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Bayman E, Chee K, Mendlen M, Denman DJ, Tien RN, Ojemann S, Kramer DR, Thompson JA. Subthalamic nucleus synchronization between beta band local field potential and single-unit activity in Parkinson's disease. Physiol Rep 2024; 12:e16001. [PMID: 38697943 PMCID: PMC11065686 DOI: 10.14814/phy2.16001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/24/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Local field potential (LFP) oscillations in the beta band (13-30 Hz) in the subthalamic nucleus (STN) of Parkinson's disease patients have been implicated in disease severity and treatment response. The relationship between single-neuron activity in the STN and regional beta power changes remains unclear. We used spike-triggered average (STA) to assess beta synchronization in STN. Beta power and STA magnitude at the beta frequency range were compared in three conditions: STN versus other subcortical structures, dorsal versus ventral STN, and high versus low beta power STN recordings. Magnitude of STA-LFP was greater within the STN compared to extra-STN structures along the trajectory path, despite no difference in percentage of the total power. Within the STN, there was a higher percent beta power in dorsal compared to ventral STN but no difference in STA-LFP magnitude. Further refining the comparison to high versus low beta peak power recordings inside the STN to evaluate if single-unit activity synchronized more strongly with beta band activity in areas of high beta power resulted in a significantly higher STA magnitude for areas of high beta power. Overall, these results suggest that STN single units strongly synchronize to beta activity, particularly units in areas of high beta power.
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Affiliation(s)
- Eric Bayman
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Keanu Chee
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Madelyn Mendlen
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Daniel J. Denman
- Department of Neurophysiology and BiophysicsUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Rex N. Tien
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Steven Ojemann
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Daniel R. Kramer
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - John A. Thompson
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of NeurologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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2
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Wang M, Graner AN, Knowles B, McRae C, Fringuello A, Paucek P, Gavrilovic M, Redwine M, Hanson C, Coughlan C, Metzger B, Bolus V, Kopper T, Smith M, Zhou W, Lenz M, Abosch A, Ojemann S, Lillehei KO, Yu X, Graner MW. A tale of two tumors: differential, but detrimental, effects of glioblastoma extracellular vesicles (EVs) on normal human brain cells. bioRxiv 2024:2024.04.08.588622. [PMID: 38645117 PMCID: PMC11030303 DOI: 10.1101/2024.04.08.588622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Glioblastomas (GBMs) are dreadful brain tumors with abysmal survival outcomes. GBM EVs dramatically affect normal brain cells (largely astrocytes) constituting the tumor microenvironment (TME). EVs from different patient-derived GBM spheroids induced differential transcriptomic, secretomic, and proteomic effects on cultured astrocytes/brain tissue slices as GBM EV recipients. The net outcome of brain cell differential changes nonetheless converges on increased tumorigenicity. GBM spheroids and brain slices were derived from neurosurgical patient tissues following informed consent. Astrocytes were commercially obtained. EVs were isolated from conditioned culture media by ultrafiltration, ultraconcentration, and ultracentrifugation. EVs were characterized by nanoparticle tracking analysis, electron microscopy, biochemical markers, and proteomics. Astrocytes/brain tissues were treated with GBM EVs before downstream analyses. EVs from different GBMs induced brain cells to alter secretomes with pro-inflammatory or TME-modifying (proteolytic) effects. Astrocyte responses ranged from anti-viral gene/protein expression and cytokine release to altered extracellular signal-regulated protein kinase (ERK1/2) signaling pathways, and conditioned media from EV-treated cells increased GBM cell proliferation. Thus, astrocytes/brain slices treated with different GBM EVs underwent non-identical changes in various 'omics readouts and other assays, indicating "personalized" tumor-specific GBM EV effects on the TME. This raises concern regarding reliance on "model" systems as a sole basis for translational direction. Nonetheless, net downstream impacts from differential cellular and TME effects still led to increased tumorigenic capacities for the different GBMs.
