - P. Valero
- Neuroradiology Section, Radiology Department, Miguel Servet Hospital; Zaragoza
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13
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Minimally invasive endovascular stent-electrode array for high-fidelity, chronic recordings of cortical neural activity. Nat Biotechnol 2016; 34:320-7. [PMID: 26854476 DOI: 10.1038/nbt.3428] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 11/09/2015] [Indexed: 12/18/2022]
Abstract
High-fidelity intracranial electrode arrays for recording and stimulating brain activity have facilitated major advances in the treatment of neurological conditions over the past decade. Traditional arrays require direct implantation into the brain via open craniotomy, which can lead to inflammatory tissue responses, necessitating development of minimally invasive approaches that avoid brain trauma. Here we demonstrate the feasibility of chronically recording brain activity from within a vein using a passive stent-electrode recording array (stentrode). We achieved implantation into a superficial cortical vein overlying the motor cortex via catheter angiography and demonstrate neural recordings in freely moving sheep for up to 190 d. Spectral content and bandwidth of vascular electrocorticography were comparable to those of recordings from epidural surface arrays. Venous internal lumen patency was maintained for the duration of implantation. Stentrodes may have wide ranging applications as a neural interface for treatment of a range of neurological conditions.
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14
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Strobbe G, Carrette E, López JD, Montes Restrepo V, Van Roost D, Meurs A, Vonck K, Boon P, Vandenberghe S, van Mierlo P. Electrical source imaging of interictal spikes using multiple sparse volumetric priors for presurgical epileptogenic focus localization. NEUROIMAGE-CLINICAL 2016; 11:252-263. [PMID: 26958464 PMCID: PMC4773507 DOI: 10.1016/j.nicl.2016.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/09/2015] [Accepted: 01/17/2016] [Indexed: 11/07/2022]
Abstract
Electrical source imaging of interictal spikes observed in EEG recordings of patients with refractory epilepsy provides useful information to localize the epileptogenic focus during the presurgical evaluation. However, the selection of the time points or time epochs of the spikes in order to estimate the origin of the activity remains a challenge. In this study, we consider a Bayesian EEG source imaging technique for distributed sources, i.e. the multiple volumetric sparse priors (MSVP) approach. The approach allows to estimate the time courses of the intensity of the sources corresponding with a specific time epoch of the spike. Based on presurgical averaged interictal spikes in six patients who were successfully treated with surgery, we estimated the time courses of the source intensities for three different time epochs: (i) an epoch starting 50 ms before the spike peak and ending at 50% of the spike peak during the rising phase of the spike, (ii) an epoch starting 50 ms before the spike peak and ending at the spike peak and (iii) an epoch containing the full spike time period starting 50 ms before the spike peak and ending 230 ms after the spike peak. To identify the primary source of the spike activity, the source with the maximum energy from 50 ms before the spike peak till 50% of the spike peak was subsequently selected for each of the time windows. For comparison, the activity at the spike peaks and at 50% of the peaks was localized using the LORETA inversion technique and an ECD approach. Both patient-specific spherical forward models and patient-specific 5-layered finite difference models were considered to evaluate the influence of the forward model. Based on the resected zones in each of the patients, extracted from post-operative MR images, we compared the distances to the resection border of the estimated activity. Using the spherical models, the distances to the resection border for the MSVP approach and each of the different time epochs were in the same range as the LORETA and ECD techniques. We found distances smaller than 23 mm, with robust results for all the patients. For the finite difference models, we found that the distances to the resection border for the MSVP inversions of the full spike time epochs were generally smaller compared to the MSVP inversions of the time epochs before the spike peak. The results also suggest that the inversions using the finite difference models resulted in slightly smaller distances to the resection border compared to the spherical models. The results we obtained are promising because the MSVP approach allows to study the network of the estimated source-intensities and allows to characterize the spatial extent of the underlying sources. A Bayesian ESI technique is evaluated to localize interictal spike activity. Averaged spikes in six patients were used that were seizure free after surgery. We compared the technique with the LORETA an ECD technique. We evaluated both spherical and 5-layered finite difference forward models. Our approach is potentially useful to delineate the irritative zone.
