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Woolnough O, Tandon N. Dissociation of reading and naming in ventral occipitotemporal cortex. Brain 2024; 147:2522-2529. [PMID: 38289871 PMCID: PMC11224612 DOI: 10.1093/brain/awae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/22/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024] Open
Abstract
Lesions in the language-dominant ventral occipitotemporal cortex (vOTC) can result in selective impairment of either reading or naming, resulting in alexia or anomia. Yet, functional imaging studies that show differential activation for naming and reading do not reveal activity exclusively tuned to one of these inputs. To resolve this dissonance in the functional architecture of the vOTC, we used focused stimulation to the vOTC in 49 adult patients during reading and naming, and generated a population-level, probabilistic map to evaluate if reading and naming are clearly dissociable within individuals. Language mapping (50 Hz, 2829 stimulations) was performed during passage reading (216 positive sites) and visual naming (304 positive sites). Within the vOTC, we isolated sites that selectively disrupted reading (24 sites in 11 patients) or naming (27 sites in 12 patients), and those that disrupted both processes (75 sites in 21 patients). The anteromedial vOTC had a higher probability of producing naming disruption, while posterolateral regions resulted in greater reading-specific disruption. Between them lay a multi-modal region where stimulation disrupted both reading and naming. This work provides a comprehensive view of vOTC organization-the existence of a heteromodal cortex critical to both reading and naming, along with a causally dissociable unimodal naming cortex, and a reading-specific visual word form area in the vOTC. Their distinct roles as associative regions may thus relate to their connectivity within the broader language network that is disrupted by stimulation, more than to highly selective tuning properties. Our work also implies that pre-surgical mapping of both reading and naming is essential for patients requiring vOTC resections, as these functions are not co-localized, and such mapping may prevent the occurrence of unexpected deficits.
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Affiliation(s)
- Oscar Woolnough
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX 77030, USA
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX 77030, USA
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Memorial Hermann Hospital, Texas Medical Center, Houston, TX 77030, USA
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2
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Chiu MY, Bolton J, Raskin JS, Curry DJ, Weiner HL, Pearl PL, Stone S. In Search of a Common Language: The Standardized Electrode Nomenclature for Stereoelectroencephalography Applications. J Clin Neurophysiol 2024; 41:405-409. [PMID: 38935653 DOI: 10.1097/wnp.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Stereoelectroencephalography (SEEG) is widely performed on individuals with medically refractory epilepsy for whom invasive seizure localization is desired. Despite increasing adoption in many centers across the world, no standardized electrode naming convention exists, generating confusion among both clinical and research teams. METHODS We have developed a novel nomenclature, named the Standardized Electrode Nomenclature for SEEG Applications system. Concise, unique, informative, and unambiguous labels provide information about entry point, deep targets, and relationships between electrodes. Inter-rater agreement was evaluated by comparing original electrode names from 10 randomly sampled cases (including 136 electrodes) with those prospectively assigned by four additional blinded raters. RESULTS The Standardized Electrode Nomenclature for SEEG Application system was prospectively implemented in 40 consecutive patients undergoing SEEG monitoring at our institution, creating unique electrode names in all cases, and facilitating implantation design, SEEG recording and mapping interpretation, and treatment planning among neurosurgeons, neurologists, and neurophysiologists. The inter-rater percent agreement for electrode names among two neurosurgeons, two epilepsy neurologists, and one neurosurgical fellow was 97.5%. CONCLUSIONS This standardized naming convention, Standardized Electrode Nomenclature for SEEG Application, provides a simple, concise, reproducible, and informative method for specifying the target(s) and relative position of each SEEG electrode in each patient, allowing for successful sharing of information in both the clinical and research settings. General adoption of this nomenclature could pave the way for improved communication and collaboration between institutions.
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Affiliation(s)
- Michelle Y Chiu
- Epilepsy Division, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey Bolton
- Epilepsy Division, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey S Raskin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, U.S.A
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, U.S.A.; and
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, U.S.A.; and
| | - Phillip L Pearl
- Epilepsy Division, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Scellig Stone
- Epilepsy Surgery Program, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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Lacuey N, Talavera B, Magana-Tellez O, Mancera-Páez O, Hupp N, Luo X, Hampson JP, Hampson J, Rani RS, Ochoa-Urrea M, Alamoudi OA, Melius S, Pati S, Gavvala J, Tandon N, Mosher JC, Lhatoo SD. Ictal Central Apnea Is Predictive of Mesial Temporal Seizure Onset: An Intracranial Investigation. Ann Neurol 2024; 95:998-1008. [PMID: 38400804 PMCID: PMC11061876 DOI: 10.1002/ana.26888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/27/2023] [Accepted: 01/23/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Ictal central apnea (ICA) is a semiological sign of focal epilepsy, associated with temporal and frontal lobe seizures. In this study, using qualitative and quantitative approaches, we aimed to assess the localizational value of ICA. We also aimed to compare ICA clinical utility in relation to other seizure semiological features of focal epilepsy. METHODS We analyzed seizures in patients with medically refractory focal epilepsy undergoing intracranial stereotactic electroencephalographic (SEEG) evaluations with simultaneous multimodal cardiorespiratory monitoring. A total of 179 seizures in 72 patients with reliable artifact-free respiratory signal were analyzed. RESULTS ICA was seen in 55 of 179 (30.7%) seizures. Presence of ICA predicted a mesial temporal seizure onset compared to those without ICA (odds ratio = 3.8, 95% confidence interval = 1.3-11.6, p = 0.01). ICA specificity was 0.82. ICA onset was correlated with increased high-frequency broadband gamma (60-150Hz) activity in specific mesial or basal temporal regions, including amygdala, hippocampus, and fusiform and lingual gyri. Based on our results, ICA has an almost 4-fold greater association with mesial temporal seizure onset zones compared to those without ICA and is highly specific for mesial temporal seizure onset zones. As evidence of symptomatogenic areas, onset-synchronous increase in high gamma activity in mesial or basal temporal structures was seen in early onset ICA, likely representing anatomical substrates for ICA generation. INTERPRETATION ICA recognition may help anatomoelectroclinical localization of clinical seizure onset to specific mesial and basal temporal brain regions, and the inclusion of these regions in SEEG evaluations may help accurately pinpoint seizure onset zones for resection. ANN NEUROL 2024;95:998-1008.
