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Gautam D, Venkatraman V, Horns J, Yang LZ, Lee HJ, Kassavetis P, Alshaikh J, Moretti P, Shofty B, Rahimpour S. Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA. BMJ Neurol Open 2024; 6:e000582. [PMID: 38618151 PMCID: PMC11015248 DOI: 10.1136/bmjno-2023-000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Background Essential tremor (ET) is a movement disorder that affects 4%-5% of adults >65 years. For patients with medically refractory ET, neurosurgical interventions such as deep brain stimulation (DBS) and unilateral MR-guided focused ultrasound thalamotomy (MRgFUS) are available. In this retrospective cohort study, we examined the demographics of patients with ET who have received MRgFUS and evaluated trends in DBS usage in the USA after the introduction of MRgFUS in 2016. Methods We used multiple databases to examine the demographics of patients who received DBS and MRgFUS, and trends in DBS. To assess the demographics, we queried the TriNetX database from 2003 to 2022 to identify patients diagnosed with ET and stratify them by DBS or MRgFUS treatment by using Current Procedural Terminology codes. Patient demographics were reported as frequencies and percentages. To examine the trends in DBS for ET, the yearly frequency of DBS procedures done for ET between 2012 and 2019 was extracted from the National Inpatient Sample (NIS) database, and breakpoint analysis was performed. Additionally, the yearly frequency of MRgFUS procedures for ET was obtained from Insightec Exlabate. Results Most of the patients (88.69%) in the cohort extracted from TriNetX database self-identified as white, followed by black or African American (2.40%) and Asian (0.52%). A higher percentage of black patients received MRgFUS treatment than DBS (4.10% vs 1.88%). According to the NIS database, from 2012 to 2020, 13 525 patients received DBS for ET. Conclusion This study provides an overview of the characteristics of patients who undergo DBS or MRgFUS. We found notable differences in sex and race among patients who underwent each treatment type. Additionally, until at least the beginning of 2020, the number of DBS procedures for ET was not negatively affected after the introduction of MRgFUS.
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Affiliation(s)
- Diwas Gautam
- University of Utah Health, Salt Lake City, Utah, USA
| | | | - Joshua Horns
- Department of Surgery, Surgical Population Analysis Core, University of Utah Health, Salt Lake City, Utah, USA
| | - Lexie Zidanyue Yang
- Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hui-Jie Lee
- Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jumana Alshaikh
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Paolo Moretti
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
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Campbell JM, Yost S, Gautam D, Herich A, Botros D, Slaughter M, Chodakiewitz M, Arain A, Peters A, Richards S, Newman B, Johnson B, Rahimpour S, Shofty B. Delays in the diagnosis and surgical treatment of drug-resistant epilepsy: A cohort study. Epilepsia 2024. [PMID: 38456604 DOI: 10.1111/epi.17944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Delay in referral for epilepsy surgery of patients with drug-resistant epilepsy (DRE) is associated with decreased quality of life, worse surgical outcomes, and increased risk of sudden unexplained death in epilepsy (SUDEP). Understanding the potential causes of delays in referral and treatment is crucial for optimizing the referral and treatment process. We evaluated the treatment intervals, demographics, and clinical characteristics of patients referred for surgical evaluation at our level 4 epilepsy center in the U.S. Intermountain West. METHODS We retrospectively reviewed the records of patients who underwent surgery for DRE between 2012 and 2022. Data collected included patient demographics, DRE diagnosis date, clinical characteristics, insurance status, distance from epilepsy center, date of surgical evaluation, surgical procedure, and intervals between different stages of evaluation. RESULTS Within our cohort of 185 patients with epilepsy (99 female, 53.5%), the mean ± standard deviation (SD) age at surgery was 38.4 ± 11.9 years. In this cohort, 95.7% of patients had received definitive epilepsy surgery (most frequently neuromodulation procedures) and 4.3% had participated in phase 2 intracranial monitoring but had not yet received definitive surgery. The median (1st-3rd quartile) intervals observed were 10.1 (3.8-21.5) years from epilepsy diagnosis to DRE diagnosis, 16.7 (6.5-28.4) years from epilepsy diagnosis to surgery, and 1.4 (0.6-4.0) years from DRE diagnosis to surgery. We observed significantly shorter median times from epilepsy diagnosis to DRE diagnosis (p < .01) and epilepsy diagnosis to surgery (p < .05) in patients who traveled further for treatment. Patients with public health insurance had a significantly longer time from DRE diagnosis to surgery (p < .001). SIGNIFICANCE Both shorter distance traveled to our epilepsy center and public health insurance were predictive of delays in diagnosis and treatment intervals. Timely referral of patients with DRE to specialized epilepsy centers for surgery evaluation is crucial, and identifying key factors that may delay referral is paramount to optimizing surgical outcomes.
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Affiliation(s)
- Justin M Campbell
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, USA
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Samantha Yost
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Diwas Gautam
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alysha Herich
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David Botros
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Mason Slaughter
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Michael Chodakiewitz
- Department of Neurosurgery, University of California, Los Angeles, California, USA
- Department of Surgery, Zucker School of Medicine at Hofstra, Hempstead, New York, USA
- Tel Aviv University, Tel Aviv, Israel
| | - Amir Arain
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Angela Peters
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Sindhu Richards
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Blake Newman
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Brian Johnson
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben Shofty
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah Health, Salt Lake City, Utah, USA
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Venkatraman V, Futch BG, Bode Padron KJ, Yang LZ, Lee HJ, Seas A, Parente B, Shofty B, Lad SP, Williamson TL, Rahimpour S. Disparities in the treatment of movement disorders using deep brain stimulation. J Neurosurg 2024:1-11. [PMID: 38306639 PMCID: PMC10898494 DOI: 10.3171/2023.11.jns23882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/16/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD) and essential tremor (ET). Although the prevalence of PD and ET can vary by sex and race, little is known about the accessibility of neurosurgical treatments for these conditions. In this nationwide study, the authors aimed to characterize trends in the use of DBS for the treatment of PD and ET and to identify disparities in the neurosurgical treatment of these diseases based on ethnic, racial, sex, insurance, income, hospital, and geographic factors. METHODS Using the dates January 1, 2012, to December 31, 2019, the authors queried the National Inpatient Sample database for all discharges with an ICD-9 or ICD-10 diagnosis of PD or ET. Among these discharges, the DBS rates were reported for each subgroup of race, ethnicity, and sex. To develop national estimates, all analyses were weighted. RESULTS Among 2,517,639 discharges with PD, 29,820 (1.2%) received DBS, and among 652,935 discharges with ET, 11,885 (1.8%) received DBS. Amid the PD cases, Black patients (n = 405 [0.2%], OR 0.16, 95% CI 0.12-0.20) were less likely than White patients (n = 23,975 [1.2%]) to receive DBS treatment, as were Hispanic patients (n = 1965 [1.1%], OR 0.76, 95% CI 0.65-0.88), whereas Asian/Pacific Islander patients (n = 855 [1.5%]) did not statistically differ from White patients. Amid the ET cases, Black (n = 230 [0.8%], OR 0.39, 95% CI 0.27-0.56), Hispanic (n = 215 [1.0%], OR 0.39, 95% CI 0.28-0.55), and Asian/Pacific Islander (n = 55 [1.0%], OR 0.51, 95% CI 0.28-0.93) patients were less likely than White patients (n = 10,440 [1.9%]) to receive DBS. Females were less likely than males to receive DBS for PD (OR 0.69, p < 0.0001) or ET (OR 0.70, p < 0.0001). CONCLUSIONS The authors describe significant racial and sex-based differences in the utilization of DBS for the treatment of PD and ET. Further research is required to ascertain the causes of these disparities, as well as any differences in access to specialty neurosurgical care and referral for neuromodulation approaches.
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Affiliation(s)
| | | | | | - Lexie Z Yang
- 2Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Hui-Jie Lee
- 2Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | | | | | - Ben Shofty
- 3Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah; and
| | | | - Theresa L Williamson
- 4Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Shervin Rahimpour
- 3Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah; and
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Allawala A, Bijanki KR, Oswalt D, Mathura RK, Adkinson J, Pirtle V, Shofty B, Robinson M, Harrison MT, Mathew SJ, Goodman WK, Pouratian N, Sheth SA, Borton DA. Prefrontal network engagement by deep brain stimulation in limbic hubs. Front Hum Neurosci 2024; 17:1291315. [PMID: 38283094 PMCID: PMC10813208 DOI: 10.3389/fnhum.2023.1291315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Prefrontal circuits in the human brain play an important role in cognitive and affective processing. Neuromodulation therapies delivered to certain key hubs within these circuits are being used with increasing frequency to treat a host of neuropsychiatric disorders. However, the detailed neurophysiological effects of stimulation to these hubs are largely unknown. Here, we performed intracranial recordings across prefrontal networks while delivering electrical stimulation to two well-established white matter hubs involved in cognitive regulation and depression: the subcallosal cingulate (SCC) and ventral capsule/ventral striatum (VC/VS). We demonstrate a shared frontotemporal circuit consisting of the ventromedial prefrontal cortex, amygdala, and lateral orbitofrontal cortex where gamma oscillations are differentially modulated by stimulation target. Additionally, we found participant-specific responses to stimulation in the dorsal anterior cingulate cortex and demonstrate the capacity for further tuning of neural activity using current-steered stimulation. Our findings indicate a potential neurophysiological mechanism for the dissociable therapeutic effects seen across the SCC and VC/VS targets for psychiatric neuromodulation and our results lay the groundwork for personalized, network-guided neurostimulation therapy.
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Affiliation(s)
- Anusha Allawala
- School of Engineering, Brown University, Providence, RI, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Kelly R. Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Denise Oswalt
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Raissa K. Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Joshua Adkinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Victoria Pirtle
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ben Shofty
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | - Meghan Robinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Matthew T. Harrison
- Division of Applied Mathematics, Brown University, Providence, RI, United States
| | - Sanjay J. Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - David A. Borton
- School of Engineering, Brown University, Providence, RI, United States
- Department of Veterans Affairs, Center for Neurorestoration and Neurotechnology, Providence, RI, United States
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5
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Gabay S, Sapir Y, Korn A, Hochberg U, Tellem R, Zegerman A, Brogan SE, Rahimpour S, Shofty B, Strauss I. Optimization of Radiofrequency Needle Placement in Percutaneous Cordotomy Using Electromyography in the Deeply Sedated Patient. Oper Neurosurg (Hagerstown) 2024; 26:22-27. [PMID: 37747336 DOI: 10.1227/ons.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/14/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cordotomy, the selective disconnection of the nociceptive fibers in the spinothalamic tract, is used to provide pain palliation to oncological patients suffering from intractable cancer-related pain. Cordotomies are commonly performed using a cervical (C1-2) percutaneous approach under imaging guidance and require patients' cooperation to functionally localize the spinothalamic tract. This can be challenging in patients suffering from extreme pain. It has recently been demonstrated that intraoperative neurophysiology monitoring by electromyography may aid in safe lesion positioning. The aim of this study was to evaluate the role of compound muscle action potential (CMAP) in deeply sedated patients undergoing percutaneous cervical cordotomy (PCC). METHODS A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy while deeply sedated between January 2019 and November 2022 in 2 academic centers. The operative report, neuromonitoring logs, and clinical medical records were evaluated. RESULTS Eleven patients underwent PCC under deep sedation. In all patients, the final motor assessment prior to ablation was done using the electrophysiological criterion alone. The median threshold for evoking CMAP activity at the lesion site was 0.9 V ranging between 0.5 and 1.5 V (average 1 V ± 0.34 V SD). An immediate, substantial decrease in pain was observed in 9 patients. The median pain scores (Numeric Rating Scale) decreased from 10 preoperatively (range 8-10) to a median 0 (range 0-10) immediately after surgery. None of our patients developed motor deficits. CONCLUSION CMAP-guided PCC may be feasible in deeply sedated patients without added risk to postoperative motor function. This technique should be considered in a group of patients who are not able to undergo awake PCC.
