1
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Tan H, Paulk AC, Stedelin B, Cleary DR, Nerison C, Tchoe Y, Brown EC, Bourhis A, Russman S, Lee J, Tonsfeldt KJ, Yang JC, Oh H, Ro YG, Lee K, Ganji M, Galton I, Siler D, Han SJ, Collins KL, Ben-Haim S, Halgren E, Cash SS, Dayeh S, Raslan AM. Intraoperative application and early experience with novel high-resolution, high-channel-count thin-film electrodes for human microelectrocorticography. J Neurosurg 2024; 140:665-676. [PMID: 37874692 DOI: 10.3171/2023.7.jns23885] [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: 04/28/2023] [Accepted: 07/18/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The study objective was to evaluate intraoperative experience with newly developed high-spatial-resolution microelectrode grids composed of poly(3,4-ethylenedioxythiophene) with polystyrene sulfonate (PEDOT:PSS), and those composed of platinum nanorods (PtNRs). METHODS A cohort of patients who underwent craniotomy for pathological tissue resection and who had high-spatial-resolution microelectrode grids placed intraoperatively were evaluated. Patient demographic and baseline clinical variables as well as relevant microelectrode grid characteristic data were collected. The primary and secondary outcome measures of interest were successful microelectrode grid utilization with usable resting-state or task-related data, and grid-related adverse intraoperative events and/or grid dysfunction. RESULTS Included in the analysis were 89 cases of patients who underwent a craniotomy for resection of neoplasms (n = 58) or epileptogenic tissue (n = 31). These cases accounted for 94 grids: 58 PEDOT:PSS and 36 PtNR grids. Of these 94 grids, 86 were functional and used successfully to obtain cortical recordings from 82 patients. The mean cortical grid recording duration was 15.3 ± 1.15 minutes. Most recordings in patients were obtained during experimental tasks (n = 52, 58.4%), involving language and sensorimotor testing paradigms, or were obtained passively during resting state (n = 32, 36.0%). There were no intraoperative adverse events related to grid placement. However, there were instances of PtNR grid dysfunction (n = 8) related to damage incurred by suboptimal preoperative sterilization (n = 7) and improper handling (n = 1); intraoperative recordings were not performed. Vaporized peroxide sterilization was the most optimal sterilization method for PtNR grids, providing a significantly greater number of usable channels poststerilization than did steam-based sterilization techniques (median 905.0 [IQR 650.8-935.5] vs 356.0 [IQR 18.0-597.8], p = 0.0031). CONCLUSIONS High-spatial-resolution microelectrode grids can be readily incorporated into appropriately selected craniotomy cases for clinical and research purposes. Grids are reliable when preoperative handling and sterilization considerations are accounted for. Future investigations should compare the diagnostic utility of these high-resolution grids to commercially available counterparts and assess whether diagnostic discrepancies relate to clinical outcomes.
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Affiliation(s)
- Hao Tan
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Angelique C Paulk
- 2Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- 3Harvard Medical School, Boston, Massachusetts
| | - Brittany Stedelin
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Daniel R Cleary
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
- Departments of4Neurological Surgery
| | - Caleb Nerison
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Youngbin Tchoe
- 5Electrical and Computer Engineering, and
- 6Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
- 10Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Erik C Brown
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
- 7Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida
| | | | | | - Jihwan Lee
- 5Electrical and Computer Engineering, and
| | - Karen J Tonsfeldt
- 5Electrical and Computer Engineering, and
- 8Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Science and Medicine, University of California, San Diego, La Jolla, California
| | - Jimmy C Yang
- 2Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- 3Harvard Medical School, Boston, Massachusetts
| | - Hongseok Oh
- 5Electrical and Computer Engineering, and
- 9Soongsil University, Seoul, Korea
| | - Yun Goo Ro
- 5Electrical and Computer Engineering, and
- 9Soongsil University, Seoul, Korea
| | | | | | - Ian Galton
- 5Electrical and Computer Engineering, and
| | - Dominic Siler
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Seunggu Jude Han
- 12Department of Neurological Surgery, Stanford University, Palo Alto, California
| | - Kelly L Collins
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
- 11Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, Oregon; and
| | | | - Eric Halgren
- 13Neurology, University of California, San Diego, California
| | - Sydney S Cash
- 2Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- 3Harvard Medical School, Boston, Massachusetts
| | | | - Ahmed M Raslan
- 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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2
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Cleary DR, Tchoe Y, Bourhis A, Dickey CW, Stedelin B, Ganji M, Lee SH, Lee J, Siler DA, Brown EC, Rosen BQ, Kaestner E, Yang JC, Soper DJ, Han SJ, Paulk AC, Cash SS, Raslan AMT, Dayeh SA, Halgren E. Modular Phoneme Processing in Human Superior Temporal Gyrus. bioRxiv 2024:2024.01.17.576120. [PMID: 38293030 PMCID: PMC10827201 DOI: 10.1101/2024.01.17.576120] [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: 02/01/2024]
Abstract
Modular organization is fundamental to cortical processing, but its presence is human association cortex is unknown. We characterized phoneme processing with 128-1024 channel micro-arrays at 50-200µm pitch on superior temporal gyrus of 7 patients. High gamma responses were highly correlated within ~1.7mm diameter modules, sharply delineated from adjacent modules with distinct time-courses and phoneme-selectivity. We suggest that receptive language cortex may be organized in discrete processing modules.
