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Barrit S, El Hadwe S, Al Barajraji M, Torcida N, Bogossian EG, André J, Niset A, Carron R, Taccone FS, Madsen J. Complications of Intracranial Multimodal Monitoring for Neurocritical Care: A Systematic Review and Meta-Analysis. Neurocrit Care 2024; 40:1182-1192. [PMID: 37991675 DOI: 10.1007/s12028-023-01885-0] [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] [Received: 06/06/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023]
Abstract
Intracranial multimodal monitoring (iMMM) is increasingly used for neurocritical care. However, concerns arise regarding iMMM invasiveness considering limited evidence in its clinical significance and safety profile. We conducted a synthesis of evidence regarding complications associated with iMMM to delineate its safety profile. We performed a systematic review and meta-analysis (PROSPERO Registration Number: CRD42021225951) according to the Preferred Reporting Items for Systematic Review and Meta-Analysis and Peer Review of Electronic Search Strategies guidelines to retrieve evidence from studies reporting iMMM use in humans that mention related complications. We assessed risk of bias using the Newcastle-Ottawa Scale and funnel plots. The primary outcomes were iMMM complications. The secondary outcomes were putative risk factors. Of the 366 screened articles, 60 met the initial criteria and were further assessed by full-text reading. We included 22 studies involving 1206 patients and 1434 iMMM placements. Most investigators used a bolt system (85.9%) and a three-lumen device (68.8%), mainly inserting iMMM into the most injured hemisphere (77.9%). A total of 54 postoperative intracranial hemorrhages (pooled rate of 4%; 95% confidence interval [CI] 0-10%; I2 86%, p < 0.01 [random-effects model]) was reported, along with 46 misplacements (pooled rate of 6%; 95% CI 1-12%; I2 78%, p < 0.01) and 16 central nervous system infections (pooled rate of 0.43%; 95% CI 0-2%; I2 64%, p < 0.01). We found 6 system breakings, 18 intracranial bone fragments, and 5 cases of pneumocephalus. Currently, iMMM systems present a similar safety profile as intracranial devices commonly used in neurocritical care. Long-term outcomes of prospective studies will complete the benefit-risk assessment of iMMM in neurocritical care. Consensus-based reporting guidelines on iMMM use are needed to bolster future collaborative efforts.
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Affiliation(s)
- Sami Barrit
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
- Neurodynamics Laboratory, Department of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
- Institut Des Neurosciences du Système, Aix Marseille Université, INSERM - Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France.
- Neurocore, Consciense Foundation, Brussels, Belgium.
| | - Salim El Hadwe
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Neurocore, Consciense Foundation, Brussels, Belgium
| | - Mejdeddine Al Barajraji
- Neurocore, Consciense Foundation, Brussels, Belgium
- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Nathan Torcida
- Neurocore, Consciense Foundation, Brussels, Belgium
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Gouvêa Bogossian
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Joachim André
- Neurocore, Consciense Foundation, Brussels, Belgium
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Niset
- Neurocore, Consciense Foundation, Brussels, Belgium
- Department of Emergency, Hôpital Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Romain Carron
- Institut Des Neurosciences du Système, Aix Marseille Université, INSERM - Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France
- Neurocore, Consciense Foundation, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Madsen
- Neurodynamics Laboratory, Department of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Neurocore, Consciense Foundation, Brussels, Belgium
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2
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Zhang A, Mandeville ET, Xu L, Stary CM, Lo EH, Lieber CM. Ultraflexible endovascular probes for brain recording through micrometer-scale vasculature. Science 2023; 381:306-312. [PMID: 37471542 PMCID: PMC11412271 DOI: 10.1126/science.adh3916] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/19/2023] [Indexed: 07/22/2023]
Abstract
Implantable neuroelectronic interfaces have enabled advances in both fundamental research and treatment of neurological diseases but traditional intracranial depth electrodes require invasive surgery to place and can disrupt neural networks during implantation. We developed an ultrasmall and flexible endovascular neural probe that can be implanted into sub-100-micrometer-scale blood vessels in the brains of rodents without damaging the brain or vasculature. In vivo electrophysiology recording of local field potentials and single-unit spikes have been selectively achieved in the cortex and olfactory bulb. Histology analysis of the tissue interface showed minimal immune response and long-term stability. This platform technology can be readily extended as both research tools and medical devices for the detection and intervention of neurological diseases.