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Affiliation(s)
- Segev Gabay
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
| | - Yechiam Sapir
- Surgical Monitoring Services, Beit Shemesh , Israel
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv , Israel
| | - Akiva Korn
- Surgical Monitoring Services, Beit Shemesh , Israel
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv , Israel
| | - Uri Hochberg
- Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Rotem Tellem
- Palliative Care Service, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
| | - Alex Zegerman
- Division of Anesthesia, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
| | - Shane E Brogan
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City , Utah , USA
| | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah, Salt Lake City , Utah , USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah, Salt Lake City , Utah , USA
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
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Venkatraman V, Futch BG, Bartlett A, Yang LZ, Lee HJ, Shofty B, Parente BA, Lad SP, Williamson TL, Rahimpour S. Disparities in Access to Deep Brain Stimulation and Responsive Neurostimulation Approaches to Drug-Resistant Epilepsy. Neuromodulation 2023:S1094-7159(23)00992-3. [PMID: 38159098 DOI: 10.1016/j.neurom.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Epilepsy affects 1% to 2% of the global population, and those who are resistant to medical treatment may be candidates for neuromodulation. In select populations, brain stimulation approaches including deep brain stimulation (DBS) and responsive neurostimulation (RNS) are used. Although studies have shown that patients from Black, Hispanic, lower income, and rural communities have less access to epilepsy care and have lower rates of epilepsy surgery, disparities in the use of brain stimulation for epilepsy treatment are currently not known. MATERIALS AND METHODS We queried the US National Inpatient Sample data base from January 1, 2014 to December 31, 2019 for all patients discharged with an International Classification of Diseases (ICD) Ninth Revision or ICD Tenth Revision diagnosis of drug-resistant epilepsy. Among these patients discharged, the rates of brain stimulation treatment, including DBS and RNS, were reported in each subgroup of race, ethnicity, and insurance. To generate national estimates, all analyses were weighted. RESULTS A total of 237,895 patients discharged with drug-resistant epilepsy were identified, of whom 4,925 (2.1%) received brain stimulation treatment for drug-resistant epilepsy. Black patients (n = 420, 0.9%, odds ratio [OR] = 0.51, 95% CI [0.40, 0.64]) were less likely to receive brain stimulation treatment than were White patients (n = 3300, 2.4%). There was no significant difference between Asian (n = 105, 2.3%, OR = 0.80, 95% CI [0.53, 1.33]) and Hispanic (n = 655, 2.6%, OR = 0.95, 95% CI [0.77, 1.17]) patients and White patients. No significant difference was observed between female (n = 2515, 2.1%, OR = 1.02, 95% CI [0.89, 1.17]) and male (n = 2410, 2.0%) patients either. Patients with Medicare (n = 1150, 1.2%, OR = 0.69, 95% CI [0.57, 0.84]) or Medicaid (n = 1150, 1.8%, OR = 0.52, 95% CI [0.44, 0.62]) were less likely to receive brain stimulation treatment than were those with private insurance as the primary payer (n = 2370, 3.9%). CONCLUSIONS We discovered significant disparities in the use of brain stimulation treatments for drug-resistant epilepsy based on race and insurance status. More research will be required to determine the cause of these disparities.
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Affiliation(s)
- Vishal Venkatraman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Brittany G Futch
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Alyssa Bartlett
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Lexie Z Yang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA
| | - Beth A Parente
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | | | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA.
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7
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Roth J, Bergman L, Weil AG, Brunette-Clement T, Weiner HL, Treiber JM, Shofty B, Cukiert A, Cukiert CM, Tripathi M, Sarat Chandra P, Bollo RJ, Machado HR, Santos MV, Gaillard WD, Oluigbo CO, Ibrahim GM, Jallo GI, Shimony N, O'Neill BR, Budke M, Pérez-Jiménez MÁ, Mangano FT, Iwasaki M, Iijima K, Gonzalez-Martinez J, Kawai K, Ishishita Y, Elbabaa SK, Bello-Espinosa L, Fallah A, Maniquis CAB, Ben-Zvi I, Tisdall M, Panigrahi M, Jayalakshmi S, Blount JP, Dorfmüller G, Bulteau C, Stone SS, Bolton J, Singhal A, Connolly M, Alsowat D, Alotaibi F, Ragheb J, Uliel-Sibony S. Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox-Gastaut syndrome: A multicenter, multinational study. Epilepsia 2023; 64:3205-3212. [PMID: 37823366 DOI: 10.1111/epi.17796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Lennox-Gastaut syndrome (LGS) is a severe form of epileptic encephalopathy, presenting during the first years of life, and is very resistant to treatment. Once medical therapy has failed, palliative surgeries such as vagus nerve stimulation (VNS) or corpus callosotomy (CC) are considered. Although CC is more effective than VNS as the primary neurosurgical treatment for LGS-associated drop attacks, there are limited data regarding the added value of CC following VNS. This study aimed to assess the effectiveness of CC preceded by VNS. METHODS This multinational, multicenter retrospective study focuses on LGS children who underwent CC before the age of 18 years, following prior VNS, which failed to achieve satisfactory seizure control. Collected data included epilepsy characteristics, surgical details, epilepsy outcomes, and complications. The primary outcome of this study was a 50% reduction in drop attacks. RESULTS A total of 127 cases were reviewed (80 males). The median age at epilepsy onset was 6 months (interquartile range [IQR] = 3.12-22.75). The median age at VNS surgery was 7 years (IQR = 4-10), and CC was performed at a median age of 11 years (IQR = 8.76-15). The dominant seizure type was drop attacks (tonic or atonic) in 102 patients. Eighty-six patients underwent a single-stage complete CC, and 41 an anterior callosotomy. Ten patients who did not initially have a complete CC underwent a second surgery for completion of CC due to seizure persistence. Overall, there was at least a 50% reduction in drop attacks and other seizures in 83% and 60%, respectively. Permanent morbidity occurred in 1.5%, with no mortality. SIGNIFICANCE CC is vital in seizure control in children with LGS in whom VNS has failed. Surgical risks are low. A complete CC has a tendency toward better effectiveness than anterior CC for some seizure types.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Lottem Bergman
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Alexander G Weil
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre and University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Tristan Brunette-Clement
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre and University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey M Treiber
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Arthur Cukiert
- Department of Neurosurgery, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil
| | - Cristine Mella Cukiert
- Department of Neurology and Neurophysiology, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil
| | - Manjari Tripathi
- Center of Excellence for Epilepsy and MEG, AIIMS, New Delhi, India
| | | | - Robert J Bollo
- Division of Pediatric Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Hélio Rubens Machado
- Division of Pediatric Neurosurgery, Center for Epilepsy Surgery in Children, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - Marcelo Volpon Santos
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - William D Gaillard
- Department of Neurology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA
| | - George M Ibrahim
- Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George I Jallo
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Nir Shimony
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brent R O'Neill
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Marcelo Budke
- Department of Neurosurgery, Niño Jesus University Children's Hospital, Madrid, Spain
| | | | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Jorge Gonzalez-Martinez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University, Tochigi, Japan
| | - Yohei Ishishita
- Department of Neurosurgery, Jichi Medical University, Tochigi, Japan
| | - Samer K Elbabaa
- Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Luis Bello-Espinosa
- Pediatric Neurology and Epilepsy, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Cassia A B Maniquis
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ido Ben-Zvi
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - Georg Dorfmüller
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | | | - Scellig S Stone
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashutosh Singhal
- Division of Pediatric Neurosurgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Connolly
- Comprehensive Epilepsy Program, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Daad Alsowat
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Faisal Alotaibi
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - John Ragheb
- Department of Surgery, Nicklaus Children's Hospital, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Shimrit Uliel-Sibony
- Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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8
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Hacker C, Mocchi M, Xiao J, Metzger B, Adkinson J, Pascuzzi B, Mathura R, Oswalt D, Watrous A, Bartoli E, Allawala A, Pirtle V, Fan X, Danstrom I, Shofty B, Banks G, Zhang Y, Armenta-Salas M, Mirpour K, Provenza N, Mathew S, Cohn J, Borton D, Goodman W, Pouratian N, Sheth S, Bijanki K. Aperiodic neural activity is a biomarker for depression severity. medRxiv 2023:2023.11.07.23298040. [PMID: 37986996 PMCID: PMC10659509 DOI: 10.1101/2023.11.07.23298040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
A reliable physiological biomarker for Major Depressive Disorder (MDD) is necessary to improve treatment success rates by shoring up variability in outcome measures. In this study, we establish a passive biomarker that tracks with changes in mood on the order of minutes to hours. We record from intracranial electrodes implanted deep in the brain - a surgical setting providing exquisite temporal and spatial sensitivity to detect this relationship in a difficult-to-measure brain area, the ventromedial prefrontal cortex (VMPFC). The aperiodic slope of the power spectral density captures the balance of activity across all frequency bands and is construed as a putative proxy for excitatory/inhibitory balance in the brain. This study demonstrates how shifts in aperiodic slope correlate with depression severity in a clinical trial of deep brain stimulation for treatment-resistant depression (TRD). The correlation between depression severity scores and aperiodic slope is significant in N=5 subjects, indicating that flatter (less negative) slopes correspond to reduced depression severity, especially in the ventromedial prefrontal cortex. This biomarker offers a new way to track patient response to MDD treatment, facilitating individualized therapies in both intracranial and non-invasive monitoring scenarios.
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Affiliation(s)
- C. Hacker
- Baylor College of Medicine Department of Neurosurgery
- Washington University in St. Louis Department of Neurosurgery
| | - M.M Mocchi
- Baylor College of Medicine Department of Neurosurgery
| | - J. Xiao
- Baylor College of Medicine Department of Neurosurgery
| | - B.A. Metzger
- Baylor College of Medicine Department of Neurosurgery
| | - J.A. Adkinson
- Baylor College of Medicine Department of Neurosurgery
| | - B.R. Pascuzzi
- Baylor College of Medicine Department of Neurosurgery
| | - R.C. Mathura
- Baylor College of Medicine Department of Neurosurgery
| | - D. Oswalt
- University of Pennsylvania Department of Neurosurgery
| | - A. Watrous
- Baylor College of Medicine Department of Neurosurgery
| | - E. Bartoli
- Baylor College of Medicine Department of Neurosurgery
| | - A. Allawala
- Brown University Department of Biomedical Engineering and Carney Institute for Brain Science
| | - V. Pirtle
- Baylor College of Medicine Department of Neurosurgery
| | - X. Fan
- Baylor College of Medicine Department of Neurosurgery
| | - I. Danstrom
- Baylor College of Medicine Department of Neurosurgery
| | - B. Shofty
- Baylor College of Medicine Department of Neurosurgery
| | - G. Banks
- Baylor College of Medicine Department of Neurosurgery
| | - Y. Zhang
- Baylor College of Medicine Department of Neurosurgery
| | | | - K. Mirpour
- University of Texas Southwestern, Department of Neurosurgery
| | - N. Provenza
- Baylor College of Medicine Department of Neurosurgery
| | - S. Mathew
- Baylor College of Medicine Department of Psychiatry
| | - J. Cohn
- University of Pittsburgh Department of Psychology
| | - D. Borton
- Brown University Department of Biomedical Engineering and Carney Institute for Brain Science
- Brown University Department of Veterans Affairs Center for Neurorestoration and Neurotechnology
| | - W. Goodman
- Baylor College of Medicine Department of Psychiatry
| | - N. Pouratian
- University of Texas Southwestern, Department of Neurosurgery
| | - S.A. Sheth
- Baylor College of Medicine Department of Neurosurgery
| | - K.R. Bijanki
- Baylor College of Medicine Department of Neurosurgery
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9
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Sheth SA, Shofty B, Allawala A, Xiao J, Adkinson JA, Mathura RK, Pirtle V, Myers J, Oswalt D, Provenza NR, Giridharan N, Noecker AM, Banks GP, Gadot R, Najera RA, Anand A, Devara E, Dang H, Bartoli E, Watrous A, Cohn J, Borton D, Mathew SJ, McIntyre CC, Goodman W, Bijanki K, Pouratian N. Stereo-EEG-guided network modulation for psychiatric disorders: Surgical considerations. Brain Stimul 2023; 16:1792-1798. [PMID: 38135358 PMCID: PMC10787578 DOI: 10.1016/j.brs.2023.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/30/2023] [Accepted: 07/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) and other neuromodulatory techniques are being increasingly utilized to treat refractory neurologic and psychiatric disorders. OBJECTIVE /Hypothesis: To better understand the circuit-level pathophysiology of treatment-resistant depression (TRD) and treat the network-level dysfunction inherent to this challenging disorder, we adopted an approach of inpatient intracranial monitoring borrowed from the epilepsy surgery field. METHODS We implanted 3 patients with 4 DBS leads (bilateral pair in both the ventral capsule/ventral striatum and subcallosal cingulate) and 10 stereo-electroencephalography (sEEG) electrodes targeting depression-relevant network regions. For surgical planning, we used an interactive, holographic visualization platform to appreciate the 3D anatomy and connectivity. In the initial surgery, we placed the DBS leads and sEEG electrodes using robotic stereotaxy. Subjects were then admitted to an inpatient monitoring unit for depression-specific neurophysiological assessments. Following these investigations, subjects returned to the OR to remove the sEEG electrodes and internalize the DBS leads to implanted pulse generators. RESULTS Intraoperative testing revealed positive valence responses in all 3 subjects that helped verify targeting. Given the importance of the network-based hypotheses we were testing, we required accurate adherence to the surgical plan (to engage DBS and sEEG targets) and stability of DBS lead rotational position (to ensure that stimulation field estimates of the directional leads used during inpatient monitoring were relevant chronically), both of which we confirmed (mean radial error 1.2±0.9 mm; mean rotation 3.6±2.6°). CONCLUSION This novel hybrid sEEG-DBS approach allows detailed study of the neurophysiological substrates of complex neuropsychiatric disorders.
