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Garavaglia J, Hardigan T, Turner R, Monachello G, Khan MB, Hodge JO, Brandmeir NJ. Continuous Intrathecal Medication Delivery With the IRRA flow Catheter: Pearls and Early Experience. Oper Neurosurg (Hagerstown) 2024; 26:293-300. [PMID: 37819074 DOI: 10.1227/ons.0000000000000940] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/04/2023] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intrathecal (IT) medications are routinely introduced through catheterization of the intraventricular space or subarachnoid space. There has been sporadic use of IT medications delivered directly to the ventricle either by intermittent injection through an external ventricular drain (EVD) or by an Ommaya reservoir with a ventricular catheter. IT medication delivery through EVD has many drawbacks, including the necessary opening of a sterile system, delivery of medication in a bolus form, and requirements to clamp the EVD after medication delivery. Despite these setbacks, IT medications delivered through EVD have been used across a wide range of applications, including antibiotic delivery treatment of vasospasm with nicardipine and delivery of tissue plasminogen activator. METHODS We used a newly developed active fluid exchange device to treat various severe conditions involved in the cerebral ventricles. Here, we present our treatment protocols and advice on the techniques related to successful active fluid exchange therapy. RESULTS Seventy patients have been treated with our system with various conditions, including subarachnoid hemorrhage, intraventricular hemorrhage, ventriculitis, and cerebral abscess. Total complication rate was 14% with only 1 catheter occlusion and low rates of hemorrhage, infection, and spinal fluid leak. CONCLUSION Current continuous IT medication dosages and protocols are based on reports and consensus statements evaluating intermittent instillation of medication boluses. The pharmacokinetics of continuous dosing and the therapeutic and safety profiles of the medications need to be studied in a prospective manner to evaluate the true optimal dosing standards. Furthermore, the ability to deliver continuous, sterile medications directly through an IT route will open new avenues of pharmacotherapy that were previously closed. This report serves as a basic guide for the safe and effective use of the IRRA flow active fluid exchange catheter to deliver IT medications.
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Affiliation(s)
- Jeffrey Garavaglia
- Department of Pharmacy, Ruby Memorial Hospital, West Virginia University, Morgantown , West Virginia, USA
| | - Trevor Hardigan
- Department of Neurosurgery, Mt. Sinai Hospital, New York City , New York , USA
| | - Ryan Turner
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown , West Virginia , USA
| | - Gracie Monachello
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown , West Virginia , USA
| | - Muhammad Babar Khan
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown , West Virginia , USA
| | - Johnie O Hodge
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown , West Virginia , USA
| | - Nicholas J Brandmeir
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown , West Virginia , USA
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Cao R, Wang J, Brunner P, Willie JT, Li X, Rutishauser U, Brandmeir NJ, Wang S. Neural mechanisms of face familiarity and learning in the human amygdala and hippocampus. Cell Rep 2024; 43:113520. [PMID: 38151023 PMCID: PMC10834150 DOI: 10.1016/j.celrep.2023.113520] [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: 09/19/2022] [Revised: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023] Open
Abstract
Recognizing familiar faces and learning new faces play an important role in social cognition. However, the underlying neural computational mechanisms remain unclear. Here, we record from single neurons in the human amygdala and hippocampus and find a greater neuronal representational distance between pairs of familiar faces than unfamiliar faces, suggesting that neural representations for familiar faces are more distinct. Representational distance increases with exposures to the same identity, suggesting that neural face representations are sharpened with learning and familiarization. Furthermore, representational distance is positively correlated with visual dissimilarity between faces, and exposure to visually similar faces increases representational distance, thus sharpening neural representations. Finally, we construct a computational model that demonstrates an increase in the representational distance of artificial units with training. Together, our results suggest that the neuronal population geometry, quantified by the representational distance, encodes face familiarity, similarity, and learning, forming the basis of face recognition and memory.
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Affiliation(s)
- Runnan Cao
- Department of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA; Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506, USA.
| | - Jinge Wang
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506, USA
| | - Peter Brunner
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Xin Li
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506, USA
| | - Ueli Rutishauser
- Departments of Neurosurgery and Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | - Shuo Wang
- Department of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA; Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506, USA; Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO 63110, USA.
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Donoghue T, Cao R, Han CZ, Holman CM, Brandmeir NJ, Wang S, Jacobs J. Single neurons in the human medial temporal lobe flexibly shift representations across spatial and memory tasks. Hippocampus 2023; 33:600-615. [PMID: 37060325 PMCID: PMC10231142 DOI: 10.1002/hipo.23539] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/19/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/16/2023]
Abstract
Investigations into how individual neurons encode behavioral variables of interest have revealed specific representations in single neurons, such as place and object cells, as well as a wide range of cells with conjunctive encodings or mixed selectivity. However, as most experiments examine neural activity within individual tasks, it is currently unclear if and how neural representations change across different task contexts. Within this discussion, the medial temporal lobe is particularly salient, as it is known to be important for multiple behaviors including spatial navigation and memory, however the relationship between these functions is currently unclear. Here, to investigate how representations in single neurons vary across different task contexts in the medial temporal lobe, we collected and analyzed single-neuron activity from human participants as they completed a paired-task session consisting of a passive-viewing visual working memory and a spatial navigation and memory task. Five patients contributed 22 paired-task sessions, which were spike sorted together to allow for the same putative single neurons to be compared between the different tasks. Within each task, we replicated concept-related activations in the working memory task, as well as target-location and serial-position responsive cells in the navigation task. When comparing neuronal activity between tasks, we first established that a significant number of neurons maintained the same kind of representation, responding to stimuli presentations across tasks. Further, we found cells that changed the nature of their representation across tasks, including a significant number of cells that were stimulus responsive in the working memory task that responded to serial position in the spatial task. Overall, our results support a flexible encoding of multiple, distinct aspects of different tasks by single neurons in the human medial temporal lobe, whereby some individual neurons change the nature of their feature coding between task contexts.