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Affiliation(s)
- Nuria Lacuey
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Blanca Talavera
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Oman Magana-Tellez
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Oscar Mancera-Páez
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Norma Hupp
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Xi Luo
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
- Department of Biostatistics and Data Science, University of Texas Health Science Center (UTHealth), School of Public Health, Houston, Texas, USA
| | - Johnson P. Hampson
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Jaison Hampson
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - R. Sandhya Rani
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Manuela Ochoa-Urrea
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Omar A. Alamoudi
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
- Biomedical Engineering Program, Faculty of Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Stephen Melius
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Sandipan Pati
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Jay Gavvala
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Nitin Tandon
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - John C. Mosher
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Samden D. Lhatoo
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
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Kullmann A, Akberali F, Van Gompel JJ, McGovern RA, Marsh WR, Kridner D, Diaz-Botia CA, Park MC. Implantation accuracy of novel polyimide stereotactic electroencephalographic depth electrodes-a human cadaveric study. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1320762. [PMID: 38456122 PMCID: PMC10917981 DOI: 10.3389/fmedt.2024.1320762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Stereoelectroencephalography (sEEG) is a minimally invasive procedure that uses depth electrodes stereotactically implanted into brain structures to map the origin and propagation of seizures in epileptic patients. Implantation accuracy of sEEG electrodes plays a critical role in the safety and efficacy of the procedure. This study used human cadaver heads, simulating clinical practice, to evaluate (1) neurosurgeon's ability to implant a new thin-film polyimide sEEG electrode according to the instructions for use (IFU), and (2) implantation accuracy. Methods Four neurosurgeons (users) implanted 24 sEEG electrodes into two cadaver heads with the aid of the ROSA robotic system. Usability was evaluated using a questionnaire that assessed completion of all procedure steps per IFU and user errors. For implantation accuracy evaluation, planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative computer tomography (CT) images. Implantation accuracy was quantified using the Euclidean distance for entry point error (EPE) and target point error (TPE). Results All sEEG electrodes were successfully placed following the IFU without user errors, and post-implant survey of users showed favorable handling characteristics. The EPE was 1.28 ± 0.86 mm and TPE was 1.61 ± 0.89 mm. Long trajectories (>50 mm) had significantly larger EPEs and TPEs than short trajectories (<50 mm), and no differences were found between orthogonal and oblique trajectories. Accuracies were similar or superior to those reported in the literature when using similar experimental conditions, and in the same range as those reported in patients. Discussion The results demonstrate that newly developed polyimide sEEG electrodes can be implanted as accurately as similar devices in the marker without user errors when following the IFU in a simulated clinical environment. The human cadaver ex-vivo test system provided a realistic test system, owing to the size, anatomy and similarity of tissue composition to that of the live human brain.
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Affiliation(s)
- Aura Kullmann
- NeuroOne Medical Technologies, Eden Prairie, MN, United States
| | | | | | - Robert A. McGovern
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, MN, United States
| | - W. Richard Marsh
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Debra Kridner
- NeuroOne Medical Technologies, Eden Prairie, MN, United States
| | | | - Michael C. Park
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, MN, United States
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, United States
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Kaewborisutsakul A, Chernov M, Yokosako S, Kubota Y. Usefulness of Robotic Stereotactic Assistance (ROSA ®) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis. Neurol Med Chir (Tokyo) 2024; 64:71-86. [PMID: 38220166 PMCID: PMC10918457 DOI: 10.2176/jns-nmc.2023-0119] [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: 05/29/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
The aim of this study was to systematically review and meta-analyze the efficiency and safety of using the Robotic Stereotactic Assistance (ROSA®) device (Zimmer Biomet; Warsaw, IN, USA) for stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was carried out. Overall, 855 nonduplicate relevant articles were determined, and 15 of them were selected for analysis. The benefits of the ROSA® device use in terms of electrode placement accuracy, as well as operative time length, perioperative complications, and seizure outcomes, were evaluated. Studies that were included reported on a total of 11,257 SEEG electrode implantations. The limited number of comparative studies hindered the comprehensive evaluation of the electrode implantation accuracy. Compared with frame-based or navigation-assisted techniques, ROSA®-assisted SEEG electrode implantation provided significant benefits for reduction of both overall operative time (mean difference [MD], -63.45 min; 95% confidence interval [CI] from -88.73 to -38.17 min; P < 0.00001) and operative time per implanted electrode (MD, -8.79 min; 95% CI from -14.37 to -3.21 min; P = 0.002). No significant differences existed in perioperative complications and seizure outcomes after the application of the ROSA® device and other techniques for electrode implantation. To conclude, the available evidence shows that the ROSA® device is an effective and safe surgical tool for trajectory-guided SEEG electrode implantation in patients with drug-resistant epilepsy, offering benefits for saving operative time and neither increasing the risk of perioperative complications nor negatively impacting seizure outcomes.
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Affiliation(s)
- Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Division of Surgery, Faculty of Medicine, Prince of Songkla University
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Mikhail Chernov
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Suguru Yokosako
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
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Yu Z, Kachenoura A, Jeannès RLB, Shu H, Berraute P, Nica A, Merlet I, Albera L, Karfoul A. Electrophysiological brain imaging based on simulation-driven deep learning in the context of epilepsy. Neuroimage 2024; 285:120490. [PMID: 38103624 DOI: 10.1016/j.neuroimage.2023.120490] [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: 08/07/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Identifying the location, the spatial extent and the electrical activity of distributed brain sources in the context of epilepsy through ElectroEncephaloGraphy (EEG) recordings is a challenging task because of the highly ill-posed nature of the underlying Electrophysiological Source Imaging (ESI) problem. To guarantee a unique solution, most existing ESI methods pay more attention to solve this inverse problem by imposing physiological constraints. This paper proposes an efficient ESI approach based on simulation-driven deep learning. Epileptic High-resolution 256-channels scalp EEG (Hr-EEG) signals are simulated in a realistic manner to train the proposed patient-specific model. More particularly, a computational neural mass model developed in our team is used to generate the temporal dynamics of the activity of each dipole while the forward problem is solved using a patient-specific three-shell realistic head model and the boundary element method. A Temporal Convolutional Network (TCN) is considered in the proposed model to capture local spatial patterns. To enable the model to observe the EEG signals from different scale levels, the multi-scale strategy is leveraged to capture the overall features and fine-grain features by adjusting the convolutional kernel size. Then, the Long Short-Term Memory (LSTM) is used to extract temporal dependencies among the computed spatial features. The performance of the proposed method is evaluated through three different scenarios of realistic synthetic interictal Hr-EEG data as well as on real interictal Hr-EEG data acquired in three patients with drug-resistant partial epilepsy, during their presurgical evaluation. A performance comparison study is also conducted with two other deep learning-based methods and four classical ESI techniques. The proposed model achieved a Dipole Localization Error (DLE) of 1.39 and Normalized Hamming Distance (NHD) of 0.28 in the case of one patch with SNR of 10 dB. In the case of two uncorrelated patches with an SNR of 10 dB, obtained DLE and NHD were respectively 1.50 and 0.28. Even in the more challenging scenario of two correlated patches with an SNR of 10 dB, the proposed approach still achieved a DLE of 3.74 and an NHD of 0.43. The results obtained on simulated data demonstrate that the proposed method outperforms the existing methods for different signal-to-noise and source configurations. The good behavior of the proposed method is also confirmed on real interictal EEG data. The robustness with respect to noise makes it a promising and alternative tool to localize epileptic brain areas and to reconstruct their electrical activities from EEG signals.