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Affiliation(s)
- Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Anusha Allawala
- Department of Engineering, Brown University, Providence, RI, USA
| | - Jiayang Xiao
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Joshua A Adkinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Raissa K Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Victoria Pirtle
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - John Myers
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Denise Oswalt
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Angela M Noecker
- Departments of Biomedical Engineering and Neurosurgery, Duke University, Durham, NC, USA
| | - Garrett P Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ricardo A Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ethan Devara
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Huy Dang
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Eleonora Bartoli
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew Watrous
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Borton
- Department of Engineering, Brown University, Providence, RI, USA
| | - Sanjay J Mathew
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Kelly Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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10
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Metzger BA, Kalva P, Mocchi MM, Cui B, Adkinson JA, Wang Z, Mathura R, Kanja K, Gavvala J, Krishnan V, Lin L, Maheshwari A, Shofty B, Magnotti JF, Willie JT, Sheth SA, Bijanki KR. Intracranial stimulation and EEG feature analysis reveal affective salience network specialization. Brain 2023; 146:4366-4377. [PMID: 37293814 PMCID: PMC10545499 DOI: 10.1093/brain/awad200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
Emotion is represented in limbic and prefrontal brain areas, herein termed the affective salience network (ASN). Within the ASN, there are substantial unknowns about how valence and emotional intensity are processed-specifically, which nodes are associated with affective bias (a phenomenon in which participants interpret emotions in a manner consistent with their own mood). A recently developed feature detection approach ('specparam') was used to select dominant spectral features from human intracranial electrophysiological data, revealing affective specialization within specific nodes of the ASN. Spectral analysis of dominant features at the channel level suggests that dorsal anterior cingulate (dACC), anterior insula and ventral-medial prefrontal cortex (vmPFC) are sensitive to valence and intensity, while the amygdala is primarily sensitive to intensity. Akaike information criterion model comparisons corroborated the spectral analysis findings, suggesting all four nodes are more sensitive to intensity compared to valence. The data also revealed that activity in dACC and vmPFC were predictive of the extent of affective bias in the ratings of facial expressions-a proxy measure of instantaneous mood. To examine causality of the dACC in affective experience, 130 Hz continuous stimulation was applied to dACC while patients viewed and rated emotional faces. Faces were rated significantly happier during stimulation, even after accounting for differences in baseline ratings. Together the data suggest a causal role for dACC during the processing of external affective stimuli.
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Affiliation(s)
- Brian A Metzger
- Department of Psychology, Swarthmore College, Swarthmore, PA 19081, USA
| | - Prathik Kalva
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Madaline M Mocchi
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Brian Cui
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Joshua A Adkinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zhengjia Wang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Raissa Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kourtney Kanja
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jay Gavvala
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Vaishnav Krishnan
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Lu Lin
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Atul Maheshwari
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah Health, Salt Lake City, UT 84132, USA
| | - John F Magnotti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
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11
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Bartoli E, Devara E, Dang HQ, Rabinovich R, Mathura RK, Anand A, Pascuzzi BR, Adkinson J, Bijanki KR, Sheth SA, Shofty B. Default mode network spatio-temporal electrophysiological signature and causal role in creativity. bioRxiv 2023:2023.09.13.557639. [PMID: 37786678 PMCID: PMC10541614 DOI: 10.1101/2023.09.13.557639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
The default mode network (DMN) is a widely distributed, intrinsic brain network thought to play a crucial role in internally-directed cognition. It subserves self-referential thinking, recollection of the past, mind wandering, and creativity. Knowledge about the electrophysiology underlying DMN activity is scarce, due to the difficulty to simultaneously record from multiple distant cortical areas with commonly-used techniques. The present study employs stereo-electroencephalography depth electrodes in 13 human patients undergoing monitoring for epilepsy, obtaining high spatiotemporal resolution neural recordings across multiple canonical DMN regions. Our results offer a rare insight into the temporal evolution and spatial origin of theta (4-8Hz) and gamma signals (30-70Hz) during two DMN-associated higher cognitive functions: mind-wandering and alternate uses. During the performance of these tasks, DMN activity is defined by a specific pattern of decreased theta coupled with increased gamma power. Critically, creativity and mind wandering engage the DMN with different dynamics: creativity recruits the DMN strongly during the covert search of ideas, while mind wandering displays the strongest modulation of DMN during the later recall of the train of thoughts. Theta band power modulations, predominantly occurring during mind wandering, do not show a predominant spatial origin within the DMN. In contrast, gamma power effects were similar for mind wandering and creativity and more strongly associated to lateral temporal nodes. Interfering with DMN activity through direct cortical stimulation within several DMN nodes caused a decrease in creativity, specifically reducing the originality of the alternate uses, without affecting creative fluency or mind wandering. These results suggest that DMN activity is flexibly modulated as a function of specific cognitive processes and supports its causal role in creative thinking. Our findings shed light on the neural constructs supporting creative cognition and provide causal evidence for the role of DMN in the generation of original connections among concepts.
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Affiliation(s)
- E Bartoli
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - E Devara
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - H Q Dang
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - R Rabinovich
- Department of Neurosurgery, University of Utah, USA
| | - R K Mathura
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - A Anand
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - B R Pascuzzi
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - J Adkinson
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - K R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, USA
- Department of Neuroscience, Baylor College of Medicine, USA
| | - S A Sheth
- Department of Neurosurgery, Baylor College of Medicine, USA
- Department of Neuroscience, Baylor College of Medicine, USA
| | - B Shofty
- Department of Neurosurgery, University of Utah, USA
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12
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Xiao J, Provenza NR, Asfouri J, Myers J, Mathura RK, Metzger B, Adkinson JA, Allawala AB, Pirtle V, Oswalt D, Shofty B, Robinson ME, Mathew SJ, Goodman WK, Pouratian N, Schrater PR, Patel AB, Tolias AS, Bijanki KR, Pitkow X, Sheth SA. Decoding Depression Severity From Intracranial Neural Activity. Biol Psychiatry 2023; 94:445-453. [PMID: 36736418 PMCID: PMC10394110 DOI: 10.1016/j.biopsych.2023.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/09/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Disorders of mood and cognition are prevalent, disabling, and notoriously difficult to treat. Fueling this challenge in treatment is a significant gap in our understanding of their neurophysiological basis. METHODS We recorded high-density neural activity from intracranial electrodes implanted in depression-relevant prefrontal cortical regions in 3 human subjects with severe depression. Neural recordings were labeled with depression severity scores across a wide dynamic range using an adaptive assessment that allowed sampling with a temporal frequency greater than that possible with typical rating scales. We modeled these data using regularized regression techniques with region selection to decode depression severity from the prefrontal recordings. RESULTS Across prefrontal regions, we found that reduced depression severity is associated with decreased low-frequency neural activity and increased high-frequency activity. When constraining our model to decode using a single region, spectral changes in the anterior cingulate cortex best predicted depression severity in all 3 subjects. Relaxing this constraint revealed unique, individual-specific sets of spatiospectral features predictive of symptom severity, reflecting the heterogeneous nature of depression. CONCLUSIONS The ability to decode depression severity from neural activity increases our fundamental understanding of how depression manifests in the human brain and provides a target neural signature for personalized neuromodulation therapies.
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Affiliation(s)
- Jiayang Xiao
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; Department of Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Joseph Asfouri
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas
| | - John Myers
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Raissa K Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Brian Metzger
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Joshua A Adkinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Victoria Pirtle
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Denise Oswalt
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Meghan E Robinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sanjay J Mathew
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas
| | - Wayne K Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Paul R Schrater
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota; Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Ankit B Patel
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas; Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Center for Neuroscience and Artificial Intelligence, Baylor College of Medicine, Houston, Texas
| | - Andreas S Tolias
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas; Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Center for Neuroscience and Artificial Intelligence, Baylor College of Medicine, Houston, Texas
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Xaq Pitkow
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas; Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Center for Neuroscience and Artificial Intelligence, Baylor College of Medicine, Houston, Texas
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
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13
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Najera RA, Provenza N, Dang H, Katlowitz KA, Hertz A, Reddy S, Shofty B, Bellows ST, Storch EA, Goodman WK, Sheth SA. Dual-Target Deep Brain Stimulation for Obsessive-Compulsive Disorder and Tourette Syndrome. Biol Psychiatry 2023; 93:e53-e55. [PMID: 36863881 DOI: 10.1016/j.biopsych.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Ricardo A Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Nicole Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Huy Dang
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Alyssa Hertz
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sandesh Reddy
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Ben Shofty
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Steven T Bellows
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
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14
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Myers J, Xiao J, Metzger B, Adkinson J, Allawala A, Pirtle V, Mathura R, Anand A, Gadot R, Najera RA, Rey HG, Shofty B, Provenza N, Goodman W, Mathew S, Pouratian N, Bijanki KR, Sheth SA. 156 Major Depression is Linked to Increased Information Flow From the Orbitofrontal Cortex. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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15
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Devara E, Dang H, Shofty B, Sheth SA. 207 An Investigation Into the Characteristics of Peri-Lead Edema After Deep Brain Stimulation Surgery. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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16
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Gadot R, Reddy S, Devara E, Dang H, Shofty B, Gavvala JR, Sheth SA. 449 Stereoencephalography of Centromedian Thalamus Reveals Distinct Patterns of Thalamocortical Synchrony Across Seizure Onset Zones. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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17
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Najera RA, Shofty B, Anand A, Gadot R, Storch E, Goodman W, Sheth SA. 155 Cost-Effectiveness Analysis of Deep Brain Stimulation Versus Treatment as Usual for Treatment-Resistant Obsessive-Compulsive Disorder. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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18
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Dang HQ, Provenza NR, Banks GP, Giridharan N, Avendano-Ortega M, McKay SA, Devara E, Shofty B, Storch EA, Sheth SA, Goodman WK. Attenuating side effects of deep brain stimulation in the bed nucleus of the stria terminalis for obsessive compulsive disorder using current-steering strategies. Brain Stimul 2023; 16:650-652. [PMID: 36958600 DOI: 10.1016/j.brs.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
- Huy Q Dang
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Garrett P Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Michelle Avendano-Ortega
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sarah A McKay
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ethan Devara
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
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19
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Shofty B, Gadot R, Provenza N, Storch EA, Goodman WK, Sheth SA. Neurosurgical Approaches for Treatment-Resistant Obsessive-Compulsive Disorder. Psychiatr Clin North Am 2023; 46:121-132. [PMID: 36740348 DOI: 10.1016/j.psc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Treatment-resistant obsessive-compulsive disorder (trOCD) is a severely disabling, life-threatening psychiatric disorder affecting ∼0.5% of the US population. Following the failure of multiple medical and psychotherapeutic treatment lines, patients with trOCD, like others with functional disorders, may benefit from invasive neuromodulation. Cumulative evidence suggests that disrupting abnormal hyperdirect cortico-striato-thalamo-cortical (CSTC) pathway activity offers sustainable, robust symptomatic relief in most patients. Multiple surgical approaches allow for modulation of the CSTC pathway, including stereotactic lesions and electrical stimulation. This review aims to describe the modern neurosurgical approaches for trOCD, recent advances in our understanding of pathophysiology, and future therapeutic directions.