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Lewis S, Radcliffe E, Ojemann S, Kramer DR, Hirt L, Case M, Holt-Becker AB, Raike R, Kern DS, Thompson JA. Pilot Study to Investigate the Use of In-Clinic Sensing to Identify Optimal Stimulation Parameters for Deep Brain Stimulation Therapy in Parkinson's Disease. Neuromodulation 2024; 27:509-519. [PMID: 36797194 DOI: 10.1016/j.neurom.2023.01.006] [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: 10/26/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) programming is time intensive. Recent advances in sensing technology of local field potentials (LFPs) may enable improvements. Few studies have compared the use of this technology with standard of care. OBJECTIVE/HYPOTHESIS Sensing technology of subthalamic nucleus (STN) DBS leads in Parkinson's disease (PD) is reliable and predicts the optimal contacts and settings as predicted by clinical assessment. MATERIALS AND METHODS Five subjects with PD (n = 9 hemispheres) with bilateral STN DBS and sensing capable battery replacement were recruited. An LFP sensing review of all bipolar contact pairs was performed three times. Contact with the maximal beta peak power (MBP) was then clinically assessed in a double-blinded fashion, and five conditions were tested: 1) entry settings, 2) off stimulation, 3) MBP at 30 μs, 4) MBP at 60 μs, and 5) MBP at 90 μs. RESULTS Contact and frequency of the MBP power in all hemispheres did not differ across sessions. The entry settings matched with the contact with the MBP power in 5 of 9 hemispheres. No clinical difference was evident in the stimulation conditions. The clinician and subject preferred settings determined by MBP power in 7 of 9 and 5 of 7 hemispheres, respectively. CONCLUSIONS This study indicates that STN LFPs in PD recorded directly from contacts of the DBS lead provide consistent recordings across the frequency range and a reliably detected beta peak. Furthermore, programming based on the MBP power provides at least clinical equivalence to standard of care programming with STN DBS.
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Affiliation(s)
- Sydnei Lewis
- Biomedical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Erin Radcliffe
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel R Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa Hirt
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michelle Case
- Brain Modulation Business, Neuromodulation Operating Unit, Medtronic, Plc, Minneapolis, MN, USA
| | - Abbey B Holt-Becker
- Brain Modulation Business, Neuromodulation Operating Unit, Medtronic, Plc, Minneapolis, MN, USA
| | - Robert Raike
- Brain Modulation Business, Neuromodulation Operating Unit, Medtronic, Plc, Minneapolis, MN, USA
| | - Drew S Kern
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Nguyen KN, Freeman LM, Ung TH, Ojemann S, Grassia F. Immunocompetent isolated cerebral mucormycosis presenting with obstructive hydrocephalus: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23672. [PMID: 38531080 DOI: 10.3171/case23672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Isolated cerebral mucormycosis is rare in immunocompetent adults and is only sparsely reported to be associated with obstructive hydrocephalus. OBSERVATIONS Here, the authors report a case of obstructive hydrocephalus secondary to central nervous system mucormycosis without other systems or rhino-orbital involvement and its technical surgical management. A 23-year-old, incarcerated, immunocompetent patient with history of intravenous (IV) drug use presented with syncope. Although clinical and radiographic findings failed to elucidate an infectious pathology, endoscopy revealed an obstructive mass lesion at the level of the third ventricle, which, on microbiological testing, was confirmed to be Rhizopus fungal ventriculitis. Perioperative cerebrospinal fluid diversion, endoscopic third ventriculostomy, endoscopic biopsy technique, patient outcomes, and the literature are reviewed here. The patient received intrathecal and IV amphotericin B followed by a course of oral antifungal treatment and currently remains in remission. LESSONS The patient's unique presentation and diagnosis of isolated cerebral mucormycosis reveal this pathogen as a cause of ventriculitis and obstructive hydrocephalus in immunocompetent adult patients, even in the absence of infectious sequelae on neuroimaging.