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Affiliation(s)
- Zuyi Yu
- Laboratory of Image Science and Technology, Southeast University, Nanjing 210096, PR China; Jiangsu Provincial Joint International Research Laboratory of Medical Information Processing, Nanjing 210096, PR China; University Rennes, INSERM, LTSI-UMR 1099, Rennes F-35042, France; Centre de Recherche en Information Biomédicale Sino-français (CRIBs), Rennes F-35042, France
| | - Amar Kachenoura
- University Rennes, INSERM, LTSI-UMR 1099, Rennes F-35042, France; Centre de Recherche en Information Biomédicale Sino-français (CRIBs), Rennes F-35042, France
| | - Régine Le Bouquin Jeannès
- University Rennes, INSERM, LTSI-UMR 1099, Rennes F-35042, France; Centre de Recherche en Information Biomédicale Sino-français (CRIBs), Rennes F-35042, France
| | - Huazhong Shu
- Laboratory of Image Science and Technology, Southeast University, Nanjing 210096, PR China; Jiangsu Provincial Joint International Research Laboratory of Medical Information Processing, Nanjing 210096, PR China.
| | | | - Anca Nica
- University Rennes, INSERM, LTSI-UMR 1099, Rennes F-35042, France; Centre Hospitalier Universitaire (CHU) de Rennes, service de neurologie, pôle des neurosciences de Rennes, Rennes F-35042, France
| | - Isabelle Merlet
- University Rennes, INSERM, LTSI-UMR 1099, Rennes F-35042, France; Centre de Recherche en Information Biomédicale Sino-français (CRIBs), Rennes F-35042, France
| | - Laurent Albera
- University Rennes, INSERM, LTSI-UMR 1099, Rennes F-35042, France; Centre de Recherche en Information Biomédicale Sino-français (CRIBs), Rennes F-35042, France.
| | - Ahmad Karfoul
- University Rennes, INSERM, LTSI-UMR 1099, Rennes F-35042, France; Centre de Recherche en Information Biomédicale Sino-français (CRIBs), Rennes F-35042, France
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Aung T, Mallela A, Ho J, Tang LW, Abou-Al-Shaar H, Gonzalez Martinez J. Challenging Cortical Explorations in Difficult-to-Localize Seizures: The Rationale and Usefulness of Perisylvian Paralimbic Explorations With Orthogonal Stereoelectroencephalography Depth Electrodes. Neurosurgery 2023:00006123-990000000-00982. [PMID: 38047640 DOI: 10.1227/neu.0000000000002787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Stereoelectroencephalography (SEEG) is an invasive monitoring method designed to define and localize the epileptogenic zone (EZ) and explore the putative network responsible for the electroclinical seizures using anatomo-functional-electroclinical correlations. When indicated by semiology in selected patients, exploration of both limbic and paralimbic (PL) regions is indispensable. However, the PL cortex is located in deep and highly vascularized areas in proximity to the anterior Sylvian fissure and middle cerebral artery branches. Thus, those explorations are considered surgically challenging because of the multilobar location and fear of hemorrhagic events. Here, we discuss and illustrate the rationale and SEEG methodology approach in usefulness of exploring the PL regions using standard orthogonal SEEG depth electrode trajectories with the Talariach reference system. METHODS We retrospectively studied PL exploration from a cohort of 71 consecutive SEEG procedures from Nov 2019 to Nov 2022 and identified 31 patients who underwent PL trajectories. RESULTS In 31 patients, there were 32 SEEG trajectories, and no major complications were observed. PL electrodes were consistently implanted in the C10/D10 coordinates of the Talariach reference coordinates. The most common confirmed EZ in our cohort was mesio-temporal (45%), followed by temporo-perisylvian regions (16%), ventromedial frontal (13%), and mesio-lateral temporal regions (13%). The PL contacts were involved in the EZ in 10 patients (32%). Of 31 patients, 25 underwent resective surgery, and 19 obtained Engel 1 outcome with a mean follow-up of 25 months (range 12-41 months) after surgery. CONCLUSION The orthogonal perisylvian PL trajectories are feasible and useful in sampling multiple PL regions with single-electrode trajectories. In patients with perisylvian seizures, sampling PL structures may contribute to an improved understanding of seizure propagation and the optimal anatomic demarcation of the EZs in this surgically challenging region.
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Affiliation(s)
- Thandar Aung
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arka Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonathan Ho
- Department of Neurology, University of Pittsburgh Medical Center and University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Lilly W Tang
- Department of Neurology, University of Pittsburgh Medical Center and University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jorge Gonzalez Martinez
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Murphy E, Forseth KJ, Donos C, Snyder KM, Rollo PS, Tandon N. The spatiotemporal dynamics of semantic integration in the human brain. Nat Commun 2023; 14:6336. [PMID: 37875526 PMCID: PMC10598228 DOI: 10.1038/s41467-023-42087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/28/2023] [Indexed: 10/26/2023] Open
Abstract
Language depends critically on the integration of lexical information across multiple words to derive semantic concepts. Limitations of spatiotemporal resolution have previously rendered it difficult to isolate processes involved in semantic integration. We utilized intracranial recordings in epilepsy patients (n = 58) who read written word definitions. Descriptions were either referential or non-referential to a common object. Semantically referential sentences enabled high frequency broadband gamma activation (70-150 Hz) of the inferior frontal sulcus (IFS), medial parietal cortex, orbitofrontal cortex (OFC) and medial temporal lobe in the left, language-dominant hemisphere. IFS, OFC and posterior middle temporal gyrus activity was modulated by the semantic coherence of non-referential sentences, exposing semantic effects that were independent of task-based referential status. Components of this network, alongside posterior superior temporal sulcus, were engaged for referential sentences that did not clearly reduce the lexical search space by the final word. These results indicate the existence of complementary cortical mosaics for semantic integration in posterior temporal and inferior frontal cortex.
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Affiliation(s)
- Elliot Murphy
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
| | - Kiefer J Forseth
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Cristian Donos
- Faculty of Physics, University of Bucharest, Măgurele, 077125, Bucharest, Romania
| | - Kathryn M Snyder
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Patrick S Rollo
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
- Memorial Hermann Hospital, Texas Medical Center, Houston, TX, 77030, USA.