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Affiliation(s)
- Ben Shofty
- Department of Neurosurgery, University of Utah, 175 North Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA
| | - Nicole Provenza
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA; Department of Psychiatry, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA.
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Najera RA, Gregory ST, Shofty B, Anand A, Gadot R, Youngerman BE, Storch EA, Goodman WK, Sheth SA. Cost-effectiveness analysis of radiosurgical capsulotomy versus treatment as usual for treatment-resistant obsessive-compulsive disorder. J Neurosurg 2023; 138:347-357. [PMID: 35907186 DOI: 10.3171/2022.5.jns22474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Stereotactic radiosurgical capsulotomy (SRS-C) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (TROCD). Unlike other procedures such as deep brain stimulation and radiofrequency ablation, the cost-effectiveness of SRS-C for TROCD has not been investigated. The authors herein report the first cost-effectiveness analysis of SRS-C for TROCD. METHODS Using a decision analytic model, the authors compared the cost-effectiveness of SRS-C to treatment as usual (TAU) for TROCD. Treatment response and complication rates were derived from a review of relevant clinical trials. Published algorithms were used to convert Yale-Brown Obsessive Compulsive Scale scores into utility scores reflecting improvements in quality of life. Costs were approached from the healthcare sector perspective and were drawn from Medicare reimbursement rates and available healthcare economics data. A Monte Carlo simulation and probabilistic sensitivity analysis were performed to estimate the incremental cost-effectiveness ratio. RESULTS One hundred fifty-eight TROCD patients across 9 studies who had undergone SRS-C and had at least 36 months of follow-up were included in the model. Compared to TAU, SRS-C was more cost-effective, with an estimated incremental cost-effectiveness ratio of $28,960 per quality-adjusted life year (QALY) gained. Within the 3-year time horizon, net QALYs gained were greater in the SRS-C group than the TAU group by 0.27 (95% CI 0.2698-0.2702, p < 0.0001). At willingness-to-pay thresholds of $50,000 and $100,000 per QALY, the Monte Carlo simulation revealed that SRS-C was more cost-effective than TAU in 83% and 100% of iterations, respectively. CONCLUSIONS Compared to TAU, SRS-C for TROCD is more cost-effective under a range of possible cost and effectiveness values.
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Affiliation(s)
- Ricardo A Najera
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Ben Shofty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Adrish Anand
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Ron Gadot
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Brett E Youngerman
- 3Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York; and
| | - Eric A Storch
- 4Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Wayne K Goodman
- 4Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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21
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Gadot R, Li N, Shofty B, Avendano-Ortega M, McKay S, Bijanki KR, Robinson ME, Banks G, Provenza N, Storch EA, Goodman WK, Horn A, Sheth SA. Tractography-Based Modeling Explains Treatment Outcomes in Patients Undergoing Deep Brain Stimulation for Obsessive-Compulsive Disorder. Biol Psychiatry 2023:S0006-3223(23)00045-8. [PMID: 36948900 PMCID: PMC10387502 DOI: 10.1016/j.biopsych.2023.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an established and expanding therapy for treatment-refractory obsessive-compulsive disorder. Previous work has suggested that a white matter circuit providing hyperdirect input from the dorsal cingulate and ventrolateral prefrontal regions to the subthalamic nucleus could be an effective neuromodulatory target. METHODS We tested this concept by attempting to retrospectively explain through predictive modeling the ranks of clinical improvement as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in 10 patients with obsessive-compulsive disorder who underwent DBS to the ventral anterior limb of internal capsule with subsequent programming uninformed by the putative target tract. RESULTS Rank predictions were carried out using the tract model by a team that was completely uninvolved in DBS planning and programming. Predicted Y-BOCS improvement ranks significantly correlated with actual Y-BOCS improvement ranks at the 6-month follow-up (r = 0.75, p = .013). Predicted score improvements correlated with actual Y-BOCS score improvements (r = 0.72, p = .018). CONCLUSIONS Here, we provide data in a first-of-its-kind report suggesting that normative tractography-based modeling can blindly predict treatment response in DBS for obsessive-compulsive disorder.
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Affiliation(s)
- Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Ningfei Li
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité Universitätsmedizin, Berlin, Germany
| | - Ben Shofty
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | | | - Sarah McKay
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Meghan E Robinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Garrett Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Nicole Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Wayne K Goodman
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Andreas Horn
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussetts
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
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22
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Shofty B, Gadot R, Viswanathan A, Provenza NR, Storch EA, McKay SA, Meyers MS, Hertz AG, Avendano-Ortega M, Goodman WK, Sheth SA. Intraoperative valence testing to adjudicate between ventral capsule/ventral striatum and bed nucleus of the stria terminalis target selection in deep brain stimulation for obsessive-compulsive disorder. J Neurosurg 2022:1-9. [PMID: 36681982 DOI: 10.3171/2022.10.jns221683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an accepted therapy for severe, treatment-refractory obsessive-compulsive disorder (trOCD). The optimal DBS target location within the anterior limb of the internal capsule, particularly along the anterior-posterior axis, remains elusive. Empirical evidence from several studies in the past decade has suggested that the ideal target lies in the vicinity of the anterior commissure (AC), either just anterior to the AC, above the ventral striatum (VS), or just posterior to the AC, above the bed nucleus of the stria terminalis (BNST). Various methods have been utilized to optimize target selection for trOCD DBS. The authors describe their practice of planning trajectories to both the VS and BNST and adjudicating between them with awake intraoperative valence testing to individualize permanent target selection. METHODS Eight patients with trOCD underwent awake DBS with trajectories planned for both VS and BNST targets bilaterally. The authors intraoperatively assessed the acute effects of stimulation on mood, energy, and anxiety and implanted the trajectory with the most reliable positive valence responses and least stimulation-induced side effects. The method of intraoperative target adjudication is described, and the OCD outcome at last follow-up is reported. RESULTS The mean patient age at surgery was 41.25 ± 15.1 years, and the mean disease duration was 22.75 ± 10.2 years. The median preoperative Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 39 (range 34-40). Two patients had previously undergone capsulotomy, with insufficient response. Seven (44%) of 16 leads were moved to the second target based on intraoperative stimulation findings, 4 of them to avoid strong negative valence effects. Three patients had an asymmetric implant (1 lead in each target). All 8 patients (100%) met full response criteria, and the mean Y-BOCS score reduction across the full cohort was 51.2% ± 12.8%. CONCLUSIONS Planning and intraoperatively testing trajectories flanking the AC-superjacent to the VS anteriorly and to the BNST posteriorly-allowed identification of positive valence responses and acute adverse effects. Awake testing helped to select between possible trajectories and identify individually optimized targets in DBS for trOCD.
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Affiliation(s)
- Ben Shofty
- 1Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
| | | | | | | | - Eric A Storch
- 3Psychiatry, Baylor College of Medicine, Houston, Texas
| | - Sarah A McKay
- 3Psychiatry, Baylor College of Medicine, Houston, Texas
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23
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Allam AK, Larkin MB, Katlowitz KA, Shofty B, Viswanathan A. Case report: MR-guided laser induced thermal therapy for palliative cingulotomy. Front Pain Res (Lausanne) 2022; 3:1028424. [PMID: 36387414 PMCID: PMC9663803 DOI: 10.3389/fpain.2022.1028424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/11/2022] [Indexed: 01/24/2023]
Abstract
In end-stage cancer, oncologic pain refractory to medical management significantly reduces patients' quality of life. In recent years, ablative surgery has seen a resurgence in treating diffuse and focal cancer pain in terminal patients. The anterior cingulate gyrus has been a key focus as it plays a role in the cognitive and emotional processing of pain. While radiofrequency ablation of the dorsal anterior cingulate is well described for treating cancer pain, MRI-guided laser-induced thermal therapy (LITT) is novel. Our paper describes a patient treated with an MRI-guided LITT therapy of the anterior cingulate gyrus for intractable debilitating pain secondary to terminal metastatic cancer.
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Affiliation(s)
- Anthony K. Allam
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - M. Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Kalman A. Katlowitz
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States,Department of Neurosurgery, University of Texas, MD Anderson, Houston, TX, United States,Correspondence: Ashwin Viswanathan
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Jalon I, Berger A, Shofty B, Goldway N, Artzi M, Gurevitch G, Hochberg U, Tellem R, Hendler T, Gonen T, Strauss I. Lesions to both somatic and affective pain pathways lead to decreased salience network connectivity. Brain 2022; 146:2153-2162. [PMID: 36314058 DOI: 10.1093/brain/awac403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Human pain is a salient stimulus composed of two main components: a sensory\somatic component, carrying peripheral nociceptive sensation via the spino-thalamic tract and brainstem nuclei to the thalamus and then to sensory cortical regions, and an affective (suffering) component, where information from central thalamic nuclei is carried to the anterior insula, dorsal anterior cingulate cortex and other regions. While the sensory component processes information about stimulus location and intensity, the affective component processes information regarding pain-related expectations, motivation to reduce pain, and pain unpleasantness. Unlike investigations of acute pain that are based on the introduction of real-time stimulus during brain recordings, chronic pain investigations are usually based on longitudinal and case-control studies, which are limited in their ability to infer the functional network topology of chronic pain. In the current study, we utilized the unique opportunity to target the central nervous system’s pain pathways in two different hierarchical locations to establish causality between pain relief and specific connectivity changes seen within the salience and sensorimotor networks. We examined how lesions to the affective and somatic pain pathways affect resting-state network topology in cancer patients suffering from severe intractable pain. Two procedures have been employed: percutaneous cervical cordotomy (n = 15), hypothesized to disrupt the transmission of the sensory component of pain along the spino-thalamic tract, or stereotactic cingulotomy (n = 7), which refers to bilateral intra-cranial ablation of an area in the dorsal anterior cingulate cortex and is known to ameliorate the affective component of pain. Both procedures led to immediate significant alleviation of experienced pain and decreased functional connectivity within the salience network. However, only the sensory procedure (cordotomy) led to decreased connectivity within the sensorimotor network. Thus, our results support the existence of two converging systems relaying experienced pain, showing that pain-related suffering can be either directly influenced by interfering with the affective pathway, or indirectly influenced by interfering with the ascending spino-thalamic tract.
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Affiliation(s)
- Itamar Jalon
- Department of Psychology, Tel Aviv University , Tel Aviv , Israel
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Department of Neurosurgery, NYU Langone Medical Center, New York University , New York , USA
| | - Ben Shofty
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Department of Neurosurgery, Baylor College of Medicine , Houston, Texas , USA
| | - Noam Goldway
- Department of Psychology, New York University , New York, NY
| | - Moran Artzi
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Guy Gurevitch
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Uri Hochberg
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- Institute of Pain Medicine, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Rotem Tellem
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- The Palliative Care Service, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Talma Hendler
- Department of Psychology, Tel Aviv University , Tel Aviv , Israel
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- Sagol School of Neuroscience Tel Aviv University , Israel
| | - Tal Gonen
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
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Gadot R, Najera R, Hirani S, Anand A, Storch E, Goodman WK, Shofty B, Sheth SA. Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328738. [PMID: 36127157 DOI: 10.1136/jnnp-2021-328738] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
Deep brain stimulation (DBS) is an established and growing intervention for treatment-resistant obsessive-compulsive disorder (TROCD). We assessed current evidence on the efficacy of DBS in alleviating OCD and comorbid depressive symptoms including newly available evidence from recent trials and a deeper risk of bias analysis than previously available. PubMed and EMBASE databases were systematically queried using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We included studies reporting primary data on multiple patients who received DBS therapy with outcomes reported through the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Primary effect measures included Y-BOCS mean difference and per cent reduction as well as responder rate (≥35% Y-BOCS reduction) at last follow-up. Secondary effect measures included standardised depression scale reduction. Risk of bias assessments were performed on randomised controlled (RCTs) and non-randomised trials. Thirty-four studies from 2005 to 2021, 9 RCTs (n=97) and 25 non-RCTs (n=255), were included in systematic review and meta-analysis based on available outcome data. A random-effects model indicated a meta-analytical average 14.3 point or 47% reduction (p<0.01) in Y-BOCS scores without significant difference between RCTs and non-RCTs. At last follow-up, 66% of patients were full responders to DBS therapy. Sensitivity analyses indicated a low likelihood of small study effect bias in reported outcomes. Secondary analysis revealed a 1 standardised effect size (Hedges' g) reduction in depressive scale symptoms. Both RCTs and non-RCTs were determined to have a predominantly low risk of bias. A strong evidence base supports DBS for TROCD in relieving both OCD and comorbid depression symptoms in appropriately selected patients.