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Affiliation(s)
- Khoa N Nguyen
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
| | - Lindsey M Freeman
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
| | - Timothy H Ung
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
| | - Steven Ojemann
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
| | - Fabio Grassia
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
- 2Division of Neurosurgery, Denver Health Medical Center, Denver, Colorado
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Welton TA, George NM, Ozbay BN, Gentile Polese A, Osborne G, Futia GL, Kushner JK, Kleinschmidt-DeMasters B, Alexander AL, Abosch A, Ojemann S, Restrepo D, Gibson EA. Two-photon microendoscope for label-free imaging in stereotactic neurosurgery. Biomed Opt Express 2023; 14:3705-3725. [PMID: 37497482 PMCID: PMC10368057 DOI: 10.1364/boe.492552] [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] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Abstract
We demonstrate a gradient refractive index (GRIN) microendoscope with an outer diameter of ∼1.2 mm and a length of ∼186 mm that can fit into a stereotactic surgical cannula. Two photon imaging at an excitation wavelength of 900 nm showed a field of view of ∼180 microns and a lateral and axial resolution of 0.86 microns and 9.6 microns respectively. The microendoscope was tested by imaging autofluorescence and second harmonic generation (SHG) in label-free human brain tissue. Furthermore, preliminary image analysis indicates that image classification models can predict if an image is from the subthalamic nucleus or the surrounding tissue using conventional, bench-top two-photon autofluorescence.
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Affiliation(s)
- Tarah A. Welton
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nicholas M. George
- Neuroscience Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Baris N. Ozbay
- Intelligent Imaging Innovations, Denver, Colorado, 80216, USA
| | - Arianna Gentile Polese
- Department of Cell and Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Gregory Osborne
- Department of Cell and Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Gregory L. Futia
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - J. Keenan Kushner
- Neuroscience Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bette Kleinschmidt-DeMasters
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Allyson L. Alexander
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Division of Pediatric Neurosurgery, Children’s Hospital Colorado, Aurora CO 80045, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Diego Restrepo
- Department of Cell and Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Emily A. Gibson
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Radcliffe EM, Baumgartner AJ, Kern DS, Al Borno M, Ojemann S, Kramer DR, Thompson JA. Oscillatory beta dynamics inform biomarker-driven treatment optimization for Parkinson's disease. J Neurophysiol 2023; 129:1492-1504. [PMID: 37198135 DOI: 10.1152/jn.00055.2023] [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: 02/03/2023] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 05/19/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by loss of dopaminergic neurons and dysregulation of the basal ganglia. Cardinal motor symptoms include bradykinesia, rigidity, and tremor. Deep brain stimulation (DBS) of select subcortical nuclei is standard of care for medication-refractory PD. Conventional open-loop DBS delivers continuous stimulation with fixed parameters that do not account for a patient's dynamic activity state or medication cycle. In comparison, closed-loop DBS, or adaptive DBS (aDBS), adjusts stimulation based on biomarker feedback that correlates with clinical state. Recent work has identified several neurophysiological biomarkers in local field potential recordings from PD patients, the most promising of which are 1) elevated beta (∼13-30 Hz) power in the subthalamic nucleus (STN), 2) increased beta synchrony throughout basal ganglia-thalamocortical circuits, notably observed as coupling between the STN beta phase and cortical broadband gamma (∼50-200 Hz) amplitude, and 3) prolonged beta bursts in the STN and cortex. In this review, we highlight relevant frequency and time domain features of STN beta measured in PD patients and summarize how spectral beta power, oscillatory beta synchrony, phase-amplitude coupling, and temporal beta bursting inform PD pathology, neurosurgical targeting, and DBS therapy. We then review how STN beta dynamics inform predictive, biomarker-driven aDBS approaches for optimizing PD treatment. We therefore provide clinically useful and actionable insight that can be applied toward aDBS implementation for PD.