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9
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Williams A, Ordaz JD, Budnick H, Desai VR, Tailor Bmbch J, Raskin JS. Accuracy of Depth Electrodes is Not Time-Dependent in Robot-Assisted Stereoelectroencephalography in a Pediatric Population. Oper Neurosurg (Hagerstown) 2023; 25:269-277. [PMID: 37219595 DOI: 10.1227/ons.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/21/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted stereoelectroencephalography (sEEG) is steadily supplanting traditional frameless and frame-based modalities for minimally invasive depth electrode placement in epilepsy workup. Accuracy rates similar to gold-standard frame-based techniques have been achieved, with improved operative efficiency. Limitations in cranial fixation and placement of trajectories in pediatric patients are believed to contribute to a time-dependent accumulation of stereotactic error. Thus, we aim to study the impact of time as a marker of cumulative stereotactic error during robotic sEEG. METHODS All patients between October 2018 and June 2022 who underwent robotic sEEG were included. Radial errors at entry and target points as well as depth and Euclidean distance errors were collected for each electrode, excluding those with errors over 10 mm. Target point errors were standardized by planned trajectory length. ANOVA and error rates over time were analyzed using GraphPad Prism 9. RESULTS Forty-four patients met inclusion criteria for a total of 539 trajectories. Number of electrodes placed ranged from 6 to 22. Average root mean squared error was 0.45 ± 0.12 mm. Average entry, target, depth, and Euclidean distance errors were 1.12 ± 0.41 mm, 1.46 ± 0.44 mm, -1.06 ± 1.43 mm, and 3.01 ± 0.71 mm, respectively. There was no significant increased error with each sequential electrode placed (entry error P -value = .54, target error P -value = .13, depth error P -value = .22, Euclidean distance P -value = .27). CONCLUSION No decremental accuracy over time was observed. This may be secondary to our workflow which prioritizes oblique and longer trajectories first and then into less error-prone trajectories. Further study on the effect of level of training may reveal a novel difference in error rates.
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Affiliation(s)
- Ari Williams
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Josue D Ordaz
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hailey Budnick
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Virendra R Desai
- Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Jignesh Tailor Bmbch
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey S Raskin
- Department of Neurosurgery, Section of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
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Thomas TM, Singh A, Bullock LP, Liang D, Morse CW, Scherschligt X, Seymour JP, Tandon N. Decoding articulatory and phonetic components of naturalistic continuous speech from the distributed language network. J Neural Eng 2023; 20:046030. [PMID: 37487487 DOI: 10.1088/1741-2552/ace9fb] [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: 11/09/2022] [Accepted: 07/24/2023] [Indexed: 07/26/2023]
Abstract
Objective.The speech production network relies on a widely distributed brain network. However, research and development of speech brain-computer interfaces (speech-BCIs) has typically focused on decoding speech only from superficial subregions readily accessible by subdural grid arrays-typically placed over the sensorimotor cortex. Alternatively, the technique of stereo-electroencephalography (sEEG) enables access to distributed brain regions using multiple depth electrodes with lower surgical risks, especially in patients with brain injuries resulting in aphasia and other speech disorders.Approach.To investigate the decoding potential of widespread electrode coverage in multiple cortical sites, we used a naturalistic continuous speech production task. We obtained neural recordings using sEEG from eight participants while they read aloud sentences. We trained linear classifiers to decode distinct speech components (articulatory components and phonemes) solely based on broadband gamma activity and evaluated the decoding performance using nested five-fold cross-validation.Main Results.We achieved an average classification accuracy of 18.7% across 9 places of articulation (e.g. bilabials, palatals), 26.5% across 5 manner of articulation (MOA) labels (e.g. affricates, fricatives), and 4.81% across 38 phonemes. The highest classification accuracies achieved with a single large dataset were 26.3% for place of articulation, 35.7% for MOA, and 9.88% for phonemes. Electrodes that contributed high decoding power were distributed across multiple sulcal and gyral sites in both dominant and non-dominant hemispheres, including ventral sensorimotor, inferior frontal, superior temporal, and fusiform cortices. Rather than finding a distinct cortical locus for each speech component, we observed neural correlates of both articulatory and phonetic components in multiple hubs of a widespread language production network.Significance.These results reveal the distributed cortical representations whose activity can enable decoding speech components during continuous speech through the use of this minimally invasive recording method, elucidating language neurobiology and neural targets for future speech-BCIs.
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Affiliation(s)
- Tessy M Thomas
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
| | - Aditya Singh
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
| | - Latané P Bullock
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
| | - Daniel Liang
- Department of Computer Science, Rice University, Houston, TX 77005, United States of America
| | - Cale W Morse
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
| | - Xavier Scherschligt
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
| | - John P Seymour
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Department of Electrical & Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
- Memorial Hermann Hospital, Texas Medical Center, Houston, TX 77030, United States of America
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11
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Woolnough O, Donos C, Murphy E, Rollo PS, Roccaforte ZJ, Dehaene S, Tandon N. Spatiotemporally distributed frontotemporal networks for sentence reading. Proc Natl Acad Sci U S A 2023; 120:e2300252120. [PMID: 37068244 PMCID: PMC10151604 DOI: 10.1073/pnas.2300252120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/14/2023] [Indexed: 04/19/2023] Open
Abstract
Reading a sentence entails integrating the meanings of individual words to infer more complex, higher-order meaning. This highly rapid and complex human behavior is known to engage the inferior frontal gyrus (IFG) and middle temporal gyrus (MTG) in the language-dominant hemisphere, yet whether there are distinct contributions of these regions to sentence reading is still unclear. To probe these neural spatiotemporal dynamics, we used direct intracranial recordings to measure neural activity while reading sentences, meaning-deficient Jabberwocky sentences, and lists of words or pseudowords. We isolated two functionally and spatiotemporally distinct frontotemporal networks, each sensitive to distinct aspects of word and sentence composition. The first distributed network engages the IFG and MTG, with IFG activity preceding MTG. Activity in this network ramps up over the duration of a sentence and is reduced or absent during Jabberwocky and word lists, implying its role in the derivation of sentence-level meaning. The second network engages the superior temporal gyrus and the IFG, with temporal responses leading those in frontal lobe, and shows greater activation for each word in a list than those in sentences, suggesting that sentential context enables greater efficiency in the lexical and/or phonological processing of individual words. These adjacent, yet spatiotemporally dissociable neural mechanisms for word- and sentence-level processes shed light on the richly layered semantic networks that enable us to fluently read. These results imply distributed, dynamic computation across the frontotemporal language network rather than a clear dichotomy between the contributions of frontal and temporal structures.