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Affiliation(s)
- Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ricardo Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Samad Hirani
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Eric Storch
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Wayne K Goodman
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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26
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Giridharan N, Katlowitz KA, Anand A, Gadot R, Najera RA, Shofty B, Snyder R, Larrinaga C, Prablek M, Karas PJ, Viswanathan A, Sheth SA. Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow. Oper Neurosurg (Hagerstown) 2022; 23:254-260. [PMID: 35972090 DOI: 10.1227/ons.0000000000000298] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A number of stereotactic platforms are available for performing deep brain stimulation (DBS) lead implantation. Robot-assisted stereotaxy has emerged more recently demonstrating comparable accuracy and shorter operating room times compared with conventional frame-based systems. OBJECTIVE To compare the accuracy of our streamlined robotic DBS workflow with data in the literature from frame-based and frameless systems. METHODS We retrospectively reviewed 126 consecutive DBS lead placement procedures using a robotic stereotactic platform. Indications included Parkinson disease (n = 94), essential tremor (n = 21), obsessive compulsive disorder (n = 7), and dystonia (n = 4). Procedures were performed using a stereotactic frame for fixation and the frame pins as skull fiducials for robot registration. We used intraoperative fluoroscopic computed tomography for registration and postplacement verification. RESULTS The mean radial error for the target point was 1.06 mm (SD: 0.55 mm, range 0.04-2.80 mm) on intraoperative fluoroscopic computed tomography. The mean operative time for an asleep, bilateral implant without implantable pulse generator placement was 238 minutes (SD: 52 minutes), and skin-to-skin procedure time was 116 minutes (SD: 42 minutes). CONCLUSION We describe a streamlined workflow for DBS lead placement using robot-assisted stereotaxy with a comparable accuracy profile. Obviating the need for checking and switching coordinates, as is standard for frame-based DBS, also reduces the chance for human error and facilitates training.
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Affiliation(s)
- Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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27
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Gadot R, Vanegas Arroyave N, Dang H, Anand A, Najera RA, Taneff LY, Bellows S, Tarakad A, Jankovic J, Horn A, Shofty B, Viswanathan A, Sheth SA. Association of clinical outcomes and connectivity in awake versus asleep deep brain stimulation for Parkinson disease. J Neurosurg 2022; 138:1016-1027. [PMID: 35932263 DOI: 10.3171/2022.6.jns212904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) for Parkinson disease (PD) is traditionally performed with awake intraoperative testing and/or microelectrode recording. Recently, however, the procedure has been increasingly performed under general anesthesia with image-based verification. The authors sought to compare structural and functional networks engaged by awake and asleep PD-DBS of the subthalamic nucleus (STN) and correlate them with clinical outcomes. METHODS Levodopa equivalent daily dose (LEDD), pre- and postoperative motor scores on the Movement Disorders Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III), and total electrical energy delivered (TEED) at 6 months were retroactively assessed in patients with PD who received implants of bilateral DBS leads. In subset analysis, implanted electrodes were reconstructed using the Lead-DBS toolbox. Volumes of tissue activated (VTAs) were used as seed points in group volumetric and connectivity analysis. RESULTS The clinical courses of 122 patients (52 asleep, 70 awake) were reviewed. Operating room and procedure times were significantly shorter in asleep cases. LEDD reduction, MDS-UPDRS III score improvement, and TEED at the 6-month follow-up did not differ between groups. In subset analysis (n = 40), proximity of active contact, VTA overlap, and desired network fiber counts with motor STN correlated with lower DBS energy requirement and improved motor scores. Discriminative structural fiber tracts involving supplementary motor area, thalamus, and brainstem were associated with optimal clinical improvement. Areas of highest structural and functional connectivity with VTAs did not significantly differ between the two groups. CONCLUSIONS Compared to awake STN DBS, asleep procedures can achieve similarly optimal targeting-based on clinical outcomes, electrode placement, and connectivity estimates-in more efficient procedures and shorter operating room times.
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Affiliation(s)
- Ron Gadot
- 1Department of Neurosurgery, Baylor College of Medicine
| | - Nora Vanegas Arroyave
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Huy Dang
- 1Department of Neurosurgery, Baylor College of Medicine
| | - Adrish Anand
- 1Department of Neurosurgery, Baylor College of Medicine
| | | | - Lisa Yutong Taneff
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Steven Bellows
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Arjun Tarakad
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Joseph Jankovic
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Andreas Horn
- 3Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany
| | - Ben Shofty
- 1Department of Neurosurgery, Baylor College of Medicine
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28
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Allam AK, Larkin Michael MB, Shofty B, Viswanathan A. Ablation Procedures. Neurosurg Clin N Am 2022; 33:339-344. [PMID: 35718404 DOI: 10.1016/j.nec.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although ablation has a limited role in the management of chronic noncancer pain, ablation continues to help patients with treatment of refractory cancer-related pain. Interdisciplinary treatment involving supportive care, pain medicine, oncology, and neurosurgery is critical to optimizing the timing and outcome of neurosurgical ablative options for pain management. In this review, 3 targets for ablative surgery-the spinothalamic tract, the dorsal column's visceral pain pathway, and the anterior cingulate cortex-are discussed with a focus on patient selection and key aspects of surgical technique.
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Affiliation(s)
- Anthony Kaspa Allam
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX 77030, USA
| | - M Benjamin Larkin Michael
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX 77030, USA
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX 77030, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX 77030, USA.
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Das A, Myers J, Mathura R, Shofty B, Metzger BA, Bijanki K, Wu C, Jacobs J, Sheth SA. Spontaneous neuronal oscillations in the human insula are hierarchically organized traveling waves. eLife 2022; 11:76702. [PMID: 35616527 PMCID: PMC9200407 DOI: 10.7554/elife.76702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
The insula plays a fundamental role in a wide range of adaptive human behaviors, but its electrophysiological dynamics are poorly understood. Here, we used human intracranial electroencephalographic recordings to investigate the electrophysiological properties and hierarchical organization of spontaneous neuronal oscillations within the insula. We analyzed the neuronal oscillations of the insula directly and found that rhythms in the theta and beta frequency oscillations are widespread and spontaneously present. These oscillations are largely organized along the anterior–posterior (AP) axis of the insula. Both the left and right insula showed anterior-to-posterior decreasing gradients for the power of oscillations in the beta frequency band. The left insula also showed a posterior-to-anterior decreasing frequency gradient and an anterior-to-posterior decreasing power gradient in the theta frequency band. In addition to measuring the power of these oscillations, we also examined the phase of these signals across simultaneous recording channels and found that the insula oscillations in the theta and beta bands are traveling waves. The strength of the traveling waves in each frequency was positively correlated with the amplitude of each oscillation. However, the theta and beta traveling waves were uncoupled to each other in terms of phase and amplitude, which suggested that insular traveling waves in the theta and beta bands operate independently. Our findings provide new insights into the spatiotemporal dynamics and hierarchical organization of neuronal oscillations within the insula, which, given its rich connectivity with widespread cortical regions, indicates that oscillations and traveling waves have an important role in intrainsular and interinsular communications.
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Affiliation(s)
- Anup Das
- Department of Biomedical Engineering, Columbia University, New York, United States
| | - John Myers
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
| | - Raissa Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
| | - Brian A Metzger
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
| | - Kelly Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, United States
| | - Joshua Jacobs
- Department of Biomedical Engineering, Columbia University, New York, United States
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, United States
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Anand A, Gavvala JR, Mathura R, Najera RA, Gadot R, Shofty B, Sheth SA. Elimination of anxiety after laser interstitial thermal ablation of the dominant cingulate gyrus for epilepsy. Surg Neurol Int 2022; 13:178. [PMID: 35509526 PMCID: PMC9062951 DOI: 10.25259/sni_241_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Anxiety is a common symptom of mental health disorders. Surgical treatment of anxiety-related disorders is limited by our understanding of the neural circuitry responsible for emotional regulation. Limbic regions communicate with other cortical and subcortical regions to generate emotional responses and behaviors toward anxiogenic stimuli. Epilepsy involving corticolimbic regions may disrupt normal neural circuitry and present with mood disorders. Anxiety presenting in patients with mesial temporal lobe epilepsy is common; however, anxiety in patients with cingulate epilepsy is not well described. Neurosurgical cases with rare clinical presentations may provide insight into the basic functionality of the human mind and ultimately lead to improvements in surgical treatments. Case Description: We present the case of a 24-year-old male with a 20-year history of nonlesional and cingulate epilepsy with an aura of anxiety and baseline anxiety. Noninvasive work-up was discordant. Intracranial evaluation using stereoelectroencephalography established the epileptogenic zone in the left anterior and mid-cingulate gyrus. Stimulation of the cingulate reproduced a sense of anxiety typical of the habitual auras. We performed laser interstitial thermal therapy of the left anterior and mid-cingulate gyrus. At 8 months following ablation, the patient reported a substantial reduction in seizure frequency and complete elimination of his baseline anxiety and anxious auras. Conclusion: This case highlights the role of the cingulate cortex (CC) in regulating anxiety. Ablation of the epileptic focus resolved both epilepsy-related anxiety and baseline features.a Future studies assessing the role of the CC in anxiety disorders may enable improvements in surgical treatments for anxiety disorders.
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Affiliation(s)
- Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
| | - Jay R. Gavvala
- Department of Neurology, Baylor College of Medicine, Houston, Texas, United States
| | - Raissa Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
| | - Ricardo A. Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States,
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Anand A, Magnotti JF, Smith DN, Gadot R, Najera RA, Hegazy MIR, Gavvala JR, Shofty B, Sheth SA. Predictive value of magnetoencephalography in guiding the intracranial implant strategy for intractable epilepsy. J Neurosurg 2022; 137:1-11. [PMID: 35303696 DOI: 10.3171/2022.1.jns212943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetoencephalography (MEG) is a useful component of the presurgical evaluation of patients with epilepsy. Due to its high spatiotemporal resolution, MEG often provides additional information to the clinician when forming hypotheses about the epileptogenic zone (EZ). Because of the increasing utilization of stereo-electroencephalography (sEEG), MEG clusters are used to guide sEEG electrode targeting with increasing frequency. However, there are no predefined features of an MEG cluster that predict ictal activity. This study aims to determine which MEG cluster characteristics are predictive of the EZ. METHODS The authors retrospectively analyzed all patients who had an MEG study (2017-2021) and underwent subsequent sEEG evaluation. MEG dipoles and sEEG electrodes were reconstructed in the same coordinate space to calculate overlap among individual contacts on electrodes and MEG clusters. MEG cluster features-including number of dipoles, proximity, angle, density, magnitude, confidence parameters, and brain region-were used to predict ictal activity in sEEG. Logistic regression was used to identify important cluster features and to train a binary classifier to predict ictal activity. RESULTS Across 40 included patients, 196 electrodes (42.2%) sampled MEG clusters. Electrodes that sampled MEG clusters had higher rates of ictal and interictal activity than those that did not sample MEG clusters (ictal 68.4% vs 39.8%, p < 0.001; interictal 71.9% vs 44.6%, p < 0.001). Logistic regression revealed that the number of dipoles (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.04-1.14, t = 3.43) and confidence volume (OR 0.02, 95% CI 0.00-0.86, t = -2.032) were predictive of ictal activity. This model was predictive of ictal activity with 77.3% accuracy (sensitivity = 80%, specificity = 74%, C-statistic = 0.81). Using only the number of dipoles had a predictive accuracy of 75%, whereas a threshold between 14 and 17 dipoles in a cluster detected ictal activity with 75.9%-85.2% sensitivity. CONCLUSIONS MEG clusters with approximately 14 or more dipoles are strong predictors of ictal activity and may be useful in the preoperative planning of sEEG implantation.