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Affiliation(s)
- Anqi Zhang
- Department of Chemical Engineering and Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA
| | - Emiri T Mandeville
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Boston, MA 02129, USA
| | - Lijun Xu
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Creed M Stary
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Eng H Lo
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Boston, MA 02129, USA
| | - Charles M Lieber
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA
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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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John SE, Donegan S, Scordas TC, Qi W, Sharma P, Liyanage K, Wilson S, Birchall I, Ooi A, Oxley TJ, May CN, Grayden DB, Opie NL. Vascular remodeling in sheep implanted with endovascular neural interface. J Neural Eng 2022; 19. [PMID: 36240737 DOI: 10.1088/1741-2552/ac9a77] [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: 09/01/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Abstract
Objective.The aim of this work was to assess vascular remodeling after the placement of an endovascular neural interface (ENI) in the superior sagittal sinus (SSS) of sheep. We also assessed the efficacy of neural recording using an ENI.Approach.The study used histological analysis to assess the composition of the foreign body response. Micro-CT images were analyzed to assess the profiles of the foreign body response and create a model of a blood vessel. Computational fluid dynamic modeling was performed on a reconstructed blood vessel to evaluate the blood flow within the vessel. Recording of brain activity in sheep was used to evaluate efficacy of neural recordings.Main results.Histological analysis showed accumulated extracellular matrix material in and around the implanted ENI. The extracellular matrix contained numerous macrophages, foreign body giant cells, and new vascular channels lined by endothelium. Image analysis of CT slices demonstrated an uneven narrowing of the SSS lumen proportional to the stent material within the blood vessel. However, the foreign body response did not occlude blood flow. The ENI was able to record epileptiform spiking activity with distinct spike morphologies.Significance. This is the first study to show high-resolution tissue profiles, the histological response to an implanted ENI and blood flow dynamic modeling based on blood vessels implanted with an ENI. The results from this study can be used to guide surgical planning and future ENI designs; stent oversizing parameters to blood vessel diameter should be considered to minimize detrimental vascular remodeling.
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Affiliation(s)
- Sam E John
- The Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Sam Donegan
- The Department of Medicine, University of Melbourne, Victoria, Australia
| | - Theodore C Scordas
- The Department of Medicine, University of Melbourne, Victoria, Australia
| | - Weijie Qi
- The Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Prayshita Sharma
- The Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia
| | - Kishan Liyanage
- The Department of Medicine, University of Melbourne, Victoria, Australia
| | - Stefan Wilson
- The Department of Medicine, University of Melbourne, Victoria, Australia
| | - Ian Birchall
- Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Andrew Ooi
- The Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Thomas J Oxley
- The Department of Medicine, University of Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Clive N May
- Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - David B Grayden
- The Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia.,Graeme Clark Institute for Biomedical Engineering, University of Melbourne, Victoria, Australia
| | - Nicholas L Opie
- The Department of Medicine, University of Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Victoria, Australia
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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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6
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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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7
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Raza SA, Opie NL, Morokoff A, Sharma RP, Mitchell PJ, Oxley TJ. Endovascular Neuromodulation: Safety Profile and Future Directions. Front Neurol 2020; 11:351. [PMID: 32390937 PMCID: PMC7193719 DOI: 10.3389/fneur.2020.00351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
Endovascular neuromodulation is an emerging technology that represents a synthesis between interventional neurology and neural engineering. The prototypical endovascular neural interface is the StentrodeTM, a stent-electrode array which can be implanted into the superior sagittal sinus via percutaneous catheter venography, and transmits signals through a transvenous lead to a receiver located subcutaneously in the chest. Whilst the StentrodeTM has been conceptually validated in ovine models, questions remain about the long term viability and safety of this device in human recipients. Although technical precedence for venous sinus stenting already exists in the setting of idiopathic intracranial hypertension, long term implantation of a lead within the intracranial veins has never been previously achieved. Contrastingly, transvenous leads have been successfully employed for decades in the setting of implantable cardiac pacemakers and defibrillators. In the current absence of human data on the StentrodeTM, the literature on these structurally comparable devices provides valuable lessons that can be translated to the setting of endovascular neuromodulation. This review will explore this literature in order to understand the potential risks of the StentrodeTM and define avenues where further research and development are necessary in order to optimize this device for human application.