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Affiliation(s)
- Daniel R Cleary
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Youngbin Tchoe
- Departments of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Andrew Bourhis
- Departments of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Charles W Dickey
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
- Departments of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA 92093, USA
- Department of Neurology and Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA 92093, USA
- Departments of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
- Departments of Radiology and Neuroscience, University of California San Diego, La Jolla, CA 92093, USA
| | - Brittany Stedelin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Mehran Ganji
- Departments of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Sang Hoen Lee
- Departments of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Jihwan Lee
- Departments of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Dominic A Siler
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Erik C Brown
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Burke Q Rosen
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA 92093, USA
| | - Jimmy C Yang
- Department of Neurology and Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniel J Soper
- Department of Neurology and Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Seunggu Jude Han
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Angelique C Paulk
- Department of Neurology and Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sydney S Cash
- Department of Neurology and Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ahmed M T Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Shadi A Dayeh
- Departments of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA 92093, USA
- Departments of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Eric Halgren
- Departments of Radiology and Neuroscience, University of California San Diego, La Jolla, CA 92093, USA
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3
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Khazanchi R, Nandoliya KR, Shahin MN, Rae AI, Chaliparambil RK, Bowden SG, Alwakeal A, Lopez Ramos CG, Stedelin B, Youngblood MW, Chandler JP, Lukas RV, Sanusi OR, Dogan A, Wood MD, Han SJ, Magill ST. Obesity and meningioma: a US population-based study paired with analysis of a multi-institutional cohort. J Neurosurg 2024:1-10. [PMID: 38241687 DOI: 10.3171/2023.11.jns23732] [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: 04/11/2023] [Accepted: 11/13/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Whether obesity is associated with meningioma and the impact of obesity by gender has been debated. The primary objective of this study was to investigate differences in BMI between male and female patients undergoing craniotomy for meningioma and compare those with patients undergoing craniotomy for other intracranial tumors. The secondary objective was to compare meningioma location and progression-free survival (PFS) between obese and nonobese patients in a multi-institutional cohort. METHODS National data were obtained from the National Surgical Quality Improvement Program (NSQIP) database. Male and female patients were analyzed separately. Patients undergoing craniotomies for meningioma were compared with patients of the same sex undergoing craniotomies for other intracranial tumors. Institutional data from two academic centers were collected for all male and an equivalent number of female meningioma patients undergoing meningioma resection. Multivariate regression controlling for age was used to determine differences in meningioma location. Kaplan-Meier curves and log-rank tests were computed to investigate differences in PFS. RESULTS From NSQIP, 4163 male meningioma patients were compared with 24,266 controls, and 9372 female meningioma patients were compared with 21,538 controls. Male and female patients undergoing meningioma resection were more likely to be overweight or obese compared with patients undergoing craniotomy for other tumors, with the odds ratio increasing with increasing weight class (all p < 0.0001). In the multi-institutional cohort, meningiomas were more common along the skull base in male patients (p = 0.0123), but not in female patients (p = 0.1246). There was no difference in PFS between obese and nonobese male (p = 0.4104) or female (p = 0.5504) patients. Obesity was associated with increased risk of pulmonary embolism in both male and female patients undergoing meningioma resection (p = 0.0043). CONCLUSIONS Male and female patients undergoing meningioma resection are more likely to be obese than patients undergoing craniotomy for other intracranial tumors. Obese males are more likely to have meningiomas in the skull base compared with other locations, but this association was not found in females. There was no significant difference in PFS among obese patients. The mechanism by which obesity increases meningioma incidence remains to be determined.