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Affiliation(s)
- Erin M Radcliffe
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Alexander J Baumgartner
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Drew S Kern
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Mazen Al Borno
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Computer Science and Engineering, University of Colorado Denver, Denver, Colorado, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Daniel R Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Hirt L, Thies KA, Ojemann S, Abosch A, Darwin ML, Thompson JA, Kern DS. Case series investigating the differences between stimulation of rostral zona incerta region in isolation or in conjunction with the subthalamic nucleus on acute clinical effects for Parkinson’s disease. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2022.101553] [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: 11/17/2022] Open
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8
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Kern D, Korsmo M, Baumgartner AJ, Kramer D, Ojemann S, Case M, Holt-Becker AB, Raike R, Thompson JA. Methylphenidate effects on a clinically informative oscillatory signal within the subthalamic nucleus in Parkinson's disease during deep brain stimulation programming. Brain Stimul 2022; 15:747-749. [DOI: 10.1016/j.brs.2022.04.019] [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: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022] Open
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9
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Razmara A, Idlett-Ali S, Chee K, Shrestha K, Bayman E, Thompson J, Jameson L, Ojemann S, Kramer D. Transient cardiac asystole during vagus nerve stimulator implantation: A case report. Surg Neurol Int 2022; 13:131. [PMID: 35509543 PMCID: PMC9062970 DOI: 10.25259/sni_21_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/18/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Vagal nerve stimulation (VNS) is a Food and Drug Administration approved therapy for seizures with a suggested mechanism of action consisting of cortical desynchronization, facilitated through broad release of inhibitory neurotransmitters in the cortex and brainstem. The vagus nerve contains visceral afferents that transmit sensory signals centrally, from locations that include the heart and the aorta. Although the vagus nerve serves a role in cardiac function, electrical stimulation with VNS has rarely resulted in adverse cardiac events. Here, we report a case of a cardiac event during left-sided VNS implantation.
Case Description:
A 22-year-old male with an 8-year history of absence seizures and a 3-year history of medically refractory generalized tonic-clonic seizure was planned for surgical implantation of a VNS device. In the operating room, the patient underwent left-sided VNS implantation. An initial impedance check was performed with subsequent wound irrigation; following a few seconds of irrigation, a 5 s complete cardiac pause was noted. A repeated impedance check, which included turning on the stimulation, did not replicate the cardiac pause. No further pauses or cardiac events were noted and the case continued to completion without issue. The patient was later activated without any further complications.
Conclusion:
This report describes the initiation of a cardiac event, unlikely resulting from VNS, but instead time linked to intraoperative irrigation directly on the vagus nerve.
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Affiliation(s)
- Ashkaun Razmara
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States,
| | - Shaquia Idlett-Ali
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States,
| | - Keanu Chee
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States,
| | - Keshari Shrestha
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States,
| | - Eric Bayman
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States,
| | - John Thompson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States,
| | - Leslie Jameson
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States,
| | - Daniel Kramer
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States,
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Hirt L, Kern DS, Ojemann S, Grassia F, Kramer D, Thompson JA. Use of three-dimensional printed brain models during deep brain stimulation surgery consultation for patient health literacy: a randomized controlled investigation. World Neurosurg 2022; 162:e526-e533. [DOI: 10.1016/j.wneu.2022.03.049] [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: 02/01/2022] [Accepted: 03/12/2022] [Indexed: 12/09/2022]
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11
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Ung TH, Kahn L, Hirt L, Chatain G, Humes E, David-Gerecht P, Drees C, Thompson JA, Ojemann S, Abosch A. Using a Robotic-Assisted Approach for Stereotactic Laser Ablation Corpus Callosotomy: A Technical Report. Stereotact Funct Neurosurg 2021; 100:61-66. [PMID: 34515241 DOI: 10.1159/000518109] [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: 04/21/2021] [Accepted: 06/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Corpus callosotomy for medically intractable epilepsy is an effective ablative procedure traditionally achieved using either standard open craniotomy or with less-invasive approaches. Advances in robotic-assisted stereotactic guidance for neurosurgery can be applied for LITT for corpus callosotomy. CLINICAL PRESENTATIONS Two patients were included in this study. One was a 25-year-old female patient with extensive bi-hemispheric malformations of cortical development and medically refractory epilepsy, and the other was an 18-year-old male with medically refractory epilepsy and atonic seizures, who underwent a complete corpus callosotomy using robotic-assisted stereotactic guidance for LITT. RESULTS Both patients underwent successful intended corpus callosotomy with volumetric analysis demonstrating a length disconnection of 74% and a volume disconnection of 55% for patient 1 and a length disconnection of 83% and a volume disconnection of 33% for patient 2. Postoperatively, both patients had clinical reductions in seizure. CONCLUSION Our experience demonstrates that robotic guidance systems can safely and effectively be adapted for minimally invasive LITT corpus callosotomy.