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Affiliation(s)
- Gregor Strobbe
- Ghent University, Department of Electronics and Information Systems, MEDISIP, De Pintelaan 185, Building BB Floor 5, 9000 Ghent, Belgium; iMinds Medical IT Department, Belgium.
| | - Evelien Carrette
- Laboratory for Clinical and Experimental Neurophysiology, Ghent University Hospital, Ghent, Belgium.
| | - José David López
- SISTEMIC, Department of Electronic Engineering, Universidad de Antioquia UDEA, Calle 70 No. 52-21,Medellín, Colombia.
| | - Victoria Montes Restrepo
- Ghent University, Department of Electronics and Information Systems, MEDISIP, De Pintelaan 185, Building BB Floor 5, 9000 Ghent, Belgium; iMinds Medical IT Department, Belgium
| | - Dirk Van Roost
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium.
| | - Alfred Meurs
- Laboratory for Clinical and Experimental Neurophysiology, Ghent University Hospital, Ghent, Belgium.
| | - Kristl Vonck
- Laboratory for Clinical and Experimental Neurophysiology, Ghent University Hospital, Ghent, Belgium.
| | - Paul Boon
- Laboratory for Clinical and Experimental Neurophysiology, Ghent University Hospital, Ghent, Belgium.
| | - Stefaan Vandenberghe
- Ghent University, Department of Electronics and Information Systems, MEDISIP, De Pintelaan 185, Building BB Floor 5, 9000 Ghent, Belgium; iMinds Medical IT Department, Belgium.
| | - Pieter van Mierlo
- Ghent University, Department of Electronics and Information Systems, MEDISIP, De Pintelaan 185, Building BB Floor 5, 9000 Ghent, Belgium; iMinds Medical IT Department, Belgium.
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15
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He BD, Ebrahimi M, Palafox L, Srinivasan L. Signal quality of endovascular electroencephalography. J Neural Eng 2016; 13:016016. [DOI: 10.1088/1741-2560/13/1/016016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Shibata S, Kunieda T, Inano R, Sawada M, Yamao Y, Kikuchi T, Matsumoto R, Ikeda A, Takahashi R, Mikuni N, Takahashi J, Miyamoto S. Risk Factors for Infective Complications with Long-Term Subdural Electrode Implantation in Patients with Medically Intractable Partial Epilepsy. World Neurosurg 2015; 84:320-6. [DOI: 10.1016/j.wneu.2015.03.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/25/2022]
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17
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Teplitzky BA, Connolly AT, Bajwa JA, Johnson MD. Computational modeling of an endovascular approach to deep brain stimulation. J Neural Eng 2014; 11:026011. [PMID: 24608363 DOI: 10.1088/1741-2560/11/2/026011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) therapy currently relies on a transcranial neurosurgical technique to implant one or more electrode leads into the brain parenchyma. In this study, we used computational modeling to investigate the feasibility of using an endovascular approach to target DBS therapy. APPROACH Image-based anatomical reconstructions of the human brain and vasculature were used to identify 17 established and hypothesized anatomical targets of DBS, of which five were found adjacent to a vein or artery with intraluminal diameter ≥1 mm. Two of these targets, the fornix and subgenual cingulate white matter (SgCwm) tracts, were further investigated using a computational modeling framework that combined segmented volumes of the vascularized brain, finite element models of the tissue voltage during DBS, and multi-compartment axon models to predict the direct electrophysiological effects of endovascular DBS. MAIN RESULTS The models showed that: (1) a ring-electrode conforming to the vessel wall was more efficient at neural activation than a guidewire design, (2) increasing the length of a ring-electrode had minimal effect on neural activation thresholds, (3) large variability in neural activation occurred with suboptimal placement of a ring-electrode along the targeted vessel, and (4) activation thresholds for the fornix and SgCwm tracts were comparable for endovascular and stereotactic DBS, though endovascular DBS was able to produce significantly larger contralateral activation for a unilateral implantation. SIGNIFICANCE Together, these results suggest that endovascular DBS can serve as a complementary approach to stereotactic DBS in select cases.