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Affiliation(s)
- Rushmin Khazanchi
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Khizar R Nandoliya
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maryam N Shahin
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Ali I Rae
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Rahul K Chaliparambil
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen G Bowden
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Amr Alwakeal
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Brittany Stedelin
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Mark W Youngblood
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James P Chandler
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rimas V Lukas
- 3Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Olabisi R Sanusi
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Aclan Dogan
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Matthew D Wood
- 4Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon
| | - Seunggu J Han
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Stephen T Magill
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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4
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Tan H, Stedelin B, Bakr SM, Nerison C, Raslan AM. Corrigendum to "Neurosurgical Ablation for Pain: A Technology Review" [World Neurosurgery 170 (2023) 114-122]. World Neurosurg 2023; 182:6. [PMID: 38039725 DOI: 10.1016/j.wneu.2023.10.074] [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: 12/03/2023]
Affiliation(s)
- Hao Tan
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Caleb Nerison
- Oregon Health & Science University, Portland, Oregon, USA
| | - Ahmed M Raslan
- Oregon Health & Science University, Portland, Oregon, USA.
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5
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Duncan GJ, Ingram SD, Emberley K, Hill J, Cordano C, Abdelhak A, McCane M, Jabassini N, Ananth K, Ferrara SJ, Stedelin B, Sivyer B, Aicher SA, Scanlan T, Watkins TA, Mishra A, Nelson J, Green AJ, Emery B. Remyelination protects neurons from DLK-mediated neurodegeneration. bioRxiv 2023:2023.09.30.560267. [PMID: 37873342 PMCID: PMC10592610 DOI: 10.1101/2023.09.30.560267] [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: 10/25/2023]
Abstract
Chronic demyelination is theorized to contribute to neurodegeneration and drive progressive disability in demyelinating diseases like multiple sclerosis. Here, we describe two genetic mouse models of inducible demyelination, one distinguished by effective remyelination, and the other by remyelination failure and persistent demyelination. By comparing these two models, we find that remyelination protects neurons from apoptosis, improves conduction, and promotes functional recovery. Chronic demyelination of neurons leads to activation of the mitogen-associated protein kinase (MAPK) stress pathway downstream of dual leucine zipper kinase (DLK), which ultimately induces the phosphorylation of c-Jun in the nucleus. Both pharmacological inhibition and CRISPR/Cas9-mediated disruption of DLK block c-Jun phosphorylation and the apoptosis of demyelinated neurons. These findings provide direct experimental evidence that remyelination is neuroprotective and identify DLK inhibition as a potential therapeutic strategy to protect chronically demyelinated neurons.
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Affiliation(s)
- Greg J Duncan
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Samantha D Ingram
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Katie Emberley
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jo Hill
- Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Christian Cordano
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genova
| | - Ahmed Abdelhak
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Michael McCane
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Nora Jabassini
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Kirtana Ananth
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Skylar J. Ferrara
- Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Brittany Stedelin
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Benjamin Sivyer
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Sue A. Aicher
- Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas Scanlan
- Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Trent A Watkins
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Anusha Mishra
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jonathan Nelson
- Division of Nephrology and Hypertension, School of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Ari J. Green
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Ben Emery
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, 97239, USA
- Lead author
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6
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Tan H, Nerison CS, Bakr SM, Stedelin B, Basha AK, Ernst LD, Kellogg MA, Raslan AM. Therapeutic value and challenges of responsive neurostimulation for intractable bilateral neocortical temporal lobe epilepsy involving the superior temporal gyrus. Clin Neurophysiol 2023; 149:9-11. [PMID: 36842191 DOI: 10.1016/j.clinph.2023.02.159] [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] [Received: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Hao Tan
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | | | - Lia D Ernst
- Oregon Health & Science University, Portland, OR, USA
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7
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Tan H, Stedelin B, Bakr SM, Nerison C, Raslan AM. Neurosurgical Ablation for Pain: A Technology Review. World Neurosurg 2023; 170:114-122. [PMID: 36400357 DOI: 10.1016/j.wneu.2022.11.047] [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: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022]
Abstract
Neurosurgical ablative procedures for pain have dramatically transformed over the years. Compared to their precursors, present day techniques are less invasive and more precise as a result of advances in both device engineering and imaging technology. From a clinical perspective, understanding the strengths and drawbacks of modern techniques is necessary to optimize patient outcomes. In this review, we provide an overview of the major contemporary neuroablative modalities/technologies used for treating pain. We will compare and contrast these modalities from one another with respect to their intraoperative monitoring needs, invasiveness, range of access, and lesion generation. Finally, we will provide a brief commentary on the future of neuroablation given the advent of neuromodulation options for pain control.