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Affiliation(s)
- Oscar Woolnough
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX77030
| | - Cristian Donos
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX77030
- Faculty of Physics, University of Bucharest, 050663Bucharest, Romania
| | - Elliot Murphy
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX77030
| | - Patrick S. Rollo
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX77030
| | - Zachary J. Roccaforte
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX77030
| | - Stanislas Dehaene
- Cognitive Neuroimaging Unit, Université Paris-Saclay, INSERM, CEA, NeuroSpin Center, 91191Gif-sur-Yvette, France
- Collège de France, 75005Paris, France
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX77030
- Memorial Hermann Hospital, Texas Medical Center, Houston, TX77030
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Abrego AM, Khan W, Wright CE, Islam MR, Ghajar MH, Bai X, Tandon N, Seymour JP. Sensing local field potentials with a directional and scalable depth electrode array. J Neural Eng 2023; 20:016041. [PMID: 36630716 DOI: 10.1088/1741-2552/acb230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
Objective. A variety of electrophysiology tools are available to the neurosurgeon for diagnosis, functional therapy, and neural prosthetics. However, no tool can currently address these three critical needs: (a) access to all cortical regions in a minimally invasive manner; (b) recordings with microscale, mesoscale, and macroscale resolutions simultaneously; and (c) access to spatially distant multiple brain regions that constitute distributed cognitive networks.Approach.We modeled, designed, and demonstrated a novel device for recording local field potentials (LFPs) with the form factor of a stereo-electroencephalographic electrode and combined with radially distributed microelectrodes.Main results. Electro-quasistatic models demonstrate that the lead body amplifies and shields LFP sources based on direction, enablingdirectional sensitivity andscalability, referred to as thedirectional andscalable (DISC) array.In vivo,DISC demonstrated significantly improved signal-to-noise ratio, directional sensitivity, and decoding accuracy from rat barrel cortex recordings during whisker stimulation. Critical for future translation, DISC demonstrated a higher signal to noise ratio (SNR) than virtual ring electrodes and a noise floor approaching that of large ring electrodes in an unshielded environment after common average referencing. DISC also revealed independent, stereoscopic current source density measures whose direction was verified after histology.Significance. Directional sensitivity of LFPs may significantly improve brain-computer interfaces and many diagnostic procedures, including epilepsy foci detection and deep brain targeting.
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Affiliation(s)
- Amada M Abrego
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX 77030, United States of America
| | - Wasif Khan
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX 77030, United States of America
| | - Christopher E Wright
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX 77030, United States of America
- Department of Bioengineering, Rice University, Houston, TX 77030, United States of America
| | - M Rabiul Islam
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX 77030, United States of America
| | - Mohammad H Ghajar
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX 77030, United States of America
| | - Xiaokang Bai
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX 77030, United States of America
| | - Nitin Tandon
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX 77030, United States of America
| | - John P Seymour
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX 77030, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77030, United States of America
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MAESAWA S, ISHIZAKI T, MUTOH M, ITO Y, TORII J, TANEI T, NAKATSUBO D, SAITO R. Clinical Impacts of Stereotactic Electroencephalography on Epilepsy Surgery and Associated Issues in the Current Situation in Japan. Neurol Med Chir (Tokyo) 2023; 63:179-190. [PMID: 37005247 DOI: 10.2176/jns-nmc.2022-0271] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demonstrative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under limited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.
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Affiliation(s)
- Satoshi MAESAWA
- Department of Neurosurgery, Nagoya University School of Medicine
| | | | - Manabu MUTOH
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Yoshiki ITO
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Jun TORII
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Takafumi TANEI
- Department of Neurosurgery, Nagoya University School of Medicine
| | | | - Ryuta SAITO
- Department of Neurosurgery, Nagoya University School of Medicine
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14
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Restrepo CE, Balaguera P, Thompson SA, Johnson J, Lacuey N, Pati S, Harris K, Lhatoo SD, Tandon N. Safety and efficacy of bihemispheric sampling via transmidline stereoelectroencephalography. J Neurosurg 2022:1-9. [PMID: 36585867 DOI: 10.3171/2022.11.jns221144] [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: 05/16/2022] [Accepted: 11/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is designed to target distributed cortical networks responsible for electroclinical seizure syndrome and to enable localization of the site of seizure onset in patients with intractable epilepsy. When the preimplantation hypothesis invokes the bilateral mesial frontal lobes, sampling of several deep-seated cortical sites in both hemispheres is required. In this study, the authors have demonstrated the feasibility of sampling bihemispheric areas with intentional implantation of an SEEG electrode crossing the midline (SECM) for sampling the cortex on both sides of the interhemispheric fissure. METHODS An analysis of 231 consecutive SEEG procedures over 8 years was used to identify instances of bihemispheric sampling by using the transmidline SEEG technique. RESULTS The authors identified 53 SEEG cases, with a total of 126 electrodes that crossed the interhemispheric fissure; all were in the frontal lobes. Eighty-three electrodes targeted the cingulate gyrus (18 rostral, 43 anterior, and 22 middle), 31 targeted the posterior orbitofrontal region, 8 sampled the medial prefrontal cortex, and 4 targeted nodular heterotopia around the frontal horns. The ictal onset zone was localized to the frontal lobe in 16 cases. SECM isolated interictal and ictal activity in the contralateral hemisphere in 6 cases and independent bihemispheric seizure activity in 2 cases. No hemorrhagic or infectious complications were noted in any of these cases. CONCLUSIONS Based on this extensive experience of bihemispheric sampling, the authors concluded that this technique is safe and effective. In this series, SECM showed contralateral interictal and/or ictal epileptiform activity in 8 (15%) cases, and 9 (16%) cases (with unilateral implantation) had sufficient data to discard contralateral involvement, contributing to support of the epileptogenic network. SECM may reduce the number of electrodes used to sample bilateral mesial frontal or orbitofrontal cortices, and such an approach may lower the risk of hemorrhage and costs.
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Affiliation(s)
- Carlos E Restrepo
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Pedro Balaguera
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Stephen A Thompson
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Jessica Johnson
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston
| | - Nuria Lacuey
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Sandipan Pati
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Katherine Harris
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Samden D Lhatoo
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,3Department of Neurology, McGovern Medical School at University of Texas Health Science Center at Houston; and.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Nitin Tandon
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston.,4Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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15
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A comparison between robot-guided and stereotactic frame-based stereoelectroencephalography (SEEG) electrode implantation for drug-resistant epilepsy. J Robot Surg 2022; 17:1013-1020. [DOI: 10.1007/s11701-022-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
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Woolnough O, Forseth KJ, Rollo PS, Roccaforte ZJ, Tandon N. Event-Related Phase Synchronization Propagates Rapidly across Human Ventral Visual Cortex. Neuroimage 2022; 256:119262. [PMID: 35504563 PMCID: PMC9382906 DOI: 10.1016/j.neuroimage.2022.119262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/31/2022] [Accepted: 04/27/2022] [Indexed: 11/01/2022] Open
Abstract
Visual inputs to early visual cortex integrate with semantic, linguistic and memory inputs in higher visual cortex, in a manner that is rapid and accurate, and enables complex computations such as face recognition and word reading. This implies the existence of fundamental organizational principles that enable such efficiency. To elaborate on this, we performed intracranial recordings in 82 individuals while they performed tasks of varying visual and cognitive complexity. We discovered that visual inputs induce highly organized posterior-to-anterior propagating patterns of phase modulation across the ventral occipitotemporal cortex. At individual electrodes there was a stereotyped temporal pattern of phase progression following both stimulus onset and offset, consistent across trials and tasks. The phase of low frequency activity in anterior regions was predicted by the prior phase in posterior cortical regions. This spatiotemporal propagation of phase likely serves as a feed-forward organizational influence enabling the integration of information across the ventral visual stream. This phase modulation manifests as the early components of the event related potential; one of the most commonly used measures in human electrophysiology. These findings illuminate fundamental organizational principles of the higher order visual system that enable the rapid recognition and characterization of a variety of inputs.