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Affiliation(s)
- Samad A Raza
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Nicholas L Opie
- Department of Medicine, Vascular Bionics Laboratory, Melbourne Brain Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rahul P Sharma
- Interventional Cardiology, Stanford Health Care, Palo Alto, CA, United States
| | - Peter J Mitchell
- Department of Radiology, The University of Melbourne & The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thomas J Oxley
- Department of Medicine, Vascular Bionics Laboratory, Melbourne Brain Centre, The University of Melbourne, Melbourne, VIC, Australia.,Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
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8
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Affiliation(s)
- Sam E John
- Department of Biomedical Engineering, The University of Melbourne , Melbourne , Australia
| | - David B Grayden
- Department of Biomedical Engineering, The University of Melbourne , Melbourne , Australia
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Choi JR, Kim SM, Ryu RH, Kim SP, Sohn JW. Implantable Neural Probes for Brain-Machine Interfaces - Current Developments and Future Prospects. Exp Neurobiol 2018; 27:453-471. [PMID: 30636899 PMCID: PMC6318554 DOI: 10.5607/en.2018.27.6.453] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Abstract
A Brain-Machine interface (BMI) allows for direct communication between the brain and machines. Neural probes for recording neural signals are among the essential components of a BMI system. In this report, we review research regarding implantable neural probes and their applications to BMIs. We first discuss conventional neural probes such as the tetrode, Utah array, Michigan probe, and electroencephalography (ECoG), following which we cover advancements in next-generation neural probes. These next-generation probes are associated with improvements in electrical properties, mechanical durability, biocompatibility, and offer a high degree of freedom in practical settings. Specifically, we focus on three key topics: (1) novel implantable neural probes that decrease the level of invasiveness without sacrificing performance, (2) multi-modal neural probes that measure both electrical and optical signals, (3) and neural probes developed using advanced materials. Because safety and precision are critical for practical applications of BMI systems, future studies should aim to enhance these properties when developing next-generation neural probes.
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Affiliation(s)
- Jong-Ryul Choi
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea
| | - Seong-Min Kim
- Department of Medical Science, College of Medicine, Catholic Kwandong University, Gangneung 25601, Korea.,Biomedical Research Institute, Catholic Kwandong University International St. Mary's Hospital, Incheon 21711, Korea
| | - Rae-Hyung Ryu
- Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea
| | - Sung-Phil Kim
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Korea
| | - Jeong-Woo Sohn
- Department of Medical Science, College of Medicine, Catholic Kwandong University, Gangneung 25601, Korea.,Biomedical Research Institute, Catholic Kwandong University International St. Mary's Hospital, Incheon 21711, Korea
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10
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Opie NL, John SE, Rind GS, Ronayne SM, May CN, Grayden DB, Oxley TJ. Effect of Implant Duration, Anatomical Location and Electrode Orientation on Bandwidth Recorded with a Chronically Implanted Endovascular Stent-Electrode Array. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1074-1077. [PMID: 30440577 DOI: 10.1109/embc.2018.8512385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Access to the brain to implant recording electrodes has conventionally required a craniotomy. To mitigate risks of open brain surgery, we previously developed a stent-electrode array that can be delivered to the cortex via cerebral vessels. Following implantation of a stent-electrode array (Stentrode) in a large animal model, we investigated the longevity of highquality signals, by measuring bandwidth in animals implanted for up to six months; no signal degradation was observed. We also investigated whether bandwidth was influenced by implant location with respect to the superior sagittal sinus and branching cortical veins; it was not. Finally, we assessed whether electrode orientation had an impact on recording quality. There was no significant difference in bandwidths from electrodes facing different orientations. Interestingly, electrodes facing the skull (180°) were still able to record neural information with high fidelity. Consequently, a minimally invasive surgical approach combined with a stent-electrode array is a safe and efficacious technique to acquire neural signals over a chronic duration.