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Affiliation(s)
- Hao Tan
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Caleb Nerison
- Oregon Health & Science University, Portland, Oregon, USA
| | - Ahmed M Raslan
- Oregon Health & Science University, Portland, Oregon, USA.
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8
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Rockhill AP, Mantovani A, Stedelin B, Nerison CS, Raslan AM, Swann NC. Stereo-EEG recordings extend known distributions of canonical movement-related oscillations. J Neural Eng 2023; 20:10.1088/1741-2552/acae0a. [PMID: 36548996 PMCID: PMC9976588 DOI: 10.1088/1741-2552/acae0a] [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: 06/21/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
Objective.Previous electrophysiological research has characterized canonical oscillatory patterns associated with movement mostly from recordings of primary sensorimotor cortex. Less work has attempted to decode movement based on electrophysiological recordings from a broader array of brain areas such as those sampled by stereoelectroencephalography (sEEG), especially in humans. We aimed to identify and characterize different movement-related oscillations across a relatively broad sampling of brain areas in humans and if they extended beyond brain areas previously associated with movement.Approach.We used a linear support vector machine to decode time-frequency spectrograms time-locked to movement, and we validated our results with cluster permutation testing and common spatial pattern decoding.Main results.We were able to accurately classify sEEG spectrograms during a keypress movement task versus the inter-trial interval. Specifically, we found these previously-described patterns: beta (13-30 Hz) desynchronization, beta synchronization (rebound), pre-movement alpha (8-15 Hz) modulation, a post-movement broadband gamma (60-90 Hz) increase and an event-related potential. These oscillatory patterns were newly observed in a wide range of brain areas accessible with sEEG that are not accessible with other electrophysiology recording methods. For example, the presence of beta desynchronization in the frontal lobe was more widespread than previously described, extending outside primary and secondary motor cortices.Significance.Our classification revealed prominent time-frequency patterns which were also observed in previous studies that used non-invasive electroencephalography and electrocorticography, but here we identified these patterns in brain regions that had not yet been associated with movement. This provides new evidence for the anatomical extent of the system of putative motor networks that exhibit each of these oscillatory patterns.
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Affiliation(s)
| | - Alessandra Mantovani
- Oregon Health & Science University, Department of Neurosurgery, Portland, OR, USA 97239
| | - Brittany Stedelin
- Oregon Health & Science University, Department of Neurosurgery, Portland, OR, USA 97239
| | - Caleb S. Nerison
- Oregon Health & Science University, Department of Neurosurgery, Portland, OR, USA 97239
| | - Ahmed M. Raslan
- Oregon Health & Science University, Department of Neurosurgery, Portland, OR, USA 97239
| | - Nicole C. Swann
- University of Oregon, Department of Human Physiology, Eugene, OR, USA 97403,University of Oregon, Institute of Neuroscience, Eugene, OR, USA 97403
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9
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Tan H, Ward E, Stedelin B, Raslan AM. Percutaneous CT-guided trigeminal tractotomy-nucleotomy under general anesthesia for intractable craniofacial pain. J Neurosurg 2022:1-9. [DOI: 10.3171/2022.10.jns222144] [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: 09/19/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE
When used to treat craniofacial pain, CT-guided trigeminal tractotomy-nucleotomy (TR-NC) is usually performed with local anesthesia. Unfortunately, local anesthesia is insufficient for patients with such severe pain that they cannot tolerate the required head positioning while awake. This study aimed to contextualize previous findings associated with TR-NC performed under general anesthesia. The authors examined clinical and operative factors that could impact postoperative pain outcomes.