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Affiliation(s)
- Oscar Woolnough
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America; Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Kiefer J Forseth
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America; Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Patrick S Rollo
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America; Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Zachary J Roccaforte
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America; Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America; Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America; Memorial Hermann Hospital, Texas Medical Center, Houston, TX, 77030, United States of America.
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Murphy E, Woolnough O, Rollo PS, Roccaforte ZJ, Segaert K, Hagoort P, Tandon N. Minimal Phrase Composition Revealed by Intracranial Recordings. J Neurosci 2022; 42:3216-3227. [PMID: 35232761 PMCID: PMC8994536 DOI: 10.1523/jneurosci.1575-21.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 11/21/2022] Open
Abstract
The ability to comprehend phrases is an essential integrative property of the brain. Here, we evaluate the neural processes that enable the transition from single-word processing to a minimal compositional scheme. Previous research has reported conflicting timing effects of composition, and disagreement persists with respect to inferior frontal and posterior temporal contributions. To address these issues, 19 patients (10 male, 9 female) implanted with penetrating depth or surface subdural intracranial electrodes, heard auditory recordings of adjective-noun, pseudoword-noun, and adjective-pseudoword phrases and judged whether the phrase matched a picture. Stimulus-dependent alterations in broadband gamma activity, low-frequency power, and phase-locking values across the language-dominant left hemisphere were derived. This revealed a mosaic located on the lower bank of the posterior superior temporal sulcus (pSTS), in which closely neighboring cortical sites displayed exclusive sensitivity to either lexicality or phrase structure, but not both. Distinct timings were found for effects of phrase composition (210-300 ms) and pseudoword processing (∼300-700 ms), and these were localized to neighboring electrodes in pSTS. The pars triangularis and temporal pole encoded anticipation of composition in broadband low frequencies, and both regions exhibited greater functional connectivity with pSTS during phrase composition. Our results suggest that the pSTS is a highly specialized region composed of sparsely interwoven heterogeneous constituents that encodes both lower and higher level linguistic features. This hub in pSTS for minimal phrase processing may form the neural basis for the human-specific computational capacity for forming hierarchically organized linguistic structures.SIGNIFICANCE STATEMENT Linguists have claimed that the integration of multiple words into a phrase demands a computational procedure distinct from single-word processing. Here, we provide intracranial recordings from a large patient cohort, with high spatiotemporal resolution, to track the cortical dynamics of phrase composition. Epileptic patients volunteered to participate in a task in which they listened to phrases (red boat), word-pseudoword or pseudoword-word pairs (e.g., red fulg). At the onset of the second word in phrases, greater broadband high gamma activity was found in posterior superior temporal sulcus in electrodes that exclusively indexed phrasal meaning and not lexical meaning. These results provide direct, high-resolution signatures of minimal phrase composition in humans, a potentially species-specific computational capacity.
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Affiliation(s)
- Elliot Murphy
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas 77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, Texas 77030
| | - Oscar Woolnough
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas 77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, Texas 77030
| | - Patrick S Rollo
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas 77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, Texas 77030
| | - Zachary J Roccaforte
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas 77030
| | - Katrien Segaert
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Max Planck Institute for Psycholinguistics, Nijmegen, 6525 XD Nijmegen, The Netherlands
| | - Peter Hagoort
- Max Planck Institute for Psycholinguistics, Nijmegen, 6525 XD Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas 77030
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, Texas 77030
- Memorial Hermann Hospital, Texas Medical Center, Houston, Texas 77030
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Shirozu H, Masuda H, Kameyama S. A Special Approach for Stereotactic Radiofrequency Thermocoagulation of Hypothalamic Hamartomas With Bilateral Attachments to the Hypothalamus: The Transthird Ventricular Approach to the Contralateral Attachment. Neurosurgery 2022; 91:295-303. [PMID: 35394461 DOI: 10.1227/neu.0000000000001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/12/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Disconnection surgery for the treatment of epileptic hypothalamic hamartomas (HHs) is strategically difficult in cases with complex-shaped HHs, especially with bilateral hypothalamic attachments, despite its effectiveness. OBJECTIVE To evaluate the feasibility of a new approach for stereotactic radiofrequency thermocoagulation (SRT) using penetration of the third ventricle (SRT-TT) aiming to disconnect bilateral hypothalamic attachments in a single-staged, unilateral procedure. METHODS Ninety patients (median age at surgery, 5.0 years) who had HHs with bilateral hypothalamic attachments and were followed for at least 1 year after their last SRT were retrospectively reviewed. RESULTS Thirty-three patients underwent SRT-TT as initial surgery. Of the 58 patients after mid-2013 when SRT-TT was introduced, 33 underwent SRT-TT and 12 (20.7%) required reoperation (ReSRT), whereas 20 of 57 patients (35.1%) without SRT-TT underwent reoperation. Reoperation was required in significantly fewer patients after mid-2013 (n = 12 of 58, 20.7%) than before mid-2013 (n = 15 of 32, 46.9%) (P = .01). Final seizure freedoms were not different between before and after mid-2013 (gelastic seizure freedom, n = 30 [93.8%] vs n = 49 [84.5%] and other types of seizure freedom, n = 21 of 31 [67.7%] vs n = 32 of 38 [84.2%]). Persistent complications were less in SRT-TT than in ReSRT using the bilateral approach, but not significantly. However, hormonal replacement was required significantly more often in ReSRT using the bilateral approach (4 of 9, 44.4%) than in SRT-TT (3 of 32, 9.4%) (P = .01). CONCLUSION SRT-TT enabled disconnection of bilateral attachments of HHs in a single-staged procedure, which reduced the additional invasiveness of reoperation. Moreover, SRT-TT reduced damage to the contralateral hypothalamus, with fewer endocrinological complications than the bilateral approach.