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Affiliation(s)
| | - John F Magnotti
- 2Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | - Jay R Gavvala
- 3Neurology, Baylor College of Medicine, Houston, Texas; and
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Gadot R, Korst G, Shofty B, Gavvala JR, Sheth SA. Thalamic stereoelectroencephalography in epilepsy surgery: a scoping literature review. J Neurosurg 2022; 137:1-16. [PMID: 35276641 DOI: 10.3171/2022.1.jns212613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (sEEG) is a well-established surgical method for defining the epileptogenic network. Traditionally reserved for identifying discrete cortical regions for resection or ablation, sEEG in current practice is also used for identifying more broadly involved subcortical epileptic network components, driven by the availability of brain-based neuromodulation strategies. In particular, sEEG investigations including thalamic nuclei are becoming more frequent in parallel with the increase in therapeutic strategies involving thalamic targets such as deep brain stimulation (DBS) and responsive neurostimulation (RNS). The objective to this study was to evaluate existing evidence and trends regarding the purpose, techniques, and relevant electrographic findings of thalamic sEEG. METHODS MEDLINE and Embase databases were systematically queried for eligible peer-reviewed studies involving sEEG electrode implantation into thalamic nuclei of patients with epilepsy. Available data were abstracted concerning preoperative workup and purpose for implanting the thalamus, thalamic targets and trajectories, and electrophysiological methodology and findings. RESULTS sEEG investigations have included thalamic targets for both basic and clinical research purposes. Medial pulvinar, dorsomedial, anterior, and centromedian nuclei have been the most frequently studied. Few studies have reported any complications with thalamic sEEG implantation, and no studies have reported long-term complications. Various methods have been utilized to characterize thalamic activity in epileptic disorders including evoked potentials, power spectrograms, synchronization indices, and the epileptogenicity index. Thalamic intracranial recordings are beginning to be used to guide neuromodulation strategies including RNS and DBS, as well as to understand complex, network-dependent seizure disorders. CONCLUSIONS Inclusion of thalamic coverage during sEEG evaluation in drug-resistant epilepsy is a growing practice and is amenable to various methods of electrographic data analysis. Further study is required to establish well-defined criteria for thalamic implantation during invasive investigations as well as safety and ethical considerations.
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Affiliation(s)
| | | | | | - Jay R Gavvala
- 2Neurology, Baylor College of Medicine, Houston, Texas
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Anand A, Gadot R, Najera RA, Smith D, Hegazy M, Gavvala JR, Shofty B, Sheth SA. 149 Predictive Value of Magnetoencephalography to Guide Intracranial Implant Strategy. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Berger A, Jalon I, Gonen T, Shofty B, Tellem R, Hochberg U, Artzi M, Ben-Bashat D, Hendler T, Strauss I. 831 Pain Networks Connectivity Changes Following the Relief of Prolonged Cancer Pain. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gadot R, Shofty B, Najera RA, Anand A, Banks G, Khan AB, LoPresti MA, Vanegas Arroyave N, Sheth SA. Case Report: Dual Target Deep Brain Stimulation With Externalized Programming for Post-traumatic Complex Movement Disorder. Front Neurosci 2021; 15:774073. [PMID: 34819837 PMCID: PMC8606815 DOI: 10.3389/fnins.2021.774073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Movement disorders can be common, persistent, and debilitating sequelae of severe traumatic brain injury. Post-traumatic movement disorders are usually complex in nature, involving multiple phenomenological manifestations, and can be difficult to control with medical management alone. Deep brain stimulation (DBS) has been used to treat these challenging cases, but distorted brain anatomy secondary to trauma can complicate effective targeting. In such cases, use of diffusion tractography imaging and inpatient testing with externalized DBS leads can be beneficial in optimizing outcomes. Case Description: We present the case of a 42-year-old man with severe, disabling post-traumatic tremor who underwent bilateral, dual target DBS to the globus pallidus internus (GPi) and a combined ventral intermediate nucleus of the thalamus (Vim)/dentato-rubro-thalamic tracts (DRTT) target. DRTT fiber tracts were reconstructed preoperatively to assist in surgical targeting given the patient’s distorted anatomy. Externalization and survey of the four leads extra-operatively with inpatient testing allowed for internalization of the leads that demonstrated benefit. Six months after surgery, the patient’s tremor and dystonic burden had decreased by 67% in the performance sub-score of The Essential Tremor Rating Scale (TETRAS). Conclusion: A patient-tailored approach including target selection guided by individualized anatomy and tractography as well as extra-operative externalized lead interrogation was shown to be effective in optimizing clinical outcome in a patient with refractory post-traumatic tremor.
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Affiliation(s)
- Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ricardo A Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Garrett Banks
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, United States
| | - Abdul Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | | | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
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Shofty B, Bergman L, Berger A, Aizenstein O, Ben-Valid S, Gurovich D, Tankus A, Attias M, Fahoum F, Strauss I. Adopting MR-guided stereotactic laser ablations for epileptic lesions: initial clinical experience and lessons learned. Acta Neurochir (Wien) 2021; 163:2797-2803. [PMID: 34269876 DOI: 10.1007/s00701-021-04903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive technique for ablating brain lesions under real-time MRI feedback and control of the ablation process. The Medtronic Visualase system was recently approved for use in Europe and Israel. We report our initial technical experience using the system in the first 16 cases in which the system was used to ablate focal epileptogenic lesions. METHODS We included all consecutive patients with intractable epilepsy who underwent MRgLITT procedures between 2018 and 2020. We reviewed medical charts and imaging studies of patients. Post-ablation MRIs were used to calculate ablation volumes. RESULTS Seventeen MRgLITT procedures were performed in 16 patients. One cooling catheter/laser fiber assemblies were placed per patient. Indications for surgery were intractable epilepsy due to TLE (n = 7), suspected low-grade glioma (n = 4), radiological cortical dysplasia (n = 1), hypothalamic hamartoma (n = 1), and MR-negative foci (n = 3). Ablations were made using 30 to 70% of the maximal energy of the Visualase system. We used serial ablations as needed along the tract of the catheter by pulling back the optic fiber; the length of the lesion ranged between 7.4 and 38.1 mm. Ablation volume ranged between 0.27 and 6.78 mm3. Immediate post-ablation MRI demonstrated good ablation of the epileptic lesion in 16/17 cases. In one case with mesial temporal sclerosis, no ablation was performed due to suboptimal position of the catheter. That patient was successfully reoperated at a later date. Mean follow-up was 14.9 months (± 11.6 months). Eleven patients had follow-up longer than 12 months. Good seizure control (Engel I, A) was achieved in 7/11 patients (63%) and 1/11 (9%) had significant improvement in seizure frequency (Angle IIIa). Three patients (27%) did not experience improvement in their seizure frequency (Engel IV, B), and one of these patients died during the follow-up period from sudden unexpected death of epilepsy (SUDEP). No immediate or delayed neurological complications were documented in any of the cases during the follow-up period. CONCLUSIONS MRgLITT is a promising technique and can be used safely as an alternative to open resection in both lesional and non-lesional intractable epilepsy cases. In our local series, the success rate of epilepsy surgery was comparable to recent publications.
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Shimony N, Popovits N, Shofty B, Abergel A, Ram Z, Grossman R. Endoscopic transsphenoidal surgery reduces the need for re-operation compared to the microscopic approach in pituitary macroadenomas. Eur J Surg Oncol 2021; 47:1352-1356. [PMID: 33637372 DOI: 10.1016/j.ejso.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/16/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Pituitary surgery has shifted in recent years from microscopic surgery(MS) to endoscopic endonasal surgery (EES). However, the comparative long-term outcome of these surgical approaches, including the need for subsequent re-operation has never been reported. We present our experience in a high-volume referral center experienced in both endoscopic and microscopic approaches to compare the need for re-operation after initial resection of non-functioning pituitary macroadenomas using these surgical approaches. METHODS 684 patients (398 with NF adenomas) underwent trans-sphenoidal pituitary surgery in our institution between 2006 and 2017. Complete follow-up (mean 72 months, minimum two years) was available in 87 newly diagnosed patients with non-functioning pituitary macroadenomas (NFPMA; 48-microscopic and 39-endoscopic). The EES approach has been used almost exclusively since 2012. The need for repeat operation for tumor resection during the follow-up period was assessed as the primary end-point of the study. Extracted data included various demographic and clinical parameters, radiographic findings as well as the extent of resection (EOR). RESULTS The EOR was similar for both groups, with a trend towards better EOR in the EES group. The rate of surgical complications was also similar for both groups. There was a strong trend towards lower need for re-operation in the EES group compared to the MS group (12.8% vs. 29.2%, p = 0.056). In a multivariate analysis, only EOR and Knosp grade were independently associated with the need for re-operation surgery. CONCLUSION Our data indicate that EES in NFPMA tends to be associated with a lower need for re-operation compared to the MS approach, with a similar rate of EOR and complications.
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Affiliation(s)
- Nir Shimony
- Institute of Neuroscience, Geisinger Commonwealth School of Medicine, Danville, PA, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nataly Popovits
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Shofty
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avraham Abergel
- Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zvi Ram
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rachel Grossman
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Roth J, Jonas Kimchi T, Shofty B, Agur A, Ben-Sira L, Constantini S. The Role of 3D Reconstruction of the Skull in Patients with Suspected Shunt Malfunction. Pediatr Neurosurg 2021; 56:110-115. [PMID: 33730727 DOI: 10.1159/000514065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mechanical shunt malfunction may lead to significant morbidity and mortality. Shunt series assessments help evaluate shunt integrity; however, they are of limited value in the area of the skull due to skull curvature, thickness, and air sinuses. We describe the role of 3D bone reconstruction CT (3DCT) in demonstrating the shunt integrity over the skull, comparing this technique to skull X-rays (SXR). METHODS Data were collected retrospectively for shunted patients with concurrent SXR and 3DCT and for patients presenting with shunt failures at the region of the skull, including clinical course and radiological findings. We compared the SXR and 3DCT findings. The 3DCT was reconstructed from standard diagnostic CT protocols performed during evaluation of suspected shunt malfunction and not thin-slice CT protocols. RESULTS Forty-eight patients with 57 shunts underwent SXR and 3DCT. Interobserver agreement was high for most variables. Both SXR and 3DCT had a high sensitivity, specificity, and accuracy identifying tubing disconnections (between 0.83 and 1). Full valve type and setting were significantly more accurate based on SXR versus 3DCT (>90 vs. <20%), and valve integrity was significantly more readily verified on 3DCT versus SXR (100 vs. 52%). CONCLUSIONS 3DCT and SXR complement each other in diagnosing mechanical shunt malfunctions over the skull. The main limitation of 3DCT is identification of valve type and settings, which are clearer on SXR, while the main limitation of SXR is a less ability to evaluate valve integrity. 3DCT also enables an intuitive 3D understanding of the shunt tubing over the skull.