METHODS
This is a retrospective single-institution cohort study of patients who underwent a percutaneous CT-guided TR-NC under general anesthesia at a single institution between 2012 and 2019. Outcome data were analyzed.
RESULTS
Twenty-five patients underwent CT-guided TR-NC procedures under general anesthesia; 23 met the inclusion criteria and underwent a total of 31 procedures. The procedure success rate was 74% (23/31). Approximately 50% and 40% of procedures provided pain relief for at least 6 and 12 months, respectively. The median duration of pain relief was 153 days. Adverse events, all minor and transient, occurred following 6/31 (19%) of procedures. Patients with a body mass index > 25 were less likely to experience a successful TR-NC (p = 0.045). Higher electrode ablation temperatures (p = 0.033) and more medial entry trajectories relative to the midsagittal plane (p = 0.029) characterized successful procedures.
CONCLUSIONS
These results suggest that CT-guided TR-NC performed under general anesthesia is safe and effective. Postoperative outcomes were found to be associated with a number of clinical and operative factors. Such associations should be further explored and evaluated in the context of future, better-powered analyses.
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Affiliation(s)
- Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Edward Ward
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Brittany Stedelin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Ahmed M. Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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10
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Russman SM, Cleary DR, Tchoe Y, Bourhis AM, Stedelin B, Martin J, Brown EC, Zhang X, Kawamoto A, Ryu WHA, Raslan AM, Ciacci JD, Dayeh SA. Constructing 2D maps of human spinal cord activity and isolating the functional midline with high-density microelectrode arrays. Sci Transl Med 2022; 14:eabq4744. [PMID: 36170445 DOI: 10.1126/scitranslmed.abq4744] [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] [Indexed: 11/02/2022]
Abstract
Intraoperative neuromonitoring (IONM) is a widely used practice in spine surgery for early detection and minimization of neurological injury. IONM is most commonly conducted by indirectly recording motor and somatosensory evoked potentials from either muscles or the scalp, which requires large-amplitude electrical stimulation and provides limited spatiotemporal information. IONM may inform of inadvertent events during neurosurgery after they occur, but it does not guide safe surgical procedures when the anatomy of the diseased spinal cord is distorted. To overcome these limitations and to increase our understanding of human spinal cord neurophysiology, we applied a microelectrode array with hundreds of channels to the exposed spinal cord during surgery and resolved spatiotemporal dynamics with high definition. We used this method to construct two-dimensional maps of responsive channels and define with submillimeter precision the electrophysiological midline of the spinal cord. The high sensitivity of our microelectrode array allowed us to record both epidural and subdural responses at stimulation currents that are well below those used clinically and to resolve postoperative evoked potentials when IONM could not. Together, these advances highlight the potential of our microelectrode arrays to capture previously unexplored spinal cord neural activity and its spatiotemporal dynamics at high resolution, offering better electrophysiological markers that can transform IONM.
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Affiliation(s)
- Samantha M Russman
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA.,Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Daniel R Cleary
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA.,Department of Neurosurgery, University of California, San Diego, La Jolla, CA 92093, USA
| | - Youngbin Tchoe
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Andrew M Bourhis
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Brittany Stedelin
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Joel Martin
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA.,Department of Neurosurgery, University of California, San Diego, La Jolla, CA 92093, USA
| | - Erik C Brown
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Xinlian Zhang
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA 92093, USA
| | - Aaron Kawamoto
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Won Hyung A Ryu
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ahmed M Raslan
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Joseph D Ciacci
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA 92093, USA
| | - Shadi A Dayeh
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA.,Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
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11
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Dickey CW, Verzhbinsky IA, Jiang X, Rosen BQ, Kajfez S, Stedelin B, Shih JJ, Ben-Haim S, Raslan AM, Eskandar EN, Gonzalez-Martinez J, Cash SS, Halgren E. Widespread ripples synchronize human cortical activity during sleep, waking, and memory recall. Proc Natl Acad Sci U S A 2022; 119:e2107797119. [PMID: 35867767 PMCID: PMC9282280 DOI: 10.1073/pnas.2107797119] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/02/2022] [Indexed: 12/02/2022] Open
Abstract