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Affiliation(s)
- Hiroshi Shirozu
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.,Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Hiroshi Masuda
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.,Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Shigeki Kameyama
- Department of Neurosurgery, Niigata Seiro Hospital, Seiro, Niigata, Japan
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19
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Woolnough O, Snyder KM, Morse CW, McCarty MJ, Lhatoo SD, Tandon N. Intraoperative localization and preservation of reading in ventral occipitotemporal cortex. J Neurosurg 2022; 137:1610-1617. [PMID: 35395633 DOI: 10.3171/2022.2.jns22170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Resective surgery in language-dominant ventral occipitotemporal cortex (vOTC) carries the risk of causing impairment to reading. Because it is not on the lateral surface, it is not easily accessible for intraoperative mapping, and extensive stimulation mapping can be time-consuming. Here the authors assess the feasibility of using task-based electrocorticography (ECoG) recordings intraoperatively to help guide stimulation mapping of reading in vOTC. METHODS In 11 patients undergoing extraoperative, intracranial seizure mapping, the authors recorded induced broadband gamma activation (70-150 Hz) during a visual category localizer. In 2 additional patients, whose pathologies necessitated resections in language-dominant vOTC, task-based functional mapping was performed intraoperatively using subdural ECoG alongside direct cortical stimulation. RESULTS Word-responsive cortex localized using ECoG showed a high sensitivity (72%) to stimulation-induced reading deficits, and the confluence of ECoG and stimulation-positive sites appears to demarcate the visual word form area. Intraoperative task-based ECoG mapping was possible in < 3 minutes, providing a high signal quality, and initial intraoperative data analysis took < 3 minutes, allowing for rapid assessment of broad areas of cortex. Cortical areas critical for reading were mapped and successfully preserved, while also enabling pathological tissue to be completely removed. CONCLUSIONS Eloquent cortex in ventral visual cortex can be rapidly mapped intraoperatively using ECoG. This method acts to guide high-probability targets for stimulation with limited patient participation and can be used to avoid iatrogenic dyslexia following surgery.
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Affiliation(s)
- Oscar Woolnough
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston; and
| | - Kathryn M Snyder
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston; and
| | - Cale W Morse
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston; and
| | - Meredith J McCarty
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston; and
| | - Samden D Lhatoo
- 2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston; and.,3Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Nitin Tandon
- 1Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston.,2Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston; and.,3Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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20
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Tay ASMS, Menaker SA, Chan JL, Mamelak AN. Placement of Stereotactic Electroencephalography Depth Electrodes Using the Stealth Autoguide Robotic System: Technical Methods and Initial Results. Oper Neurosurg (Hagerstown) 2022; 22:e150-e157. [PMID: 35289779 PMCID: PMC10602512 DOI: 10.1227/ons.0000000000000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Robotic systems are gaining acceptance as a preferred tool for the placement of electrodes for stereotactic electroencephalography (SEEG) studies. OBJECTIVE To describe the technical methods for insertion of SEEG using the Medtronic Stealth Autoguide robotic system and detailed outcomes in the initial 9 patients implanted. METHODS Nine patients underwent placement of electrodes for SEEG studies with the use of the Autoguide system. Patients had at least 10 electrodes placed. Targets were planned on a Stealth S8 planning station, and electrodes were placed under general anesthesia. A technique for placement is described in detail. Patient outcomes and accuracy of electrode placement were evaluated. Methods to improve accuracy were investigated. Comparison of postoperative MRIs with preoperative planning MRIs was performed to determine the accuracy of electrode placement. RESULTS One hundred two electrodes were placed in 9 patients. Methods for placement and technical nuances are detailed. The distance from the planned target to the actual position of the electrode tip was measured in 8 of the 9 patients. The mean Euclidean distance was 4.67 ± 0.27 mm. There was 1 placement-related hemorrhage deficit in the first patient, and no deaths or infections. Adequate positioning of electrodes for seizure monitoring was obtained in all patients. CONCLUSION Autoguide can be used for placement of electrodes for SEEG studies with acceptable degrees of patient safety, accuracy, and efficiency. Considering the cost of Autoguide compared with other robotic devices, it may be attractive option.
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Affiliation(s)
| | - Simon A. Menaker
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Julie L. Chan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Adam N. Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA;
- Comprehensive Epilepsy Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
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21
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Woolnough O, Kadipasaoglu CM, Conner CR, Forseth KJ, Rollo PS, Rollo MJ, Baboyan VG, Tandon N. Dataset of human intracranial recordings during famous landmark identification. Sci Data 2022; 9:28. [PMID: 35102154 PMCID: PMC8803828 DOI: 10.1038/s41597-022-01125-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
For most people, recalling information about familiar items in a visual scene is an effortless task, but it is one that depends on coordinated interactions of multiple, distributed neural components. We leveraged the high spatiotemporal resolution of direct intracranial recordings to better delineate the network dynamics underpinning visual scene recognition. We present a dataset of recordings from a large cohort of humans while they identified images of famous landmarks (50 individuals, 52 recording sessions, 6,775 electrodes, 6,541 trials). This dataset contains local field potential recordings derived from subdural and penetrating electrodes covering broad areas of cortex across both hemispheres. We provide this pre-processed data with behavioural metrics (correct/incorrect, response times) and electrode localisation in a population-normalised cortical surface space. This rich dataset will allow further investigation into the spatiotemporal progression of multiple neural processes underlying visual processing, scene recognition and cued memory recall.
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Affiliation(s)
- Oscar Woolnough
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Cihan M Kadipasaoglu
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Christopher R Conner
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America
- Memorial Hermann Hospital, Texas Medical Center, Houston, TX, 77030, United States of America
| | - Kiefer J Forseth
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Patrick S Rollo
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Matthew J Rollo
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America
| | - Vatche G Baboyan
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, 77030, United States of America.
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America.
- Memorial Hermann Hospital, Texas Medical Center, Houston, TX, 77030, United States of America.