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Affiliation(s)
| | - Runnan Cao
- Lane Department of Computer Science and Electrical Engineering, West Virginia University
| | - Claire Z. Han
- Department of Biomedical Engineering, Columbia University
| | | | | | - Shuo Wang
- Department of Radiology, Washington University in St. Louis
| | - Joshua Jacobs
- Department of Biomedical Engineering, Columbia University
- Department of Neurological Surgery, Columbia University
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Chandi S, Dekeseredy P, Brandmeir NJ, Fang W, Sedney CL. Traumatic brain injury in college students and the influence of alcohol consumption: A retrospective review from a rural state. J Neurosci Rural Pract 2023; 14:298-301. [PMID: 37181163 PMCID: PMC10174116 DOI: 10.25259/jnrp_64_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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/24/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives There is a strong association between alcohol consumption and traumatic brain injury (TBI). Students are known to consume alcohol at a high rate. Despite the connection between alcohol and TBI, this is one of few studies to examine the connection between students, alcohol, and TBI. The objective of this study was to explore the relationship between students, alcohol, and TBI. Materials and Methods A retrospective chart review utilizing the institutional trauma data back was performed for patients 18-26 years of age, admitted to the emergency department with a diagnosis of a TBI and positive blood alcohol. Patient diagnosis, injury mechanism, alcohol level on admission, urine drug screen, mortality, injury severity score, and discharge disposition were recorded. The data were analyzed using Wilcoxon rank-sum tests and Chi-square tests to identify differences between students and non-student groups. Results Six hundred and thirty-six charts were reviewed for patients aged 18-26 with a positive blood alcohol level and TBI. The sample included 186 students, 209 non-students, and 241 uncertain of status. The student group had significantly higher levels of alcohol than the non-student group (P < 0.0001). P < 0.0001 showed that overall alcohol levels for males are significantly higher than levels of alcohol for females in the student group. Conclusion Alcohol consumption contributes to significant injuries such as TBI in college students. Male students had a higher prevalence of TBI, and higher alcohol levels than female students. These results can be used to inform and better target harm reduction and alcohol awareness programs.
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Affiliation(s)
- Sonia Chandi
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States
| | - Patricia Dekeseredy
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, United States
| | - Nicholas J. Brandmeir
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, United States
| | - Wei Fang
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, West Virginia, United States
| | - Cara L. Sedney
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States
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Thakur V, Kessler B, Khan MB, Hodge JO, Brandmeir NJ. Outpatient Deep Brain Stimulation Surgery Is a Safe Alternative to Inpatient Admission. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00656. [PMID: 36929766 DOI: 10.1227/ons.0000000000000683] [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: 09/26/2022] [Accepted: 01/17/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is usually performed as an inpatient procedure. The COVID-19 pandemic effected a practice change at our institution with outpatient DBS performed because of limited inpatient and surgical resources. Although this alleviated use of hospital resources, the comparative safety of outpatient DBS surgery is unclear. OBJECTIVE To compare the safety and incidence of early postoperative complications in patients undergoing DBS procedures in the outpatient vs inpatient setting. METHODS We retrospectively reviewed all outpatient and inpatient DBS procedures performed by a single surgeon between January 2018 and November 2022. The main outcome measures used for comparison between the 2 groups were total complications, length of stay, rate of postoperative infection, postoperative hemorrhage rate, 30-day emergency department (ED) visits and readmissions, and IV antihypertensive requirement. RESULTS A total of 44 outpatient DBS surgeries were compared with 70 inpatient DBS surgeries. The outpatient DBS cohort had a shorter mean postoperative stay (4.19 vs 39.59 hours, P = .0015), lower total complication rate (2.3% vs 12.8%, P = .1457), and lower wound infection rate (0% vs 2.9%, P = .52) compared with the inpatient cohort, but the difference in complications was not statistically significant. In the 30-day follow-up period, ED visits were similar between the cohorts (6.8% vs 7.1%, P = .735), but no outpatient DBS patient required readmission, whereas all inpatient DBS patients visiting the ED were readmitted (P = .155). CONCLUSION Our study demonstrates that DBS can be safely performed on an outpatient basis with same-day hospital discharge and close continuous monitoring.
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Affiliation(s)
- Vishal Thakur
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
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Donoghue T, Cao R, Han CZ, Holman CM, Brandmeir NJ, Wang S, Jacobs J. Single neurons in the human medial temporal lobe flexibly shift representations across spatial and memory tasks. bioRxiv 2023:2023.02.22.529437. [PMID: 36865334 PMCID: PMC9980106 DOI: 10.1101/2023.02.22.529437] [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: 02/24/2023]
Abstract
Investigations into how individual neurons encode behavioral variables of interest have revealed specific representations in single neurons, such as place and object cells, as well as a wide range of cells with conjunctive encodings or mixed selectivity. However, as most experiments examine neural activity within individual tasks, it is currently unclear if and how neural representations change across different task contexts. Within this discussion, the medial temporal lobe is particularly salient, as it is known to be important for multiple behaviors including spatial navigation and memory, however the relationship between these functions is currently unclear. Here, to investigate how representations in single neurons vary across different task contexts in the MTL, we collected and analyzed single-neuron activity from human participants as they completed a paired-task session consisting of a passive-viewing visual working memory and a spatial navigation and memory task. Five patients contributed 22 paired-task sessions, which were spike sorted together to allow for the same putative single neurons to be compared between the different tasks. Within each task, we replicated concept-related activations in the working memory task, as well as target-location and serial-position responsive cells in the navigation task. When comparing neuronal activity between tasks, we first established that a significant number of neurons maintained the same kind of representation, responding to stimuli presentations across tasks. Further, we found cells that changed the nature of their representation across tasks, including a significant number of cells that were stimulus responsive in the working memory task that responded to serial position in the spatial task. Overall, our results support a flexible encoding of multiple, distinct aspects of different tasks by single neurons in the human MTL, whereby some individual neurons change the nature of their feature coding between task contexts.