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Mehrali M, Bagherifard S, Akbari M, Thakur A, Mirani B, Mehrali M, Hasany M, Orive G, Das P, Emneus J, Andresen TL, Dolatshahi‐Pirouz A. Blending Electronics with the Human Body: A Pathway toward a Cybernetic Future. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2018; 5:1700931. [PMID: 30356969 PMCID: PMC6193179 DOI: 10.1002/advs.201700931] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/24/2018] [Indexed: 05/22/2023]
Abstract
At the crossroads of chemistry, electronics, mechanical engineering, polymer science, biology, tissue engineering, computer science, and materials science, electrical devices are currently being engineered that blend directly within organs and tissues. These sophisticated devices are mediators, recorders, and stimulators of electricity with the capacity to monitor important electrophysiological events, replace disabled body parts, or even stimulate tissues to overcome their current limitations. They are therefore capable of leading humanity forward into the age of cyborgs, a time in which human biology can be hacked at will to yield beings with abilities beyond their natural capabilities. The resulting advances have been made possible by the emergence of conformal and soft electronic materials that can readily integrate with the curvilinear, dynamic, delicate, and flexible human body. This article discusses the recent rapid pace of development in the field of cybernetics with special emphasis on the important role that flexible and electrically active materials have played therein.
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Affiliation(s)
- Mehdi Mehrali
- Technical University of DenmarkDTU NanotechCenter for Nanomedicine and Theranostics2800KgsDenmark
| | - Sara Bagherifard
- Department of Mechanical EngineeringPolitecnico di Milano20156MilanItaly
| | - Mohsen Akbari
- Laboratory for Innovations in MicroEngineering (LiME)Department of Mechanical EngineeringUniversity of VictoriaVictoriaBCV8P 5C2Canada
- Center for Biomedical ResearchUniversity of VictoriaVictoriaV8P 5C2Canada
- Center for Advanced Materials and Related Technologies (CAMTEC)University of VictoriaVictoriaV8P 5C2Canada
| | - Ashish Thakur
- Technical University of DenmarkDTU NanotechCenter for Nanomedicine and Theranostics2800KgsDenmark
| | - Bahram Mirani
- Laboratory for Innovations in MicroEngineering (LiME)Department of Mechanical EngineeringUniversity of VictoriaVictoriaBCV8P 5C2Canada
- Center for Biomedical ResearchUniversity of VictoriaVictoriaV8P 5C2Canada
- Center for Advanced Materials and Related Technologies (CAMTEC)University of VictoriaVictoriaV8P 5C2Canada
| | - Mohammad Mehrali
- Process and Energy DepartmentDelft University of TechnologyLeeghwaterstraat 392628CBDelftThe Netherlands
| | - Masoud Hasany
- Technical University of DenmarkDTU NanotechCenter for Nanomedicine and Theranostics2800KgsDenmark
| | - Gorka Orive
- NanoBioCel GroupLaboratory of PharmaceuticsSchool of PharmacyUniversity of the Basque Country UPV/EHUPaseo de la Universidad 701006Vitoria‐GasteizSpain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine (CIBER‐BBN)Vitoria‐Gasteiz28029Spain
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU‐Fundación Eduardo Anitua)Vitoria01007Spain
| | - Paramita Das
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Jenny Emneus
- Technical University of DenmarkDTU Nanotech2800KgsDenmark
| | - Thomas L. Andresen
- Technical University of DenmarkDTU NanotechCenter for Nanomedicine and Theranostics2800KgsDenmark
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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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Rajah G, Saber H, Singh R, Rangel-Castilla L. Endovascular delivery of leads and stentrodes and their applications to deep brain stimulation and neuromodulation: a review. Neurosurg Focus 2018; 45:E19. [DOI: 10.3171/2018.4.focus18130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neuromodulation and deep brain stimulation (DBS) have been increasingly used in many neurological ailments, including essential tremor, Parkinson’s disease, epilepsy, and more. Yet for many patients and practitioners the desire to utilize these therapies is met with caution, given the need for craniotomy, lead insertion through brain parenchyma, and, at many times, bilateral invasive procedures. Currently endovascular therapy is a standard of care for emergency thrombectomy, aneurysm treatment, and other vascular malformation/occlusive disease of the cerebrum. Endovascular techniques and delivery catheters have advanced greatly in both their ability to safely reach remote brain locations and deliver devices. In this review the authors discuss minimally invasive endovascular delivery of devices and neural stimulating and recording from cortical and DBS targets via the neurovascular network.