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Affiliation(s)
- Jonathan Roth
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
| | - Tali Jonas Kimchi
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ben Shofty
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Agur
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Liat Ben-Sira
- Pediatric Radiology Unit, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Grossman R, Haim O, Abramov S, Shofty B, Artzi M. Differentiating Small-Cell Lung Cancer From Non-Small-Cell Lung Cancer Brain Metastases Based on MRI Using Efficientnet and Transfer Learning Approach. Technol Cancer Res Treat 2021; 20:15330338211004919. [PMID: 34030542 PMCID: PMC8155765 DOI: 10.1177/15330338211004919] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/01/2021] [Accepted: 02/12/2021] [Indexed: 11/15/2022] Open
Abstract
Differentiation between small-cell lung cancer (SCLC) from non-small-cell lung cancer (NSCLC) brain metastases is crucial due to the different clinical behaviors of the two tumor types. We propose the use of a deep learning and transfer learning approach based on conventional magnetic resonance imaging (MRI) for non-invasive classification of SCLC vs. NSCLC brain metastases. Sixty-nine patients with brain metastasis of lung cancer origin were included. Of them, 44 patients had NSCLC and 25 patients had SCLC. Classification was performed with EfficientNet architecture on crop images of lesion areas and based on post-contrast T1-weighted, T2-weighted and FLAIR imaging input data. Evaluation of the model was carried out in a 5-fold cross-validation manner, and based on accuracy, precision, recall, F1 score and area under the receiver operating characteristic curve. The best classification results were obtained with multiparametric MRI input data (T1WI+c+FLAIR+T2WI), with a mean overall accuracy of 0.90 ± 0.04, and F1 score of 0.92 ± 0.05 for NSCLC and 0.87 ± 0.08 for SCLC for the validation data and an accuracy of 0.87 ± 0.05, with an F1 score of 0.88 ± 0.05 for NSCLC and 0.85 ± 0.05 for SCLC for the test dataset. The proposed method provides an automatic noninvasive method for the classification of brain metastasis with high sensitivity and specificity for differentiation between NSCLC vs. SCLC brain metastases. It may be used as a diagnostic tool for improving decision-making in the treatment of patients with these metastases. Further studies on larger patient samples are required to validate the current results.
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Affiliation(s)
- Rachel Grossman
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel
Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv,
Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv,
Israel
| | - Oz Haim
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel
Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv,
Israel
| | - Shani Abramov
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel
Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv,
Israel
| | - Ben Shofty
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel
Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv,
Israel
| | - Moran Artzi
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv,
Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv,
Israel
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv,
Israel
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Karas PJ, Giridharan N, Treiber JM, Prablek MA, Khan AB, Shofty B, Krishnan V, Chu J, Van Ness PC, Maheshwari A, Haneef Z, Gavvala JR, Sheth SA. Accuracy and Workflow Improvements for Responsive Neurostimulation Hippocampal Depth Electrode Placement Using Robotic Stereotaxy. Front Neurol 2020; 11:590825. [PMID: 33424745 PMCID: PMC7793880 DOI: 10.3389/fneur.2020.590825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/19/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Robotic stereotaxy is increasingly common in epilepsy surgery for the implantation of stereo-electroencephalography (sEEG) electrodes for intracranial seizure monitoring. The use of robots is also gaining popularity for permanent stereotactic lead implantation applications such as in deep brain stimulation and responsive neurostimulation (RNS) procedures. Objective: We describe the evolution of our robotic stereotactic implantation technique for placement of occipital-approach hippocampal RNS depth leads. Methods: We performed a retrospective review of 10 consecutive patients who underwent robotic RNS hippocampal depth electrode implantation. Accuracy of depth lead implantation was measured by registering intraoperative post-implantation fluoroscopic CT images and post-operative CT scans with the stereotactic plan to measure implantation accuracy. Seizure data were also collected from the RNS devices and analyzed to obtain initial seizure control outcome estimates. Results: Ten patients underwent occipital-approach hippocampal RNS depth electrode placement for medically refractory epilepsy. A total of 18 depth electrodes were included in the analysis. Six patients (10 electrodes) were implanted in the supine position, with mean target radial error of 1.9 ± 0.9 mm (mean ± SD). Four patients (8 electrodes) were implanted in the prone position, with mean radial error of 0.8 ± 0.3 mm. The radial error was significantly smaller when electrodes were implanted in the prone position compared to the supine position (p = 0.002). Early results (median follow-up time 7.4 months) demonstrate mean seizure frequency reduction of 26% (n = 8), with 37.5% achieving ≥50% reduction in seizure frequency as measured by RNS long episode counts. Conclusion: Prone positioning for robotic implantation of occipital-approach hippocampal RNS depth electrodes led to lower radial target error compared to supine positioning. The robotic platform offers a number of workflow advantages over traditional frame-based approaches, including parallel rather than serial operation in a bilateral case, decreased concern regarding human error in setting frame coordinates, and surgeon comfort.
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Affiliation(s)
- Patrick J Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Jeffrey M Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Marc A Prablek
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - A Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Vaishnav Krishnan
- Department of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United States
| | - Jennifer Chu
- Department of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United States
| | - Paul C Van Ness
- Department of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United States
| | - Atul Maheshwari
- Department of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United States
| | - Zulfi Haneef
- Department of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United States
| | - Jay R Gavvala
- Department of Neurology, Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
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Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) patients may present a wide spectrum of spinal pathologies. Osseous changes may lead to severe deformities with significant implications on growth and quality of life. Neurogenic tumors and soft tissue abnormalities may cause neuropathic pain and dysfunction ranging from minor paresthesias to profound motor and sensory deficits. Advanced imaging such as whole-body MRI, and volumetric tumor burden assessment have an evolving role in the evaluation and follow-up of patients with high spinal tumor load. Novel biological agents that target the hyperactivated ras pathway are currently under investigation and are reshaping current and future treatment paradigms. Surgical interventions for benign and malignant tumors, as well as deformity correction remain pivotal in treatment frameworks and require careful assessment by a dedicated multidisciplinary team. PURPOSE In this manuscript we review the various spinal manifestations of NF1 patients, indication for surgical intervention and oncological treatments.
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Affiliation(s)
- Ben Shofty
- Department of Neurosurgery, Tel-Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel.,The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv, Israel
| | - Ori Barzilai
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Morsi Khashan
- Department of Neurosurgery, Tel-Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Zvi Lidar
- Department of Neurosurgery, Tel-Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv, Israel. .,Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center and Tel Aviv University, Tel-Aviv, Israel.
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Abstract
BACKGROUND Optic Pathway Gliomas (OPG) are the most common brain tumor in Neurofibromatosis 1 patients (NF1). They are found along the optic pathway and may involve the optic nerves, chiasm, retro-chiasmatic structures, and the optic radiations. NF1 associate OPG (NF1-OPG) have variable presentation, disease course and response to treatment. The optimal management is patient-specific and should be tailored by a multidisciplinary team. Age, sex, histology, and molecular markers may be important factors in the individualized decision-making process. Chemotherapy is the first-line treatment in cases of progressive tumors, and visual preservation is the main goal of treatment. PURPOSE In this paper we will review the disease, practical management, and recent advances of NF1-OPG.
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Affiliation(s)
- Ben Shofty
- Department of Neurosurgery, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, Tel Aviv, Israel
| | - Liat Ben Sira
- Pediatric Radiology, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, 6th Weizmann St., 64239, Tel-Aviv, Israel.
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43
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Artzi M, Gershov S, Ben-Sira L, Roth J, Kozyrev D, Shofty B, Gazit T, Halag-Milo T, Constantini S, Ben Bashat D. Automatic segmentation, classification, and follow-up of optic pathway gliomas using deep learning and fuzzy c-means clustering based on MRI. Med Phys 2020; 47:5693-5701. [PMID: 32969025 DOI: 10.1002/mp.14489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Optic pathway gliomas (OPG) are low-grade pilocytic astrocytomas accounting for 3-5% of pediatric intracranial tumors. Accurate and quantitative follow-up of OPG using magnetic resonance imaging (MRI) is crucial for therapeutic decision making, yet is challenging due to the complex shape and heterogeneous tissue pattern which characterizes these tumors. The aim of this study was to implement automatic methods for segmentation and classification of OPG and its components, based on MRI. METHODS A total of 202 MRI scans from 29 patients with chiasmatic OPG scanned longitudinally were retrospectively collected and included in this study. Data included T2 and post-contrast T1 weighted images. The entire tumor volume and its components were manually annotated by a senior neuro-radiologist, and inter- and intra-rater variability of the entire tumor volume was assessed in a subset of scans. Automatic tumor segmentation was performed using deep-learning method with U-Net+ResNet architecture. A fivefold cross-validation scheme was used to evaluate the automatic results relative to manual segmentation. Voxel-based classification of the tumor into enhanced, non-enhanced, and cystic components was performed using fuzzy c-means clustering. RESULTS The results of the automatic tumor segmentation were: mean dice score = 0.736 ± 0.025, precision = 0.918 ± 0.014, and recall = 0.635 ± 0.039 for the validation data, and dice score = 0.761 ± 0.011, precision = 0.794 ± 0.028, and recall = 0.742 ± 0.012 for the test data. The accuracy of the voxel-based classification of tumor components was 0.94, with precision = 0.89, 0.97, and 0.85, and recall = 1.00, 0.79, and 0.94 for the non-enhanced, enhanced, and cystic components, respectively. CONCLUSION This study presents methods for automatic segmentation of chiasmatic OPG tumors and classification into the different components of the tumor, based on conventional MRI. Automatic quantitative longitudinal assessment of these tumors may improve radiological monitoring, facilitate early detection of disease progression and optimize therapy management.
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Affiliation(s)
- Moran Artzi
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Sapir Gershov
- The Iby and Aladar, Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Liat Ben-Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.,Division of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel.,The Gilbert Israeli Neurofibromatosis Center, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel
| | - Jonathan Roth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.,The Gilbert Israeli Neurofibromatosis Center, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel.,Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel
| | - Danil Kozyrev
- Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel
| | - Ben Shofty
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.,Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel
| | - Tomer Gazit
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel
| | - Tali Halag-Milo
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel
| | - Shlomi Constantini
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.,The Gilbert Israeli Neurofibromatosis Center, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel.,Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 6997801, Israel
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Sapir Y, Korn A, Bitan-Talmor Y, Vendrov I, Berger A, Shofty B, Zegerman A, Strauss I. Intraoperative Neurophysiology for Optimization of Percutaneous Spinothalamic Cordotomy for Intractable Cancer Pain. Oper Neurosurg (Hagerstown) 2020; 19:E566-E572. [PMID: 32710768 DOI: 10.1093/ons/opaa209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Percutaneous ablation of the cervical spinothalamic tract (STT) remains a therapeutic remedy for intractable cancer pain. However, it is accompanied by the risk of collateral damage to essential spinal cord circuitry, including the corticospinal tract (CST). Recent studies describe threshold-based mapping of the CST with the objective of motor bundle preservation during intramedullary spinal cord and supratentorial surgery. OBJECTIVE To assess the possibility that application of spinal cord mapping using intraoperative neuromonitoring in percutaneous cordotomy procedures may aid in minimizing iatrogenic motor tract injury. METHODS We retrospectively reviewed the files of 11 patients who underwent percutaneous cervical cordotomy for intractable oncological pain. We performed quantitative electromyogram (EMG) recordings to stimulation of the ablation needle prior to the STT-ablative stage. We compared evoked motor and sensory electrical thresholds, and the electrical span between them as a reliable method to confirm safe electrode location inside the STT. RESULTS Quantified EMG data were collected in 11 patients suffering from intractable cancer pain. The threshold range for evoking motor activity was 0.3 to 1.2 V. Stimulation artifacts were detected from trapezius muscles even at the lowest stimulation intensity, while thenar muscles were found to be maximally sensitive and specific. The minimal stimulation intensity difference between the motor and the sensory threshold, set as "Δ-threshold," was 0.26 V, with no new motor deficit at 3 days or 1 month postoperatively. CONCLUSION Selective STT ablation is an effective procedure for treating intractable pain. It can be aided by quantitative evoked EMG recordings, with tailored parameters and thresholds.