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Affiliation(s)
| | - Runnan Cao
- Lane Department of Computer Science and Electrical Engineering, West Virginia University
| | - Claire Z Han
- Department of Biomedical Engineering, Columbia University
| | | | | | - Shuo Wang
- Department of Radiology, Washington University in St. Louis
| | - Joshua Jacobs
- Department of Biomedical Engineering, Columbia University
- Department of Neurological Surgery, Columbia University
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Hodge JO, Cook P, Brandmeir NJ. Awake Deep Brain Stimulation Surgery Without Intraoperative Imaging Is Accurate and Effective: A Case Series. Oper Neurosurg (Hagerstown) 2022; 23:133-138. [PMID: 35486875 DOI: 10.1227/ons.0000000000000249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/09/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The success of deep brain stimulation (DBS) surgery depends on the accuracy of electrode placement. Several factors can affect this such as brain shift, the quality of preoperative planning, and technical factors. It is crucial to determine whether techniques yield accurate lead placement and effective symptom relief. Many of the studies establishing the accuracy of frameless techniques used intraoperative imaging to further refine lead placement. OBJECTIVE To determine whether awake lead placement without intraoperative imaging can achieve similar minimal targeting error while preserving clinical results. METHODS Eighty-two trajectories in 47 patients who underwent awake, frameless DBS lead placement with the Fred Haer Corporation STarFix system for essential tremor or Parkinson's disease were analyzed. Neurological testing during lead placement was used to determine appropriate lead locations, and no intraoperative imaging was performed. Accuracy data were compared with previously performed studies. RESULTS The Euclidean error for the patient cohort was 1.79 ± 1.02 mm, and the Pythagorean error was 1.40 ± 0.95 mm. The percentage symptom improvement evaluated by the Unified Parkinson's Disease Rating Scale for Parkinson's disease or the Fahn-Tolosa-Marin scale for essential tremor was similar to reported values at 58% ± 17.2% and 67.4% ± 24.7%, respectively. The operative time was 95.0 ± 30.3 minutes for all study patients. CONCLUSION Awake, frameless DBS surgery with the Fred Haer Corporation STarFix system does not require intraoperative imaging for stereotactic accuracy or clinical effectiveness.
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Affiliation(s)
- Johnie O Hodge
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
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8
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Abstract
The human amygdala and hippocampus have long been associated with face perception. Here, we present a dataset of single-neuron activity in the human amygdala and hippocampus during face perception. We recorded 2082 neurons from the human amygdala and hippocampus when neurosurgical patients with intractable epilepsy performed a one-back task using natural face stimuli, which mimics natural face perception. Specifically, our data include (1) single-neuron activity from the amygdala (996 neurons) and hippocampus (1086 neurons), (2) eye movements (gaze position and pupil), (3) psychological assessment of the patients, and (4) social trait judgment ratings from a subset of patients and a large sample of participants from the general population. Together, our comprehensive dataset with a large population of neurons can facilitate multifaceted investigation of face perception with the highest spatial and temporal resolution currently available in humans.
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Affiliation(s)
- Runnan Cao
- grid.268154.c0000 0001 2156 6140Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506 USA
| | - Chujun Lin
- grid.254880.30000 0001 2179 2404Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755 USA
| | - Nicholas J. Brandmeir
- grid.268154.c0000 0001 2156 6140Department of Neurosurgery, West Virginia University, Morgantown, WV 26506 USA
| | - Shuo Wang
- grid.268154.c0000 0001 2156 6140Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506 USA ,grid.4367.60000 0001 2355 7002Department of Radiology, Washington University in St. Louis, St. Louis, MO 63110 USA
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Abstract
STUDY DESIGN Retrospective chart review with matched control. OBJECTIVE To evaluate the indications and complications of spine surgery on super obese patients. METHODS A retrospective review assessed super obese patients undergoing spine surgery at a level-1 trauma and spine referral center from 2012 to 2016. Outcomes were compared to age-matched controls with body mass index (BMI) <50 kg/m2. The control group was further subdivided into patients with BMI <30 kg/m2 (normal) and BMI between 30 and 50 kg/m2 (obese). RESULTS Sixty-three super obese patients undergoing 86 surgeries were identified. Sixty patients (78 surgeries) were in the control group. Age and number of elective versus nonelective cases were not significantly different. Mean BMI of the super obese group was 55 kg/m2 (range 50-77 kg/m2) versus 29 kg/m2 in the controls (range 20-49 kg/m2). Fifty-two percent of surgeries were elective, and the most common indication was degenerative disease (39%). Compared with controls, super obese patients had a higher complication rate (30% [n = 19] vs 10% [N = 6], P = .0055) but similar 30-day mortality rate (5% vs 5%), a finding that was upheld when comparing super obese with each of the control group stratifications (BMI 30-50 and BMI <30 kg/m2). The most common complication among super obese patients was wound dehiscence/infection (n = 8, 13%); 2 patients' surgeries were aborted. Complication rates for elective surgery were 21% (n = 7) for super obese patients and 4% (n = 1) for controls (P = .121); complication rates for nonelective procedures were 40% (n = 12) and 14% (n = 5), respectively (P = .023). CONCLUSION The complication rate of spine surgery in super obese patients (BMI ≥ 50 kg/m2) is significantly higher than other patients, particularly for nonelective cases.
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Affiliation(s)
| | - Scott D. Daffner
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA,Scott D. Daffner, Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196, USA.
| | | | - Sanford E. Emery
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - John C. France
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Cara L. Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, WV, USA
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Cao R, Todorov A, Brandmeir NJ, Wang S. Task Modulation of Single-Neuron Activity in the Human Amygdala and Hippocampus. eNeuro 2022; 9:ENEURO.0398-21.2021. [PMID: 34933946 PMCID: PMC8805196 DOI: 10.1523/eneuro.0398-21.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/26/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022] Open
Abstract
The human amygdala and hippocampus are critically involved in various processes in face perception. However, it remains unclear how task demands or evaluative contexts modulate processes underlying face perception. In this study, we employed two task instructions when participants viewed the same faces and recorded single-neuron activity from the human amygdala and hippocampus. We comprehensively analyzed task modulation for three key aspects of face processing and we found that neurons in the amygdala and hippocampus (1) encoded high-level social traits such as perceived facial trustworthiness and dominance and this response was modulated by task instructions; (2) encoded low-level facial features and demonstrated region-based feature coding, which was not modulated by task instructions; and (3) encoded fixations on salient face parts such as the eyes and mouth, which was not modulated by task instructions. Together, our results provide a comprehensive survey of task modulation of neural processes underlying face perception at the single-neuron level in the human amygdala and hippocampus.