Declarative memory encoding, consolidation, and retrieval require the integration of elements encoded in widespread cortical locations. The mechanism whereby such "binding" of different components of mental events into unified representations occurs is unknown. The "binding-by-synchrony" theory proposes that distributed encoding areas are bound by synchronous oscillations enabling enhanced communication. However, evidence for such oscillations is sparse. Brief high-frequency oscillations ("ripples") occur in the hippocampus and cortex and help organize memory recall and consolidation. Here, using intracranial recordings in humans, we report that these ∼70-ms-duration, 90-Hz ripples often couple (within ±500 ms), co-occur (≥ 25-ms overlap), and, crucially, phase-lock (have consistent phase lags) between widely distributed focal cortical locations during both sleep and waking, even between hemispheres. Cortical ripple co-occurrence is facilitated through activation across multiple sites, and phase locking increases with more cortical sites corippling. Ripples in all cortical areas co-occur with hippocampal ripples but do not phase-lock with them, further suggesting that cortico-cortical synchrony is mediated by cortico-cortical connections. Ripple phase lags vary across sleep nights, consistent with participation in different networks. During waking, we show that hippocampo-cortical and cortico-cortical coripples increase preceding successful delayed memory recall, when binding between the cue and response is essential. Ripples increase and phase-modulate unit firing, and coripples increase high-frequency correlations between areas, suggesting synchronized unit spiking facilitating information exchange. co-occurrence, phase synchrony, and high-frequency correlation are maintained with little decrement over very long distances (25 cm). Hippocampo-cortico-cortical coripples appear to possess the essential properties necessary to support binding by synchrony during memory retrieval and perhaps generally in cognition.
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Affiliation(s)
- Charles W. Dickey
- Neurosciences Graduate Program, University of California San Diego, La Jolla, CA 92093
- Medical Scientist Training Program, University of California San Diego, La Jolla, CA 92093
| | - Ilya A. Verzhbinsky
- Neurosciences Graduate Program, University of California San Diego, La Jolla, CA 92093
- Medical Scientist Training Program, University of California San Diego, La Jolla, CA 92093
| | - Xi Jiang
- Neurosciences Graduate Program, University of California San Diego, La Jolla, CA 92093
| | - Burke Q. Rosen
- Neurosciences Graduate Program, University of California San Diego, La Jolla, CA 92093
| | - Sophie Kajfez
- Department of Radiology, University of California San Diego, La Jolla, CA 92093
| | - Brittany Stedelin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239
| | - Jerry J. Shih
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093
| | - Sharona Ben-Haim
- Department of Neurological Surgery, University of California San Diego, La Jolla, CA 92093
| | - Ahmed M. Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239
| | - Emad N. Eskandar
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461
| | | | - Sydney S. Cash
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Eric Halgren
- Department of Radiology, University of California San Diego, La Jolla, CA 92093
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093
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12
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Rockhill AP, Larson E, Stedelin B, Mantovani A, Raslan AM, Gramfort A, Swann NC. Intracranial Electrode Location and Analysis in MNE-Python. J Open Source Softw 2022; 7:3897. [PMID: 35992635 PMCID: PMC9387757 DOI: 10.21105/joss.03897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Eric Larson
- Institute for Learning and Brain Sciences, University of Washington, Seattle, WA, USA
| | - Brittany Stedelin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Alessandra Mantovani
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - Nicole C Swann
- Department of Human Physiology, University of Oregon, Eugene OR, USA
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13
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Tchoe Y, Bourhis AM, Cleary DR, Stedelin B, Lee J, Tonsfeldt KJ, Brown EC, Siler DA, Paulk AC, Yang JC, Oh H, Ro YG, Lee K, Russman SM, Ganji M, Galton I, Ben-Haim S, Raslan AM, Dayeh SA. Human brain mapping with multithousand-channel PtNRGrids resolves spatiotemporal dynamics. Sci Transl Med 2022; 14:eabj1441. [PMID: 35044788 DOI: 10.1126/scitranslmed.abj1441] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Electrophysiological devices are critical for mapping eloquent and diseased brain regions and for therapeutic neuromodulation in clinical settings and are extensively used for research in brain-machine interfaces. However, the existing clinical and experimental devices are often limited in either spatial resolution or cortical coverage. Here, we developed scalable manufacturing processes with a dense electrical connection scheme to achieve reconfigurable thin-film, multithousand-channel neurophysiological recording grids using platinum nanorods (PtNRGrids). With PtNRGrids, we have achieved a multithousand-channel array of small (30 μm) contacts with low impedance, providing high spatial and temporal resolution over a large cortical area. We demonstrated that PtNRGrids can resolve submillimeter functional organization of the barrel cortex in anesthetized rats that captured the tissue structure. In the clinical setting, PtNRGrids resolved fine, complex temporal dynamics from the cortical surface in an awake human patient performing grasping tasks. In addition, the PtNRGrids identified the spatial spread and dynamics of epileptic discharges in a patient undergoing epilepsy surgery at 1-mm spatial resolution, including activity induced by direct electrical stimulation. Collectively, these findings demonstrated the power of the PtNRGrids to transform clinical mapping and research with brain-machine interfaces.