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22
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Ladisich B, Machegger L, Romagna A, Krainz H, Steinbacher J, Leitinger M, Kalss G, Thon N, Trinka E, Winkler PA, Schwartz C. VarioGuide® frameless neuronavigation-guided stereoelectroencephalography in adult epilepsy patients: technique, accuracy and clinical experience. Acta Neurochir (Wien) 2021; 163:1355-1364. [PMID: 33580853 PMCID: PMC8053662 DOI: 10.1007/s00701-021-04755-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
Background Stereoelectroencephalography (SEEG) allows the identification of deep-seated seizure foci and determination of the epileptogenic zone (EZ) in drug-resistant epilepsy (DRE) patients. We evaluated the accuracy and treatment-associated morbidity of frameless VarioGuide® (VG) neuronavigation-guided depth electrode (DE) implantations. Methods We retrospectively identified all consecutive adult DRE patients, who underwent VG-neuronavigation DE implantations, between March 2013 and April 2019. Clinical data were extracted from the electronic patient charts. An interdisciplinary team agreed upon all treatment decisions. We performed trajectory planning with iPlan® Cranial software and DE implantations with the VG system. Each electrode’s accuracy was assessed at the entry (EP), the centre (CP) and the target point (TP). We conducted correlation analyses to identify factors associated with accuracy. Results The study population comprised 17 patients (10 women) with a median age of 32.0 years (range 21.0–54.0). In total, 220 DEs (median length 49.3 mm, range 25.1–93.8) were implanted in 21 SEEG procedures (range 3–16 DEs/surgery). Adequate signals for postoperative SEEG were detected for all but one implanted DEs (99.5%); in 15/17 (88.2%) patients, the EZ was identified and 8/17 (47.1%) eventually underwent focus resection. The mean deviations were 3.2 ± 2.4 mm for EP, 3.0 ± 2.2 mm for CP and 2.7 ± 2.0 mm for TP. One patient suffered from postoperative SEEG-associated morbidity (i.e. conservatively treated delayed bacterial meningitis). No mortality or new neurological deficits were recorded. Conclusions The accuracy of VG-SEEG proved sufficient to identify EZ in DRE patients and associated with a good risk-profile. It is a viable and safe alternative to frame-based or robotic systems. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-04755-w.
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Affiliation(s)
- Barbara Ladisich
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria
| | - Lukas Machegger
- University Institute of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Alexander Romagna
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria
- Department of Neurosurgery, München Klinik Bogenhausen, Englschalkingerstr. 77, 81925, Munich, Germany
| | - Herbert Krainz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria
| | - Jürgen Steinbacher
- University Institute of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Niklas Thon
- Department of Neurosurgery, University Hospital Munich, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eugen Trinka
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Peter A Winkler
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, A-5020, Salzburg, Austria.
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23
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Dlaka D, Švaco M, Chudy D, Jerbić B, Šekoranja B, Šuligoj F, Vidaković J, Romić D, Raguž M. Frameless stereotactic brain biopsy: A prospective study on robot-assisted brain biopsies performed on 32 patients by using the RONNA G4 system. Int J Med Robot 2021; 17:e2245. [PMID: 33591608 DOI: 10.1002/rcs.2245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We present a novel robotic neuronavigation system (RONNA G4), used for precise preoperative planning and frameless neuronavigation, developed by a research group from the University of Zagreb and neurosurgeons from the University Hospital Dubrava, Zagreb, Croatia. The aim of study is to provide comprehensive error measurement analysis of the system used for the brain biopsy. METHODS Frameless stereotactic robot-assisted biopsies were performed on 32 consecutive patients. Post-operative CT and MRI scans were assessed to precisely measure and calculate target point error (TPE) and entry point error (EPE). RESULTS The application accuracy of the RONNA system for TPE was 1.95 ± 1.11 mm, while for EPE was 1.42 ± 0.74 mm. The total diagnostic yield was 96.87%. Linear regression showed statistical significance between the TPE and EPE, and the angle of the trajectory on the bone. CONCLUSION The RONNA G4 robotic system is a precise and highly accurate autonomous neurosurgical assistant for performing frameless brain biopsies.
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Affiliation(s)
- Domagoj Dlaka
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Švaco
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.,Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia.,Department of Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Bojan Jerbić
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bojan Šekoranja
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Filip Šuligoj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Vidaković
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.,Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Dominik Romić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.,Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
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Zheng J, Liu YL, Zhang D, Cui XH, Sang LX, Xie T, Li WL. Robot-assisted versus stereotactic frame-based stereoelectroencephalography in medically refractory epilepsy. Neurophysiol Clin 2020; 51:111-119. [PMID: 33272822 DOI: 10.1016/j.neucli.2020.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022] Open
Abstract
AIM To explore the difference between robot assisted (RA) and stereotactic frame based (SF) stereoelectroencephalography (SEEG) in patients with medically refractory epilepsy. METHODS We undertook a retrospective review of 33 SEEG cases at our center, of which 14 were SF performed from March to October 2018 and 19 were RA performed from November 2018 to December 2019. Detailed review of medical histories and operative records as well as imaging and trajectory plans was carried out for each patient, and the results related to each technique compared. A multiple linear regression model was used to test for variables that significantly influenced placement error. RESULTS Compared to the SF group, the RA group had a higher mean number of electrodes per patient (10.7 ± 2.8 versus 6.4 ± 0.8, P < 0.0001) and a significantly shorter mean operative time (127.3 ± 40.7 versus 152.7 ± 13.6 min, P = 0.033). For the RA group, the intracranial implantation length was positively correlated with target point error (p = 0.000), depth error (p = 0.043), and two-dimensional (2D) radial error (p = 0.041). Conversely, skull thickness was negatively correlated with the TP error (p = 0.004), depth error (p = 0.037) and 2D radial error (p = 0.000). We also analyzed the mean entry point, target point, depth and 2D radial errors, the complication rates, and the results of epileptogenic zone (EZ) localization and Engel class. The results showed no difference in these aspects between the SF group and the RA group. CONCLUSION This study suggests that, compared to stereotactic frame based SEEG, robot assisted SEEG is significantly more efficient and comparable in safety and effectiveness.
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Affiliation(s)
- Jie Zheng
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang 050000, China
| | - Ying-Li Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China
| | - Di Zhang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang 050000, China
| | - Xue-Hua Cui
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang 050000, China
| | - Lin-Xia Sang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang 050000, China
| | - Tao Xie
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang 050000, China
| | - Wen-Ling Li
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang 050000, China.
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25
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Spatiotemporal dynamics of orthographic and lexical processing in the ventral visual pathway. Nat Hum Behav 2020; 5:389-398. [PMID: 33257877 PMCID: PMC10365894 DOI: 10.1038/s41562-020-00982-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Reading is a rapid, distributed process that engages multiple components of the ventral visual stream. To understand the neural constituents and their interactions that allow us to identify written words, we performed direct intra-cranial recordings in a large cohort of humans. This allowed us to isolate the spatiotemporal dynamics of visual word recognition across the entire left ventral occipitotemporal cortex. We found that mid-fusiform cortex is the first brain region sensitive to lexicality, preceding the traditional visual word form area. The magnitude and duration of its activation are driven by the statistics of natural language. Information regarding lexicality and word frequency propagates posteriorly from this region to visual word form regions and to earlier visual cortex, which, while active earlier, show sensitivity to words later. Further, direct electrical stimulation of this region results in reading arrest, further illustrating its crucial role in reading. This unique sensitivity of mid-fusiform cortex to sub-lexical and lexical characteristics points to its central role as the orthographic lexicon-the long-term memory representations of visual word forms.
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