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Affiliation(s)
- Runnan Cao
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506
| | | | | | - Shuo Wang
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506
- Department of Radiology, Washington University in St. Louis, St. Louis, MO 63110
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Cao R, Li X, Brandmeir NJ, Wang S. Encoding of facial features by single neurons in the human amygdala and hippocampus. Commun Biol 2021; 4:1394. [PMID: 34907323 PMCID: PMC8671411 DOI: 10.1038/s42003-021-02917-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 11/18/2021] [Indexed: 12/05/2022] Open
Abstract
Faces are salient social stimuli that attract a stereotypical pattern of eye movement. The human amygdala and hippocampus are involved in various aspects of face processing; however, it remains unclear how they encode the content of fixations when viewing faces. To answer this question, we employed single-neuron recordings with simultaneous eye tracking when participants viewed natural face stimuli. We found a class of neurons in the human amygdala and hippocampus that encoded salient facial features such as the eyes and mouth. With a control experiment using non-face stimuli, we further showed that feature selectivity was specific to faces. We also found another population of neurons that differentiated saccades to the eyes vs. the mouth. Population decoding confirmed our results and further revealed the temporal dynamics of face feature coding. Interestingly, we found that the amygdala and hippocampus played different roles in encoding facial features. Lastly, we revealed two functional roles of feature-selective neurons: 1) they encoded the salient region for face recognition, and 2) they were related to perceived social trait judgments. Together, our results link eye movement with neural face processing and provide important mechanistic insights for human face perception.
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Affiliation(s)
- Runnan Cao
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV, 26506, USA.
| | - Xin Li
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV, 26506, USA
| | - Nicholas J Brandmeir
- Department of Neurosurgery, West Virginia University, Morgantown, WV, 26506, USA
| | - Shuo Wang
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV, 26506, USA.
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, 63110, USA.
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Davanzo J, Brandmeir NJ. Surgical Technique and Patient Selection for Spinal Cord Stimulation for Chronic Pain. Neurol India 2021; 68:S213-S217. [PMID: 33318353 DOI: 10.4103/0028-3886.302462] [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: 11/04/2022]
Abstract
Spinal cord stimulation (SCS) is a neuromodulation surgical technique that allows the treatment of various causes of chronic pain. SCS is effective in the treatment of chronic low back pain, neuropathic pain, chronic regional pain syndrome, and failed back surgery syndrome, among others. The mechanisms underlying the efficacy are still under investigation and different mechanisms are likely responsible for the effects of different waveforms used in the therapy. Successful application of SCS to individual patients depends on patient selection and meticulous surgical technique. Important factors in patient selection depend on preoperative imaging, maximizing noninvasive therapy, and neuropsychological evaluation. Percutaneous and open techniques exist for placing both paddle-shaped epidural leads as well as typical cylindrical leads. Benefits and risks exist for both techniques and the exact technique that is optimal depends on surgeon experience and surgeon and patient preference. Complications are rare and can be minimized and managed with appropriate preoperative mitigation.
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Affiliation(s)
- Justin Davanzo
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Nicholas J Brandmeir
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
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Hodge JO, Brandmeir CL, Brandmeir NJ. Neuromodulation Therapies for Spasticity Control: Now and Beyond. Neurol India 2021; 68:S241-S248. [PMID: 33318358 DOI: 10.4103/0028-3886.302464] [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: 11/04/2022]
Abstract
Spasticity is a major cause of disability following upper motor neuron (UMN) injury. The diagnosis and treatment of spasticity has been a focus of clinicians and researchers alike. In recent years, there have been significant advances both in strategies for spasticity assessment and in the development of novel treatments. Currently, several well-established spasticity management techniques fall into the major categories of physiotherapy, pharmacotherapy, and surgical management. The majority of recent developments in all of these broad categories have focused more on methods of neuromodulation instead of simple symptomatic treatment, attempting to address the underlying cause of spasticity more directly. The following narrative review briefly discusses the causes and clinical assessment of spasticity and also details the wide variety of current and developing treatment approaches for this often-debilitating condition.
