Microvascular Transposition Without Teflon: A Single Institution's 17-Year Experience Treating Trigeminal Neuralgia

BACKGROUND

Trigeminal neuralgia (TN) refractory to medical management is often treated with microvascular decompression (MVD) involving the intracranial placement of Teflon. The placement of Teflon is an effective treatment, but does apply distributed pressure to the nerve and has been associated with pain recurrence.

OBJECTIVE

To report the rate of postoperative pain recurrence in TN patients who underwent MVD surgery using a transposition technique with fibrin glue without Teflon.

METHODS

Patients were eligible for our study if they were diagnosed with TN, did not have multiple sclerosis, and had an offending vessel that was identified and transposed with fibrin glue at our institution. All eligible patients were given a follow-up survey. We used a Kaplan-Meier (KM) model to estimate overall pain recurrence.

RESULTS

A total of 102 patients met inclusion criteria, of which 85 (83%) responded to our survey. Overall, 76 (89.4%) participants responded as having no pain recurrence. Approximately 1-yr pain-free KM estimates were 94.1% (n = 83), 5-yr pain-free KM estimates were 94.1% (n = 53), and 10-yr pain-free KM estimates were 83.0% (n = 23).

CONCLUSION

Treatment for TN with an MVD transposition technique using fibrin glue may avoid some cases of pain recurrence. The percentage of patients in our cohort who remained pain free at a maximum of 17 yr follow-up is on the high end of pain-free rates reported by MVD studies using Teflon. These results indicate that a transposition technique that emphasizes removing any compression near the trigeminal nerve root provides long-term pain-free rates for patients with TN.

Brain Activity Tracks Population Information Sharing by Capturing Consensus Judgments of Value

Information that is shared widely can profoundly shape society. Evidence from neuroimaging suggests that activity in the ventromedial prefrontal cortex (vmPFC), a core region of the brain's valuation system tracks with this sharing. However, the mechanisms linking vmPFC responses in individuals to population behavior are still unclear. We used a multilevel brain-as-predictor approach to address this gap, finding that individual differences in how closely vmPFC activity corresponded with population news article sharing related to how closely its activity tracked with social consensus about article value. Moreover, how closely vmPFC activity corresponded with population behavior was linked to daily life news experience: frequent news readers tended to show high vmPFC across all articles, whereas infrequent readers showed high vmPFC only to articles that were more broadly valued and heavily shared. Using functional connectivity analyses, we found that superior tracking of consensus value was related to decreased connectivity of vmPFC with a dorsolateral PFC region associated with controlled processing. Taken together, our results demonstrate variability in the brain's capacity to track crowd wisdom about information value, and suggest (lower levels of) stimulus experience and vmPFC-dlPFC connectivity as psychological and neural sources of this variability.

Freehand C2 Laminar Screw Placement: Technical Note and Operative Video

The placement of C2 laminar screws is a safe and useful method of axis fixation. The freehand method of screw placement was originally described by Wright et al., and requires detailed knowledge of the C2 posterior element anatomy, relationship to vital neurovascular structures, and technical acumen. The current evidence, surgical anatomy and technical details of screw insertion are investigated and highlighted in this manuscript and surgical video.

A Minimum Free Energy Model of Motor Learning

Even highly trained behaviors demonstrate variability, which is correlated with performance on current and future tasks. An objective of motor learning that is general enough to explain these phenomena has not been precisely formulated. In this six-week longitudinal learning study, participants practiced a set of motor sequences each day, and neuroimaging data were collected on days 1, 14, 28, and 42 to capture the neural correlates of the learning process. In our analysis, we first modeled the underlying neural and behavioral dynamics during learning. Our results demonstrate that the densities of whole-brain response, task-active regional response, and behavioral performance evolve according to a Fokker-Planck equation during the acquisition of a motor skill. We show that this implies that the brain concurrently optimizes the entropy of a joint density over neural response and behavior (as measured by sampling over multiple trials and subjects) and the expected performance under this density; we call this formulation of learning minimum free energy learning (MFEL). This model provides an explanation as to how behavioral variability can be tuned while simultaneously improving performance during learning. We then develop a novel variant of inverse reinforcement learning to retrieve the cost function optimized by the brain during the learning process, as well as the parameter used to tune variability. We show that this population-level analysis can be used to derive a learning objective that each subject optimizes during his or her study. In this way, MFEL effectively acts as a unifying principle, allowing users to precisely formulate learning objectives and infer their structure.

Diversity in migratory patterns among Neotropical fishes in a highly regulated river basin

Migratory behaviour of selected fish species is described in the Paraná River, Brazil-Argentina-Paraguay, to search for patterns relevant to tropical regulated river systems. In a 10 year mark-recapture study, spanning a 1425 km section of the river, 32 867 fishes composed of 18 species were released and 1083 fishes were recaptured. The fishes recaptured were at liberty an average 166 days (maximum 1548 days) and travelled an average 35 km (range 0-625 km). Cluster analysis applied to variables descriptive of movement behaviour identified four general movement patterns. Cluster 1 included species that moved long distances (mean 164 km) upstream (54%) and downstream (40%) the mainstem river and showed high incidence (27%) of passage through dams; cluster 2 also exhibited high rate of movement along the mainstem (49% upstream, 13% downstream), but moved small distances (mean 10 km); cluster 3 included the most fishes moving laterally into tributaries (45%) or not moving at all (25%), but little downstream movement (8%); fishes in cluster 4 exhibited little upstream movement (13%) and farthest downstream movements (mean 41 km). Whereas species could be numerically clustered with statistical models, a species ordination showed ample spread, suggesting that species exhibit diverse movement patterns that cannot be easily classified into just a few classes. The cluster and ordination procedures also showed that adults and juveniles of the same species exhibit similar movement patterns. Conventional concepts about Neotropical migratory fishes portray them as travelling long distances upstream. The present results broaden these concepts suggesting that migratory movements are more diverse, could be long, short or at times absent, upriver, downriver or lateral, and the diversity of movements can vary within and among species. The intense lateral migrations exhibited by a diversity of species, especially to and from large tributaries (above reservoirs) and reservoir tributaries, illustrate the importance of these habitats for the fish species life cycle. Considering that the Paraná River is highly impounded, special attention should be given to the few remaining low-impact habitats as they continue to be targets of hydropower development that will probably intensify the effects on migratory fish stocks.