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Affiliation(s)
| | - Akiva Korn
- Surgical Monitoring Services, Beit Shemesh, Israel.,Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yifat Bitan-Talmor
- Surgical Monitoring Services, Beit Shemesh, Israel.,Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Irina Vendrov
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Shofty
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Zegerman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Anesthesia and Critical Care, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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45
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Shofty B, Artzi M, Shtrozberg S, Fanizzi C, DiMeco F, Haim O, Peleg Hason S, Ram Z, Bashat DB, Grossman R. Virtual biopsy using MRI radiomics for prediction of BRAF status in melanoma brain metastasis. Sci Rep 2020; 10:6623. [PMID: 32313236 PMCID: PMC7170839 DOI: 10.1038/s41598-020-63821-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/06/2020] [Indexed: 12/27/2022] Open
Abstract
Brain metastases are common in patients with advanced melanoma and constitute a major cause of morbidity and mortality. Between 40% and 60% of melanomas harbor BRAF mutations. Selective BRAF inhibitor therapy has yielded improvement in clinical outcome; however, genetic discordance between the primary lesion and the metastatic tumor has been shown to occur. Currently, the only way to characterize the genetic landscape of a brain metastasis is by tissue sampling, which carries risks and potential complications. The aim of this study was to investigate the use of radiomics analysis for non-invasive identification of BRAF mutation in patients with melanoma brain metastases, based on conventional magnetic resonance imaging (MRI) data. We applied a machine-learning method, based on MRI radiomics features for noninvasive characterization of the BRAF status of brain metastases from melanoma (BMM) and applied it to BMM patients from two tertiary neuro-oncological centers. All patients underwent surgical resection for BMM, and their BRAF mutation status was determined as part of their oncological work-up. Their routine preoperative MRI study was used for radiomics-based analysis in which 195 features were extracted and classified according to their BRAF status via a support vector machine. The BRAF status of 53 study patients, with 54 brain metastases (25 positive, 29 negative for BRAF mutation) was predicted with mean accuracy = 0.79 ± 0.13, mean precision = 0.77 ± 0.14, mean sensitivity = 0.72 ± 0.20, mean specificity = 0.83 ± 0.11 and with a 0.78 area under the receiver operating characteristic curve for positive BRAF mutation prediction. Radiomics-based noninvasive genetic characterization is feasible and should be further verified using large prospective cohorts.
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Affiliation(s)
- Ben Shofty
- Department of Neurosurgery, Tel Aviv Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Moran Artzi
- Sagol Brain Institute, Tel Aviv Medical Center, and the Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
| | - Shai Shtrozberg
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Claudia Fanizzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Oz Haim
- Department of Neurosurgery, Tel Aviv Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shira Peleg Hason
- Division of Oncology, Tel Aviv Medical Center, Tel Aviv, Israel and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zvi Ram
- Department of Neurosurgery, Tel Aviv Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel Aviv Medical Center, and the Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
| | - Rachel Grossman
- Department of Neurosurgery, Tel Aviv Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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46
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Shofty B, Mauda-Havakuk M, Ben-Sira L, Bokstein F, Lidar Z, Salame K, Korn A, Constantini S. Surgical Management of "Kissing" Spinal Plexiform Neurofibromas in Neurofibromatosis Type 1 Patients. World Neurosurg 2019; 134:e1143-e1147. [PMID: 31786384 DOI: 10.1016/j.wneu.2019.11.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND "Kissing" neurofibromas (KNs) are a unique group of spinal tumors found in neurofibromatosis type 1 (NF1) patients. These are bilateral neurofibromas that approximate each other at the same level, with significant impingement compression of the cord or thecal sac. The best management options and surgical strategies for NF1 patients with KN have not been standardized. METHODS We conducted a retrospective study evaluating adult NF1 patients with KN. All patients are followed routinely at the Gilbert Israeli NF Center. Patients' files were reviewed for natural history, imaging features, surgical technique, and surgical outcome. RESULTS Twelve patients with at least 1 pair of KN were identified (6 females). Median age at spinal presentation was 24 (range 17-48). KNSs were located at the cervical (n = 8) and lumbar (n = 8) region, with no thoracic involvement. Seven of the 12 patients were operated; all underwent surgery due to cervical compression with progressive myelopathy. Four patients remained asymptomatic during the follow-up period. Three patients underwent multiple operations. Operative outcome was favorable in 71% of patients, with marked overall motor improvement or stabilization of neurologic deterioration. Two patients who entered surgery with a low functional reserve deteriorated after surgery. CONCLUSIONS In our series, KN caused progressive cord compression in 7 of the 8 patients with cervical tumors. No intervention was needed for lumbar tumors. Cervical tumors should be followed closely, with a low threshold for intervention. NF1 patients harboring KN should be followed both clinically and radiologically for life.
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Affiliation(s)
- Ben Shofty
- Department of Neurosurgery, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel; The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Mauda-Havakuk
- The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel
| | - Liat Ben-Sira
- The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel
| | - Felix Bokstein
- The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel
| | - Zvi Lidar
- Department of Neurosurgery, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel
| | - Khalil Salame
- Department of Neurosurgery, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel
| | - Akiva Korn
- Department of Neurosurgery, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomi Constantini
- The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel; Department of Pediatric Neurosurgery, Tel-Aviv Medical Center, and Tel-Aviv University, Tel-Aviv, Israel.
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47
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Shofty B, Richetta C, Haim O, Kashanian A, Gurevich A, Grossman R. 5-ALA-assisted stereotactic brain tumor biopsy improve diagnostic yield. Eur J Surg Oncol 2019; 45:2375-2378. [DOI: 10.1016/j.ejso.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/02/2019] [Indexed: 01/04/2023] Open
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van Baarsen K, Roth J, Serova N, Packer RJ, Shofty B, Thomale UW, Cinalli G, Toledano H, Michowiz S, Constantini S. Optic pathway-hypothalamic glioma hemorrhage: a series of 9 patients and review of the literature. J Neurosurg 2019; 129:1407-1415. [PMID: 29424646 DOI: 10.3171/2017.8.jns163085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/08/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEHemorrhage (also known as apoplexy) in optic pathway gliomas (OPGs) is rare. Because of the variable presentations and low incidence of OPG hemorrhages, little is known about their clinical course and the best treatment options. The aim of this work was to review risk factors, clinical course, and treatment strategies of optic glioma hemorrhages in the largest possible number of cases.METHODSA total of 34 patients were analyzed. Nine new cases were collected, and 25 were identified in the literature. Data regarding demographics, radiological and histological features, treatment, and outcome were retrospectively reviewed.RESULTSThe majority of patients were younger than 20 years. Only 3 patients were known to have neurofibromatosis. The histopathological diagnosis was pilocytic astrocytoma in the majority of cases. Five patients had intraorbital hemorrhages, whereas 29 patients had intracranial hemorrhage; the majority of intracranial bleeds were treated surgically. Six patients, all with intracranial hemorrhage, died due to recurrent bleeding, hydrocephalus, or surgical complications. No clear risk factors could be identified.CONCLUSIONSIntracerebral OPG hemorrhages have a fatal outcome in 20% of cases. Age, hormonal status, neurofibromatosis involvement, and histopathological diagnosis have been suggested as risk factors for hemorrhage, but this cannot be reliably established from the present series. The goals of surgery should be patient survival and prevention of further neurological and ophthalmological deterioration.
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Affiliation(s)
- Kirsten van Baarsen
- 1Department of Pediatric Neurosurgery, International Israel Neurofibromatosis Center (IINFC), Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel.,2Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jonathan Roth
- 1Department of Pediatric Neurosurgery, International Israel Neurofibromatosis Center (IINFC), Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel
| | - Natalia Serova
- 3Department of Neuro-ophthalmology, Burdenko Neurosurgical Institute, Moscow, Russia
| | - Roger J Packer
- 4Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC
| | - Ben Shofty
- 1Department of Pediatric Neurosurgery, International Israel Neurofibromatosis Center (IINFC), Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel
| | - Ulrich-W Thomale
- 5Department of Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany
| | - Giuseppe Cinalli
- 6Department of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy; and
| | - Helen Toledano
- Departments of7Pediatric Oncology and.,8Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shalom Michowiz
- 8Sackler Faculty of Medicine, Tel Aviv University, Israel.,9Pediatric Neurosurgery, Schneider Children's Medical Center of Israel, Petach Tikva; and
| | - Shlomi Constantini
- 1Department of Pediatric Neurosurgery, International Israel Neurofibromatosis Center (IINFC), Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel
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49
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Shofty B, Bergmann E, Zur G, Asleh J, Bosak N, Kavushansky A, Castellanos FX, Ben-Sira L, Packer RJ, Vezina GL, Constantini S, Acosta MT, Kahn I. Autism-associated Nf1 deficiency disrupts corticocortical and corticostriatal functional connectivity in human and mouse. Neurobiol Dis 2019; 130:104479. [PMID: 31128207 PMCID: PMC6689441 DOI: 10.1016/j.nbd.2019.104479] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/11/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022] Open
Abstract
Children with the autosomal dominant single gene disorder, neurofibromatosis type 1 (NF1), display multiple structural and functional changes in the central nervous system, resulting in neuropsychological cognitive abnormalities. Here we assessed the pathological functional organization that may underlie the behavioral impairments in NF1 using resting-state functional connectivity MRI. Coherent spontaneous fluctuations in the fMRI signal across the entire brain were used to interrogate the pattern of functional organization of corticocortical and corticostriatal networks in both NF1 pediatric patients and mice with a heterozygous mutation in the Nf1 gene (Nf1+/-). Children with NF1 demonstrated abnormal organization of cortical association networks and altered posterior-anterior functional connectivity in the default network. Examining the contribution of the striatum revealed that corticostriatal functional connectivity was altered. NF1 children demonstrated reduced functional connectivity between striatum and the frontoparietal network and increased striatal functional connectivity with the limbic network. Awake passive mouse functional connectivity MRI in Nf1+/- mice similarly revealed reduced posterior-anterior connectivity along the cingulate cortex as well as disrupted corticostriatal connectivity. The striatum of Nf1+/- mice showed increased functional connectivity to somatomotor and frontal cortices and decreased functional connectivity to the auditory cortex. Collectively, these results demonstrate similar alterations across species, suggesting that NF1 pathogenesis is linked to striatal dysfunction and disrupted corticocortical connectivity in the default network.
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Affiliation(s)
- Ben Shofty
- Department of Neuroscience, Rappaport Faculty of Medicine and Institute, Technion - Israel Institute of Technology, Haifa, Israel; The Gilbert Israeli NF Center, Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, and Tel Aviv University, Tel Aviv, Israel
| | - Eyal Bergmann
- Department of Neuroscience, Rappaport Faculty of Medicine and Institute, Technion - Israel Institute of Technology, Haifa, Israel
| | - Gil Zur
- Department of Neuroscience, Rappaport Faculty of Medicine and Institute, Technion - Israel Institute of Technology, Haifa, Israel
| | - Jad Asleh
- Department of Neuroscience, Rappaport Faculty of Medicine and Institute, Technion - Israel Institute of Technology, Haifa, Israel
| | - Noam Bosak
- Department of Neuroscience, Rappaport Faculty of Medicine and Institute, Technion - Israel Institute of Technology, Haifa, Israel
| | - Alexandra Kavushansky
- Department of Neuroscience, Rappaport Faculty of Medicine and Institute, Technion - Israel Institute of Technology, Haifa, Israel
| | - F Xavier Castellanos
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Liat Ben-Sira
- The Gilbert Israeli NF Center, Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, and Tel Aviv University, Tel Aviv, Israel
| | - Roger J Packer
- The Gilbert Family Neurofibromatosis Institute, Children's National Health System, Department of Neurology and Pediatrics, George Washington University, Washington, DC, USA
| | - Gilbert L Vezina
- Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, USA
| | - Shlomi Constantini
- The Gilbert Israeli NF Center, Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, and Tel Aviv University, Tel Aviv, Israel
| | - Maria T Acosta
- The Gilbert Family Neurofibromatosis Institute, Children's National Health System, Department of Neurology and Pediatrics, George Washington University, Washington, DC, USA; National Human Genome Research Institute, National Institutes of Health, Bethesda, MD USA
| | - Itamar Kahn
- Department of Neuroscience, Rappaport Faculty of Medicine and Institute, Technion - Israel Institute of Technology, Haifa, Israel.
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Artzi M, Shofty B, Kashanian A, Ram Z, Shimony N, Popovits N, Jonas-Kimchi T, Grossman R, Ben Bashat D. COMP-23. ASSESSMENT OF PITUITARY ADENOMA CONSISTENCY AND VASCULARITY USING TEXTURE ANALYSIS OF CONVENTIONAL MRI. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Moran Artzi
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ben Shofty
- Division of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Alon Kashanian
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Ram
- Division of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nir Shimony
- Division of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nataly Popovits
- Division of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Rachel Grossman
- Division of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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