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Affiliation(s)
- Johnie O Hodge
- Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Cheryl L Brandmeir
- Department of Human Performance, West Virginia University, Morgantown, WV, United States
| | - Nicholas J Brandmeir
- Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WV, United States
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Mahoney JJ, Haut MW, Hodder SL, Zheng W, Lander LR, Berry JH, Farmer DL, Marton JL, Ranjan M, Brandmeir NJ, Finomore VS, Hensley JL, Aklin WM, Wang GJ, Tomasi D, Shokri-Kojori E, Rezai AR. Deep brain stimulation of the nucleus accumbens/ventral capsule for severe and intractable opioid and benzodiazepine use disorder. Exp Clin Psychopharmacol 2021; 29:210-215. [PMID: 34043402 PMCID: PMC8422285 DOI: 10.1037/pha0000453] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Given high relapse rates and the prevalence of overdose deaths, novel treatments for substance use disorder (SUD) are desperately needed for those who are treatment refractory. The objective of this study was to evaluate the safety of deep brain stimulation (DBS) for SUD and the effects of DBS on substance use, substance craving, emotional symptoms, and frontal/executive functions. DBS electrodes were implanted bilaterally within the Nucleus Accumbens/Ventral anterior internal capsule (NAc/VC) of a man in his early 30s with >10-year history of severe treatment refractory opioid and benzodiazepine use disorders. DBS of the NAc/VC was found to be safe with no serious adverse events noted and the participant remained abstinent and engaged in comprehensive treatment at the 12-week endpoint (and 12-month extended follow-up). Using a 0-100 visual analog scale, substance cravings decreased post-DBS implantation; most substantially in benzodiazepine craving following the final DBS titration (1.0 ± 2.2) compared to baseline (53.4 ± 29.5; p < .001). A trend toward improvement in frontal/executive function was observed on the balloon analog risk task performance following the final titration (217.7 ± 76.2) compared to baseline (131.3 ± 28.1, p = .066). FDG PET demonstrated an increase in glucose metabolism in the dorsolateral prefrontal and medial premotor cortices at the 12-week endpoint compared to post-surgery/pre-DBS titration. Heart Rate Variability (HRV) improved following the final titration (rMSSD = 56.0 ± 11.7) compared to baseline (19.2 ± 8.2; p < .001). In a participant with severe, treatment refractory opioid and benzodiazepine use disorder, DBS of the NAc/VC was safe, reduced substance use and craving, and improved frontal and executive functions. Confirmation of these findings with future studies is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- James J. Mahoney
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Marc W. Haut
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM),Department of Neurology, Department of Radiology, RNI, WVUSOM
| | - Sally L. Hodder
- West Virginia Clinical and Translational Science Institute, WVUSOM
| | - Wanhong Zheng
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Laura R. Lander
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Daniel L. Farmer
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Jennifer L. Marton
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Manish Ranjan
- Department of Neurosurgery, Department of Neuroscience, RNI, WVUSOM
| | | | | | | | - Will M. Aklin
- National Institutes of Health, National Institute on Drug Abuse, Bethesda, Maryland, United States
| | - Gene-Jack Wang
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States
| | - Dardo Tomasi
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States
| | - Ehsan Shokri-Kojori
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States
| | - Ali R. Rezai
- Department of Neurosurgery, Department of Neuroscience, RNI, WVUSOM
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Katsevman GA, Brandmeir NJ. Trepanation of the Outer Table as a Treatment for Scalping Injuries: Historical Perspective and Modern Applications. World Neurosurg 2020; 145:301-305. [PMID: 33010504 DOI: 10.1016/j.wneu.2020.09.147] [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: 06/11/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
Complex cranial wounds represent complex surgical problems. In modern times, these are mostly due to accidental trauma. During the period of the American Frontier, violent scalping was a common practice. Innovative techniques were utilized to improve outcomes for this condition that still have relevance in today's practice. We provide a historical perspective with vignettes that identify survivors of violent scalping from the American Frontier as well as the surgical techniques used to treat them. The techniques identified were then modified for modern practice and applied to a complex cranial wound. A review of primary and secondary historical sources was carried out. Nine separate incidences of violent scalping were identified from this period. Successful treatment relied on exposure of the diploe leading to granulation tissue formation and eventual scalp coverage. This was accomplished as a byproduct of the violence of the scalping or as an application of the technique first described by Augustin Belloste in 1696. Application of this technique in a modern setting may allow for improved wound healing. Trepanation of the outer table to aid in healing and closure of complex cranial wounds has a long history of successful practice and can be successfully applied to modern practice.
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Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Nicholas J Brandmeir
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
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Brandmeir NJ, Murray A, Cheyuo C, Ferari C, Rezai AR. Deep Brain Stimulation for Multiple Sclerosis Tremor: A Meta-Analysis. Neuromodulation 2019; 23:463-468. [PMID: 31755637 DOI: 10.1111/ner.13063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/10/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the effect of deep brain stimulation (DBS) on multiple sclerosis (MS)-tremor, as measured by a normalized scale of tremor severity, with a meta-analysis of the published literature. METHODS Medline and EBSCO Host (January, 1998 to June, 2018) were systematically reviewed with librarian guidance, using the keywords "Deep brain stimulation" and "multiple sclerosis." Bibliographies and experts in the field were also consulted to identify missed articles. All therapeutic studies on DBS for MS-tremor, reported in the English language, within the study period were included. Papers that reported outcomes without a measure of central tendency and/or distribution were excluded. The papers were read in their entirety and graded for risk of bias according to the American Academy of Neurology (AAN) standards. To maximize statistical power, papers using different stimulation targets were grouped together. Outcomes were reported with the Fahn-Tolosa-Marin scale (FTM), the Bain-Finchley scale (CRS) and 3- and 4-point tremor severity scales and normalized with a Hedges g. RESULTS The search produced 13 studies suitable for meta-analysis. The random-effects meta-analysis showed that DBS improved the Hedges standardized mean tremor score by 2.86 (95%CI 2.03-3.70, p < .00001). Heterogeneity was high, with an I2 of 84%, suggesting that random effects model is more appropriate. Adverse event rates varied from 8% to 50%. CONCLUSIONS This meta-analysis provides level III evidence that DBS may improve MS-related tremor as measured by standardized tremor severity scales.
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Affiliation(s)
- Nicholas J Brandmeir
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.,Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Ann Murray
- Department of Neurology, West Virginia University, Morgantown, West Virginia.,Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Cletus Cheyuo
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.,Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Christopher Ferari
- West Virginia School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Ali R Rezai
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.,Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
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17
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Brandmeir NJ, Brandmeir CL, Carr D, Kuzma K, McInerney J. Deep Brain Stimulation for Parkinson Disease Does not Worsen or Improve Postural Instability: A Prospective Cohort Trial. Neurosurgery 2019; 83:1173-1182. [PMID: 29444300 DOI: 10.1093/neuros/nyx602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 11/25/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls and postural instability (PI) are major sources of morbidity in Parkinson disease (PD). Deep brain stimulation (DBS) is a major therapy for PD. The effects of DBS on PI and falls remain controversial. OBJECTIVE To study if DBS worsens PI, validated measures of PI (Timed Up and Go, Berg Balance Scale, Unified Parkinson's Disease Rating Scale 3.12 [Pull Test], and the Biodex Sway Index with eyes closed on a firm and soft surface) and reported falls were used to prospectively evaluate the effect of DBS on PI at 3 and 12 mo postoperatively compared to baseline measurements. The primary outcomes were a positive result on 4 out of the 5 PI tests and falls. METHODS Patients presenting for DBS were prospectively enrolled and evaluated at presentation and, 3 and 12 mo postoperatively. All tests were performed at each visit. RESULTS At 3 mo 4 of 5 positive showed noninferiority to baseline, with a rate of 28% vs 41% (relative risk [RR] 0.8 [0.5-1.3]). At 12 mo, 4 of 5 positive had a rate of 35% vs 30% (RR 1.2 [0.8-1.8]) and falls had a rate of 54% vs 46% (RR 1.2 [0.6-2.3]). These did not meet criteria to prove noninferiority. Sensitivity analysis at 12 mo showed noninferiority for 4 of 5 (RR 0.9 [0.6-1.5]) but not falls (RR 1.1 [0.5-2.3]). CONCLUSION This evidence is consistent with the hypothesis that DBS does not worsen PI when measured at 3 and 12 mo postoperatively.