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Affiliation(s)
- Benjamin A Teplitzky
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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18
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Mikuni N, Miyamoto S, Ikeda A, Satow T, Taki J, Takahashi J, Ohigashi Y, Hashimoto N. Subtemporal Hippocampectomy Preserving the Basal Temporal Language Area for Intractable Mesial Temporal Lobe Epilepsy: Preliminary Results. Epilepsia 2006; 47:1347-53. [PMID: 16922880 DOI: 10.1111/j.1528-1167.2006.00610.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Decline in verbal memory as a surgical complication remains an unresolved problem in mesial temporal lobe epilepsy. Some areas in the temporal lobe associated with the language function, often including the basal temporal language area, have been removed or transected by conventional surgical procedures. The authors defined the basal temporal language area and removed only the epileptogenic zone with a subtemporal approach. METHODS The basal temporal language area was evaluated by using long-term subdural electrodes in five patients with language-dominant-side mesial temporal lobe epilepsy. While preserving this area, the hippocampus and the parahippocampal gyrus were removed by using a combined subtemporal, transventricular, transchoroidal fissure approach. Verbal memory performance was assessed with the Wechsler Memory Scale-Revised (WMS-R) before and after the operation. RESULTS The basal temporal language area, defined as a part of the inferior temporal gyrus, the fusiform gyrus, and the parahippocampal gyrus, was spared by entering the temporal horn via collateral sulcus. Verbal memory was significantly improved by 3 months and 1 year after the operation. CONCLUSIONS In language-dominant-side mesial temporal lobe epilepsy, preserving the basal temporal language area would have potential to improve verbal memory outcomes after removal of the epileptogenic zone.
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Affiliation(s)
- Nobuhiro Mikuni
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Kunieda T, Ikeda A, Mikuni N, Ohara S, Sadato A, Taki W, Hashimoto N, Shibasaki H. Use of cavernous sinus EEG in the detection of seizure onset and spread in mesial temporal lobe epilepsy. Epilepsia 2000; 41:1411-9. [PMID: 11077454 DOI: 10.1111/j.1528-1157.2000.tb00116.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The study goal was to evaluate the clinical usefulness of intravenous EEG recording by placing wire electrodes in the cavernous sinus (CS) and the superior petrosal sinus (SPS) in patients with intractable temporal lobe epilepsy (TLE), with special emphasis on the ictal recording. METHODS We placed Seeker Lite-10 guide wire as electrodes in the bilateral CS, SPS, or both to simultaneously record both ictal and interictal EEGs with the scalp EEG in five patients with TLE. In addition, in one patient, we averaged interictal scalp and intravascular EEG time-locked to the epileptiform discharge recorded from the CS/SPS-EEG to further delineate the relationship of the spikes between scalp and intravenous recording. RESULTS In four of five patients, clinically useful recording was obtained to determine ictal focus. We recorded habitual seizures in three patients, and the detailed characteristics of ictal epileptiform discharges were shown. The averaged waveform of interictal epileptiform discharges clarified the spike distribution in the scalp EEGs, which was otherwise undetectable in the single trace. All of the patients completed the intravenous EEG monitoring without any neurological or psychological problems. CONCLUSIONS The CS/SPS-EEG is a relatively noninvasive method that is useful for the detection of ictal focus and its spreading pattern and thus for the selection of surgical candidate among patients with intractable TLE. Although the number of seizures detected during the short monitoring period may be limited, due to the advantages of its safety and simplicity, it is worth trying for potential surgical candidates before more invasive examinations are applied. A further study with a larger number of patients is needed to estimate its practical risk.
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Affiliation(s)
- T Kunieda
- Departments of Neurology, Neurosurgery and Brain Pathophysiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Mikuni N, Ikeda A, Terada K, Taki W, Kikuchi H, Kimura J, Sengoku A, Shibasaki H. Frontopolar ictal epileptiform discharges on scalp electroencephalogram in temporal lobe epilepsy. J Clin Neurophysiol 1997; 14:507-12. [PMID: 9458057 DOI: 10.1097/00004691-199711000-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report 3 patients with medically intractable complex partial seizures (CPS) arising from the temporal lobe judged by surgical outcome, in whom scalp electroencephalogram (EEG) showed ictal epileptiform discharges at the frontopolar region. In all patients, results of cranial magnetic resonance imaging (MRI), positron emission tomography (PET), and ictal single photon emission computed tomography (SPECT) were consistent with those of temporal lobe epilepsy (TLE). The epileptogenic area was defined in the temporal lobe by chronic subdural recording in 2 patients. After surgical treatment (amygdalohippocampectomy, anterior temporal lobectomy, and temporal lesionectomy, respectively), all 3 patients became seizure-free and the interictal frontopolar epileptiform discharges on scalp EEG disappeared. Patients with TLE may show ictal scalp EEG with frontopolar onset. This is most likely explained by direction of dipolar orientation of epileptiform discharges in 1 of our patients; rapid spread of ictal activity to the frontopolar area can also be considered in the 2.
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Affiliation(s)
- N Mikuni
- Department of Brain Pathophysiology, Kyoto University School of Medicine, Japan
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