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Affiliation(s)
- Youngbin Tchoe
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Andrew M Bourhis
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Daniel R Cleary
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Neurological Surgery, University of California San Diego, La Jolla, CA 92093, USA
| | - Brittany Stedelin
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jihwan Lee
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Karen J Tonsfeldt
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Science and Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Erik C Brown
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Dominic A Siler
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jimmy C Yang
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hongseok Oh
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Yun Goo Ro
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Keundong Lee
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Samantha M Russman
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Mehran Ganji
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Ian Galton
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Sharona Ben-Haim
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Neurological Surgery, University of California San Diego, La Jolla, CA 92093, USA
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Shadi A Dayeh
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Neurological Surgery, University of California San Diego, La Jolla, CA 92093, USA.,Graduate Program of Materials Science and Engineering, University of California San Diego, La Jolla, CA 92093, USA
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14
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Stedelin B, Cleary D, Paulk A, Bourhis A, Dayeh S, Tchoe Y, Halgren E, Raslan AM. Implementation of High-Resolution Non-penetrating Cortical Thin-Film Electrodes in the Awake Craniotomy for Research. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_645] [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: 11/14/2022] Open
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15
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Nugent JG, Stedelin B, Teton ZE, Siler DA, Motika P, Cetas JS, Zonies D, Schreiber M, Raslan AM. Early Findings of Intracortical Depth Electrocorticography Monitoring in Traumatic Brain Injury Patients. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_637] [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: 11/12/2022] Open
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16
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Stedelin B, Pangelinan K, Edwards J, Cheaney B, Rai K, Raslan AM, Ernst L. Surgical Outcomes Following Intracranial Monitoring for Patients With Lesional Versus Nonlesional Medically Refractory Focal Epilepsy. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_654] [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: 11/13/2022] Open
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17
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Stedelin B, Pangelinan K, Edwards J, Cheaney B, Raslan AM, Ernst L. Short-Term Outcomes of Laser Interstitial Thermal Therapy vs Resection for Refractory Mesial Temporal Lobe Epilepsy. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_657] [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: 11/12/2022] Open
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18
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Bakr S, Basha A, Stedelin B, Ernst L, Kellogg M, Raslan AM. Bilateral Neocortical Temporal Lope Epilepsy Managed by Responsive Neurostimulation. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_650] [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: 11/13/2022] Open
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19
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Shahin M, Stedelin B, Ramos CL, Rae A, Edwards J, Bagley J, Bowden S, Bullis C, Wood M, Cetas J, Han S. EPID-25. SKULL BASE MENINGIOMAS ARE ASSOCIATED WITH OBESITY IN MALES. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.343] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The female predominance of meningiomas may reflect hormonal influences on meningioma development, with known presence of estrogen and progesterone receptors. Progestin-associated meningiomas demonstrate a shift in the mutational landscape and are more frequently located at the skull base. Obesity and increased adipocytes increase aromatase and affect male hormone synthesis, thus increases circulating estrogen.
OBJECTIVE
Report prevalence of obesity in a consecutive series of male patients presenting with meningioma and the interaction with obesity.
METHODS
A retrospective review (20012019) was performed of male patients diagnosed with meningioma. Body mass index (BMI) >30 kg/m2 was considered obese. Obese male meningioma patients were characterized and compared to nonobese male meningioma patients.