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Affiliation(s)
- Nicholas J Brandmeir
- Blanchette Rockefeller Neuroscience Institute.,West Virginia University Department of Neurosurgery, Morgantown, WV
| | - Cheryl L Brandmeir
- West Virginia University Department of Neurosurgery, Morgantown, WV.,West Virginia University Department of Human Performance, Morgantown, WV
| | - David Carr
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Kristine Kuzma
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - James McInerney
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Brandmeir NJ, Savaliya S, Rohatgi P, Sather M. The comparative accuracy of the ROSA stereotactic robot across a wide range of clinical applications and registration techniques. J Robot Surg 2017; 12:157-163. [DOI: 10.1007/s11701-017-0712-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/01/2017] [Indexed: 12/01/2022]
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19
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Brandmeir NJ, Sather MD. A Technical Report of Robot-Assisted Stereotactic Percutaneous Rhizotomy. Pain Medicine 2017; 18:2512-2514. [DOI: 10.1093/pm/pnx110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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20
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Brandmeir NJ, Sather MD. Letter to the Editor. Stereotactic laser ablation for hypothalamic hamartomas after SRS failure. Neurosurg Focus 2017; 42:E18. [PMID: 28463619 DOI: 10.3171/2016.11.focus16426] [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: 11/06/2022]
Affiliation(s)
| | - Michael D Sather
- Penn State Health, Milton S. Hershey Medical Center, Hershey, PA
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21
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Brandmeir NJ, Brandmeir CL, Kuzma K, McInerney J. Response to Comment on: A Prospective Evaluation of an Outpatient Assessment of Postural Instability to Predict Risk of Falls in Patients with Parkinson's Disease Presenting for Deep Brain Stimulation. Mov Disord Clin Pract 2017; 4:283-284. [PMID: 30838272 PMCID: PMC6353399 DOI: 10.1002/mdc3.12413] [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: 06/09/2016] [Accepted: 06/14/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nicholas J. Brandmeir
- Department of NeurosurgeryPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Cheryl L. Brandmeir
- Department of Therapy ServicesPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Kristine Kuzma
- Department of NeurosurgeryPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - James McInerney
- Department of NeurosurgeryPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
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22
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Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, Patel AS, Rizk EB, Suki D, Sawaya R, Glantz M. Association of the Extent of Resection With Survival in Glioblastoma: A Systematic Review and Meta-analysis. JAMA Oncol 2017; 2:1460-1469. [PMID: 27310651 DOI: 10.1001/jamaoncol.2016.1373] [Citation(s) in RCA: 602] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Glioblastoma multiforme (GBM) remains almost invariably fatal despite optimal surgical and medical therapy. The association between the extent of tumor resection (EOR) and outcome remains undefined, notwithstanding many relevant studies. Objective To determine whether greater EOR is associated with improved 1- and 2-year overall survival and 6-month and 1-year progression-free survival in patients with GBM. Data Sources Pubmed, CINAHL, and Web of Science (January 1, 1966, to December 1, 2015) were systematically reviewed with librarian guidance. Additional articles were included after consultation with experts and evaluation of bibliographies. Articles were collected from January 15 to December 1, 2015. Study Selection Studies of adult patients with newly diagnosed supratentorial GBM comparing various EOR and presenting objective overall or progression-free survival data were included. Pediatric studies were excluded. Data Extraction and Synthesis Data were extracted from the text of articles or the Kaplan-Meier curves independently by investigators who were blinded to each other's results. Data were analyzed to assess mortality after gross total resection (GTR), subtotal resection (STR), and biopsy. The body of evidence was evaluated according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria and PRISMA guidelines. Main Outcome and Measures Relative risk (RR) for mortality at 1 and 2 years and progression at 6 months and 1 year. Results The search produced 37 studies suitable for inclusion (41 117 unique patients). The meta-analysis revealed decreased mortality for GTR compared with STR at 1 year (RR, 0.62; 95% CI, 0.56-0.69; P < .001; number needed to treat [NNT], 9) and 2 years (RR, 0.84; 95% CI, 0.79-0.89; P < .001; NNT, 17). The 1-year risk for mortality for STR compared with biopsy was reduced significantly (RR, 0.85; 95% CI, 0.80-0.91; P < .001). The risk for mortality was similarly decreased for any resection compared with biopsy at 1 year (RR, 0.77; 95% CI, 0.71-0.84; P < .001; NNT, 21) and 2 years (RR, 0.94; 95% CI, 0.89-1.00; P = .04; NNT, 593). The likelihood of disease progression was decreased with GTR compared with STR at 6 months (RR, 0.72; 95% CI, 0.48-1.09; P = .12; NNT, 14) and 1 year (RR, 0.66; 95% CI, 0.43-0.99; P < .001; NNT, 26). The quality of the body of evidence by the GRADE criteria was moderate to low. Conclusion and Relevance This analysis represents the largest systematic review and only quantitative systematic review to date performed on this subject. Compared with STR, GTR substantially improves overall and progression-free survival, but the quality of the supporting evidence is moderate to low.