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Affiliation(s)
- Gary Rajah
- Departments of 1Neurosurgery and
- 3Wayne State University School of Medicine, Detroit, Michigan; and
| | - Hamidreza Saber
- 2Neurology, Wayne State University, and
- 3Wayne State University School of Medicine, Detroit, Michigan; and
| | - Rasanjeet Singh
- 3Wayne State University School of Medicine, Detroit, Michigan; and
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Won SM, Song E, Zhao J, Li J, Rivnay J, Rogers JA. Recent Advances in Materials, Devices, and Systems for Neural Interfaces. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:e1800534. [PMID: 29855089 DOI: 10.1002/adma.201800534] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/28/2018] [Indexed: 06/08/2023]
Abstract
Technologies capable of establishing intimate, long-lived optical/electrical interfaces to neural systems will play critical roles in neuroscience research and in the development of nonpharmacological treatments for neurological disorders. The development of high-density interfaces to 3D populations of neurons across entire tissue systems in living animals, including human subjects, represents a grand challenge for the field, where advanced biocompatible materials and engineered structures for electrodes and light emitters will be essential. This review summarizes recent progress in these directions, with an emphasis on the most promising demonstrated concepts, materials, devices, and systems. The article begins with an overview of electrode materials with enhanced electrical and/or mechanical performance, in forms ranging from planar films, to micro/nanostructured surfaces, to 3D porous frameworks and soft composites. Subsequent sections highlight integration with active materials and components for multiplexed addressing, local amplification, wireless data transmission, and power harvesting, with multimodal operation in soft, shape-conformal systems. These advances establish the foundations for scalable architectures in optical/electrical neural interfaces of the future, where a blurring of the lines between biotic and abiotic systems will catalyze profound progress in neuroscience research and in human health/well-being.
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Affiliation(s)
- Sang Min Won
- Department of Electrical and Computer Engineering, Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
| | - Enming Song
- Department of Materials Science and Engineering, Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana Champaign, Northwestern University, Evanston, IL, 60208, USA
| | - Jianing Zhao
- Department of Mechanical Science and Engineering, Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
| | - Jinghua Li
- Department of Materials Science and Engineering, Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana Champaign, Northwestern University, Evanston, IL, 60208, USA
| | - Jonathan Rivnay
- Department of Biomedical Engineering, Simpson Querrey Institute for Nanobiotechnology, Northwestern University, Evanston, IL, 60208, USA
| | - John A Rogers
- Center for Bio-Integrated Electronics, Department of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, and Neurological Surgery, Simpson Querrey Institute for Nano/biotechnology, McCormick School of Engineering and Feinberg School of Medicine, Northwestern University, Evanston, IL, 60208, USA
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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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Lebedev MA, Nicolelis MAL. Brain-Machine Interfaces: From Basic Science to Neuroprostheses and Neurorehabilitation. Physiol Rev 2017; 97:767-837. [PMID: 28275048 DOI: 10.1152/physrev.00027.2016] [Citation(s) in RCA: 235] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Brain-machine interfaces (BMIs) combine methods, approaches, and concepts derived from neurophysiology, computer science, and engineering in an effort to establish real-time bidirectional links between living brains and artificial actuators. Although theoretical propositions and some proof of concept experiments on directly linking the brains with machines date back to the early 1960s, BMI research only took off in earnest at the end of the 1990s, when this approach became intimately linked to new neurophysiological methods for sampling large-scale brain activity. The classic goals of BMIs are 1) to