RESULTS
Of 239 male patients with meningioma, 97 (40.6%) were obese at the time of surgery with overall mean BMI (30.0 kg/m2). This is above the age-adjusted baseline prevalence of obesity for males in Oregon, which was 34.8% between 2015–2016. Mean age at diagnosis for obese males was 55.3 years and 57.0 years for nonobese males. Within the obese group, most lesions were located on the skull base (48.5% n=47) compared to 34.0% convexity (n=33), 15.4% falx (n=16) and 1.0% multiple (n=1). Tumors were WHO grade I (73.6%), grade II (25.6%) or grade III (1.2%). Of the men in our series, patients with skull base meningiomas were more likely to be obese (OR: 1.7, 95% CI: 1.01–2.9, p=0.0309).
CONCLUSIONS
There is likely a hormonal influence on the pathogenesis of meningioma, and many men diagnosed with this disease are obese. Of 239 male patients with meningioma in our series, 97 (40.6%) were obese which exceeds the 34% age-adjusted baseline prevalence of obesity for males in Oregon. Patients with skull base meningiomas were more likely to be obese, consistent with prior series and suggestive of a hormone-driven association with skull base meningioma.
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Affiliation(s)
- Maryam Shahin
- Oregon Health and Science University, Portland, OR, USA
| | | | | | - Ali Rae
- Oregon Health and Science University, Portland, OR, USA
| | - Jared Edwards
- Oregon Health and Science University, Portland, OR, USA
| | - Jacob Bagley
- Oregon Health and Science University, Portland, OR, USA
| | | | - Carli Bullis
- Oregon Health and Science University, Portland, OR, USA
| | - Matthew Wood
- Oregon Health and Science University, Portland, OR, USA
| | - Justin Cetas
- Oregon Health and Science University, Portland, OR, USA
| | - Seunggu Han
- Oregon Health and Science University, Portland, OR, USA
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20
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Bowden SG, Siler DA, Radu S, Woll SCS, Rae AI, Cheaney B, Nugent JG, Stedelin B, Cetas JS, Dogan A, Han SJ. Changing Hands: A Rising Role of the Tumor Surgeon in Teaching Sylvian Fissure Dissection. World Neurosurg 2020; 146:e86-e90. [PMID: 33059079 DOI: 10.1016/j.wneu.2020.10.026] [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: 08/01/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The landscape of microneurosurgery has changed considerably over the past 2 decades, with a decline in indications for open surgery on cerebrovascular pathology and ever-increasing indications for open resection of brain tumors. This study investigated how these trends in case volume affected residents' training experiences in microsurgery and, specifically, Sylvian fissure dissection. METHODS Resident case logs were reviewed, identifying open cerebrovascular operations and craniotomies for tumor. Operations involving Sylvian fissure dissection were identified through operative reports. Changes in case number by resident were plotted over time, and linear regression was applied. RESULTS Among 23 chief residents, 3045 operations were identified, 1071 of which were for cerebrovascular pathology and 1974 for tumor. Open cerebrovascular experience decreased (P < 0.0001) while tumor volume remained unchanged (P = 0.221). The number of Sylvian fissure dissections per resident did not change over time overall (P = 0.583) or within cerebrovascular operations (P = 0.071). The number of Sylvian fissure dissections in tumor operations increased (P = 0.004). This effect was predominated by an increase in intraaxial tumors approached via Sylvian fissure dissection (P = 0.003). The proportion of Sylvian fissure dissections in tumor surgery increased from 15% in 2009 to 34% by 2019 (P = 0.003). CONCLUSIONS Residents are seeing an increasing proportion of their Sylvian fissure dissection experience during tumor operations. The distribution of this experience will continue to evolve as surgical indications change but suggests a growing role for tumor surgeons in resident training in microsurgery.
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Affiliation(s)
- Stephen G Bowden
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Dominic A Siler
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Stephanie Radu
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - S Cody Schoettler Woll
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Ali I Rae
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Barry Cheaney
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph G Nugent
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Brittany Stedelin
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Justin S Cetas
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Aclan Dogan
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Seunggu J Han
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
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21
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Brown EC, Texakalidis P, Stedelin B, Tora MS, Rindler RS, Grossberg JA, Peterson RB, Campbell M, Cetas JS, Boulis NM, Raslan AM. Dural Arteriovenous Fistula Presenting as Trigeminal Neuralgia: 2 Case Reports and Review of the Literature. World Neurosurg 2020; 139:298-308. [DOI: 10.1016/j.wneu.2020.02.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 11/24/2022]
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