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Affiliation(s)
- Timothy J Brown
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Matthew C Brennan
- Ann Barshinger Cancer Center, Lancaster General Health, Lancaster, Pennsylvania
| | - Michael Li
- Department of Neurosurgery, University of Rochester Medical Center, Pittsford, New York
| | - Ephraim W Church
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Nicholas J Brandmeir
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kevin L Rakszawski
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Akshal S Patel
- Department of Neurosurgery, Swedish Cerebrovascular Institute, Seattle, Washington
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Dima Suki
- Division of Surgery, Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston
| | - Raymond Sawaya
- Division of Surgery, Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston
| | - Michael Glantz
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Brandmeir NJ, McInerney J, Zacharia BE. The use of custom 3D printed stereotactic frames for laser interstitial thermal ablation: technical note. Neurosurg Focus 2016; 41:E3. [DOI: 10.3171/2016.8.focus16219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over the last several years, laser interstitial thermotherapy (LITT) has gained wide acceptance for the treatment of a myriad of cranial lesions. A wide variety of techniques for placement of the laser fiber have been reported with a spectrum of perceived benefits and drawbacks. The authors present the first report of a customized 3D printed stereotactic frame for LITT.
Approximately 1 week prior to surgery, 3–4 skull fiducials were placed after each of 5 patients received a local anesthetic as an outpatient. Radiographs with these fiducials were then used to create a trajectory to the lesion that would be treated with LITT. After the plan was completed, software was used to render a customized frame. On the day of surgery, the frame was attached to the implanted skull fiducials and the LITT catheter was placed. This procedure was carried out in 5 consecutive patients. In 2 patients, a needle biopsy was also performed.
Intraoperative and postoperative imaging studies confirmed the accurate placement of the LITT catheter and the lesion created. Mean operating room time for all patients was 45 minutes but only 26 minutes when excluding the cases in which a biopsy was performed.
To the best of the authors' knowledge, this is the first report of the use of a specific system, the STarFix microTargeting system, for use with LITT and brain biopsy. This system offers several advantages including fast operating times, extensive preoperative planning, no need for cranial fixation, and no need for frame or fiducial placement on the day of surgery. The accuracy of the system combined with these advantages may make this a preferred stereotactic method for LITT, especially in centers where LITT is performed in a diagnostic MRI suite.
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24
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Brown TJ, Brennan MC, Li YM, Church EW, Brandmeir NJ, Rakszawski K, Patel AS, Rizk EB, Suki D, Sawaya R, Glantz MJ. Examining extent of resection and progression-free survival in glioblastoma: A systematic review and meta-analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Timothy J Brown
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Yan Michael Li
- University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY
| | | | | | | | | | - Elias B Rizk
- Penn State Milton S Hershey Medical Center, Hershey, PA
| | - Dima Suki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raymond Sawaya
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Church EW, Anderson BL, Bogason ET, Brandmeir NJ, Daggubati LC, Davanzo JR, Hussain NS, Lane JR, McDermott D, Payne R, Rohatgi P, Savaliya S, Sieg EP, Ziu E. Journal Club: Neurosurgical Practice Liability: Relative Risk by Procedure Type. Neurosurgery 2016; 78:306-8. [PMID: 26779786 DOI: 10.1227/neu.0000000000001121] [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: 11/19/2022] Open
Affiliation(s)
- Ephraim W Church
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
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26
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Brandmeir NJ, Sather MD. Spinal Cord Stimulation for the Treatment of Neuropathic Pain Associated With Leprosy: A Case Report. Neuromodulation 2015; 18:762-4. [DOI: 10.1111/ner.12295] [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] [Received: 01/26/2015] [Accepted: 02/10/2015] [Indexed: 11/29/2022]
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27
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Brandmeir NJ, Brandmeir CL, Kuzma K, McInerney J. A Prospective Evaluation of an Outpatient Assessment of Postural Instability to Predict Risk of Falls in Patients with Parkinson's Disease Presenting for Deep Brain Stimulation. Mov Disord Clin Pract 2015; 3:151-155. [PMID: 30713907 DOI: 10.1002/mdc3.12257] [Citation(s) in RCA: 9] [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: 04/10/2015] [Revised: 08/04/2015] [Accepted: 08/08/2015] [Indexed: 11/11/2022] Open
Abstract
Background Postural instability (PI) and falls, major causes of morbidity in patients with PD, are often overlooked. DBS is a mainstay therapy for Parkinson's disease (PD) and has been purported to both worsen and improve PI. An effective PI evaluation that can predict fall risk in patients with PD presenting for DBS is needed. Methods Forty-nine consecutive patients with PD were enrolled. Self-reported falls were the gold standard. Tests evaluated were the Berg Balance Scale (BBS), Timed-Up-and-Go (TUG), Pull Test, and Biodex Balance System Sway Index on firm (SI-FIRM) and soft (SI-SOFT) surfaces. Results The best single tests for fall risk were the BBS and SI-FIRM, each with sensitivities of 79% and specificities of 60% and 65%, respectively. When the evaluation was combined into a composite measure requiring four positive tests out of five, the sensitivity was 72% and specificity was 80%. Conclusions A simple, efficient outpatient physical therapy assessment is effective in diagnosing fall risk in patients with PD.