unveil and utilize principles of operation and plastic properties of the distributed and dynamic circuits of the brain and 2) to create new therapies to restore mobility and sensations to severely disabled patients. Over the past decade, a wide range of BMI applications have emerged, which considerably expanded these original goals. BMI studies have shown neural control over the movements of robotic and virtual actuators that enact both upper and lower limb functions. Furthermore, BMIs have also incorporated ways to deliver sensory feedback, generated from external actuators, back to the brain. BMI research has been at the forefront of many neurophysiological discoveries, including the demonstration that, through continuous use, artificial tools can be assimilated by the primate brain's body schema. Work on BMIs has also led to the introduction of novel neurorehabilitation strategies. As a result of these efforts, long-term continuous BMI use has been recently implicated with the induction of partial neurological recovery in spinal cord injury patients.
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Opie NL, John SE, Rind GS, Ronayne SM, Grayden DB, Burkitt AN, May CN, O'Brien TJ, Oxley TJ. Chronic impedance spectroscopy of an endovascular stent-electrode array. J Neural Eng 2016; 13:046020. [PMID: 27378157 DOI: 10.1088/1741-2560/13/4/046020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Recently, we reported a minimally invasive stent-electrode array capable of recording neural signals from within a blood vessel. We now investigate the use of electrochemical impedance spectroscopy (EIS) measurements to infer changes occurring to the electrode-tissue interface from devices implanted in a cohort of sheep for up to 190 days. APPROACH In a cohort of 15 sheep, endovascular stent-electrode arrays were implanted in the superior sagittal sinus overlying the motor cortex for up to 190 days. EIS was performed routinely to quantify viable electrodes for up to 91 days. An equivalent circuit model (ECM) was developed from the in vivo measurements to characterize the electrode-tissue interface changes occurring to the electrodes chronically implanted within a blood vessel. Post-mortem histological assessment of stent and electrode incorporation into the wall of the cortical vessels was compared to the electrical impedance measurements. MAIN RESULTS EIS could be used to infer electrode viability and was consistent with x-ray analysis performed in vivo, and post-mortem evaluation. Viable electrodes exhibited consistent 1 kHz impedances across the 91 day measurement period, with the peak resistance frequency for the acquired data also stable over time. There was a significant change in 100 Hz phase angles, increasing from -67.8° ± 8.8° at day 0 to -43.8° ± 0.8° at day 91, which was observed to stabilize after eight days. ECM's modeled to the data suggested this change was due to an increase in the capacitance of the electrode-tissue interface. This was supported by histological assessment with >85% of the implanted stent struts covered with neointima and incorporated into the blood vessel within two weeks. CONCLUSION This work demonstrated that EIS could be used to determine the viability of electrode implanted chronically within a blood vessel. Impedance measurements alone were not observed to be a useful predictor of alterations occurring at the electrode tissue interface. However, measurement of 100 Hz phase angles was in good agreement with the capacitive changes predicted by the ECM and consistent with suggestions that this represents protein absorption on the electrode surface. 100 Hz phase angles stabilized after 8 days, consistent with histologically assessed samples. SIGNIFICANCE These findings demonstrate the potential application of this technology for use as a chronic neural recording system and indicate the importance of conducting EIS as a measure to identify viable electrodes and changes occurring at the electrode-tissue interface.
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Affiliation(s)
- Nicholas L Opie
- Vascular Bionics Laboratory, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, 3010, Australia. The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, 3010, Australia. The Department of Electrical and Electronic Engineering, The University of Melbourne, Victoria, 3052, Australia
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