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Affiliation(s)
- Nicholas J Brandmeir
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - Cheryl L Brandmeir
- Department of Therapy Services Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - Kristine Kuzma
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - James McInerney
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
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28
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Bogason ET, Anderson B, Brandmeir NJ, Church EW, Cooke J, Davies GM, Hussain N, Patel AS, Payne R, Rohatgi P, Sieg E, Zalatimo O, Ziu E. Journal Club. Neurosurgery 2014; 74:227-9. [DOI: 10.1227/neu.0000000000000240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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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29
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Church EW, Anderson B, Bogason E, Brandmeir NJ, Cooke J, Davies GM, Kainth K, Kelleher J, Patel AS, Payne R, Rohatgi P, Sieg E, Zalatimo O. Journal club: the impact of provider volume on the outcomes after surgery for lumbar spinal stenosis. Neurosurgery 2013; 72:E314-7. [PMID: 23328651 DOI: 10.1227/neu.0b013e31827bc38b] [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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30
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Geser F, Martinez-Lage M, Robinson J, Uryu K, Neumann M, Brandmeir NJ, Xie SX, Kwong LK, Elman L, McCluskey L, Clark CM, Malunda J, Miller BL, Zimmerman EA, Qian J, Van Deerlin V, Grossman M, Lee VMY, Trojanowski JQ. Clinical and pathological continuum of multisystem TDP-43 proteinopathies. ACTA ACUST UNITED AC 2009; 66:180-9. [PMID: 19204154 DOI: 10.1001/archneurol.2008.558] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.9] [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]
Abstract
OBJECTIVE To determine the extent of transactivation response DNA-binding protein with a molecular weight of 43 kDa (TDP-43) pathology in the central nervous system of patients with clinically and autopsy-confirmed diagnoses of frontotemporal lobar degeneration with and without motor neuron disease and amyotrophic lateral sclerosis with and without cognitive impairment. DESIGN Performance of immunohistochemical whole-central nervous system scans for evidence of pathological TDP-43 and retrospective clinical medical record review. SETTING An academic medical center. PARTICIPANTS We included 64 patients with clinically and pathologically confirmed frontotemporal lobar degeneration with ubiquitinated inclusions with or without motor neuron disease and amyotrophic lateral sclerosis with or without cognitive impairment. MAIN OUTCOME MEASURE Neuronal and glial TDP-43 pathology. RESULTS We found evidence of neuronal and glial TDP-43 pathology in all disease groups throughout the neuraxis, albeit with variations in the frequency, morphology, and distribution of TDP-43 lesions. Moreover, the major clinical manifestations (eg, cognitive impairments, motor neuron signs, extrapyramidal symptoms, neuropsychiatric features) were reflected by the predominant distribution and burden of TDP-43 pathology. CONCLUSION These findings strongly suggest that amyotrophic lateral sclerosis, frontotemporal lobar degeneration with amyotrophic lateral sclerosis or motor neuron disease, and frontotemporal lobar degeneration with ubiquitinated inclusions are different manifestations of a multiple-system TDP-43 proteinopathy linked to similar mechanisms of neurodegeneration.
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Affiliation(s)
- Felix Geser
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4283, USA
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Geser F, Brandmeir NJ, Kwong LK, Martinez-Lage M, Elman L, McCluskey L, Xie SX, Lee VMY, Trojanowski JQ. Evidence of multisystem disorder in whole-brain map of pathological TDP-43 in amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2008; 65:636-41. [PMID: 18474740 DOI: 10.1001/archneur.65.5.636] [Citation(s) in RCA: 227] [Impact Index Per Article: 14.2] [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]
Abstract
BACKGROUND Pathological 43-kDa transactivating responsive sequence DNA-binding protein (TDP-43) has been identified recently as the major disease protein in amyotrophic lateral sclerosis (ALS), and in frontotemporal lobar degeneration with ubiquitinated inclusions, with or without motor neuron disease, but the distribution of TDP-43 pathology in ALS may be more widespread than previously described. OBJECTIVE To determine the extent of TDP-43 pathology in the central nervous systems of patients with clinically confirmed and autopsy confirmed diagnoses of ALS. DESIGN Performance of an immunohistochemical whole-central nervous system scan for evidence of pathological TDP-43 in ALS patients. SETTING An academic medical center. PARTICIPANTS We included 31 patients with clinically and pathologically confirmed ALS and 8 control participants. MAIN OUTCOME MEASURES Immunohistochemistry and double-labeling immunofluorescence to assess the frequency and severity of TDP-43 pathology. RESULTS In addition to the stereotypical involvement of upper and lower motor neurons, neuronal and glial TDP-43 pathology was present in multiple areas of the central nervous systems of ALS patients, including in the nigro-striatal system, the neocortical and allocortical areas, and the cerebellum, but not in those of the controls. CONCLUSIONS These findings suggest that ALS does not selectively affect only the pyramidal motor system, but rather is a multisystem neurodegenerative TDP-43 proteinopathy.
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Affiliation(s)
- Felix Geser
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Alzheimer's Disease Core Center, Institute on Aging, Philadelphia, USA
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Brandmeir NJ, Geser F, Kwong LK, Zimmerman E, Qian J, Lee VMY, Trojanowski JQ. Severe subcortical TDP-43 pathology in sporadic frontotemporal lobar degeneration with motor neuron disease. Acta Neuropathol 2008; 115:123-31. [PMID: 18004574 DOI: 10.1007/s00401-007-0315-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 10/27/2007] [Accepted: 10/28/2007] [Indexed: 12/12/2022]
Abstract
Recently, TDP-43, a 43 kDa nuclear TAR DNA-binding protein, was identified as the major disease protein in frontotemporal lobar degeneration with ubiquitinated inclusions (FTLD-U), FTLD-U with motor neuron disease (FTLD-MND), and amyotrophic lateral sclerosis. To date, TDP-43 pathology in sporadic FTLD-MND has been reported only in select central nervous system areas. However, this distribution of lesions is insufficient to explain all clinical signs of FTLD-MND and the extent of TDP-43 pathology, throughout the brain, remains unknown. Therefore, as a pilot study, we performed an immunohistochemical whole brain scan of two cases diagnosed clinically as FTLD-MND and two control subjects. We found evidence of both neuronal and glial TDP-43 pathology in multiple brain areas including the nigro-striatal system, neo- and allocortical brain areas, with varying frequency, morphology, and degree, and nowhere in control tissue. The finding of a distinct cytopathological profile consisting of a cell nucleus devoid of endogenous TDP-43 staining coupled with diffuse/granular cytoplasmic staining ("pre-inclusion") was prominent in a couple of brain areas. These pre-inclusions were not or only weakly ubiquitin-immunoreactive. While the findings of severe involvement of extracortical or extrapyramidal areas are strongly suggestive for FTLD-MND being a TDP-43 multisystem proteinopathy rather than a disease predominantly affecting the cortex and spinal cord, more detailed clinicopathological studies of larger cohorts are needed to fully elucidate the distribution and severity of pathological TDP-43 in this disease.
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