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Affiliation(s)
- Timothy H Ung
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Lora Kahn
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Lisa Hirt
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA
| | - Gregoire Chatain
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Elizabeth Humes
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Pamela David-Gerecht
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Cornelia Drees
- School of Medicine, University of Colorado, Aurora, Colorado, USA.,Department of Neurology, University of Colorado Hospital, Aurora, Colorado, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
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Davis RA, Giordano J, Hufford DB, Sheth SA, Warnke P, Widge AS, Richardson RM, Rosenow JM, Rossi PJ, Storch EA, Winston H, Zboyan J, Dougherty DD, Foote KD, Goodman WK, McLaughlin NCR, Ojemann S, Rasmussen S, Abosch A, Okun MS. Restriction of Access to Deep Brain Stimulation for Refractory OCD: Failure to Apply the Federal Parity Act. Front Psychiatry 2021; 12:706181. [PMID: 34456762 PMCID: PMC8387630 DOI: 10.3389/fpsyt.2021.706181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rachel A. Davis
- Department of Psychiatry, University of Colorado Anschutz, Aurora, CO, United States
| | - James Giordano
- Neuroethics Studies Program, Department of Neurology, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, United States
| | | | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Peter Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL, United States
| | - Alik S. Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurosurgery, Harvard Medical School, Boston, MA, United States
| | - Joshua M. Rosenow
- Department of Neurological Surgery, Northwestern University, Chicago, IL, United States
| | - Peter Justin Rossi
- University of California San Francisco Department of Psychiatry, San Francisco, CA, United States
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Helena Winston
- Department of Psychiatry, University of Colorado Anschutz, Aurora, CO, United States
- Denver Health Hospital Authority, Denver, CO, United States
| | - JoAnne Zboyan
- Springer and Steinberg, PC, Denver, CO, United States
| | - Darin D. Dougherty
- Department of Neurosurgery, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Kelly D. Foote
- Departments of Neurosurgery and Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nicole C. R. McLaughlin
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz, Aurora, CO, United States
| | - Steven Rasmussen
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
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Belanger K, Grassia F, Kortz MW, Thompson JA, DeStefano S, Ojemann S. Management of post-operative delirium following stereoelectroencephalography electrode placement for drug resistant epilepsy: Lessons learned from two case reports. Epilepsy Behav Rep 2021; 16:100438. [PMID: 33997756 PMCID: PMC8093411 DOI: 10.1016/j.ebr.2021.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
Post-operative delirium poses unique challenges in neurosurgical patients. Substance use is a modifiable risk factor for post-operative delirium after SEEG. SEEG patients have increased risk of harm when experiencing post-operative delirium.
Post-operative delirium (POD) represents a unique challenge in the care of any surgical patient but is especially challenging in neurosurgical inpatient management due to a host of potentially significant predisposing factors. Patients undergoing stereoencephalography (SEEG) for diagnosis of drug resistant epilepsy are at unique risk due to safety concerns, yet POD has been underdiscussed in this population. Patients should be counseled pre-operatively about their risk and subsequent steps be taken post-operatively. We present two cases of POD status-post SEEG and propose a mechanism by which future post-operative care be coordinated by the physician, patient, and patient’s family.
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Affiliation(s)
- Katherine Belanger
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA
| | - Fabio Grassia
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA.,Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA
| | - Michael W Kortz
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA
| | - John A Thompson
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA.,Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA
| | - Sam DeStefano
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA
| | - Steven Ojemann
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA.,Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO 80217, USA
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Hixon AM, Brown MG, McDermott D, Destefano S, Abosch A, Kahn L, Ojemann S, Drees C. RNS modifications to eliminate stimulation-triggered signs or symptoms (STS): Case series and practical guide. Epilepsy Behav 2020; 112:107327. [PMID: 32717707 PMCID: PMC7658023 DOI: 10.1016/j.yebeh.2020.107327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/05/2020] [Indexed: 11/16/2022]
Abstract
Responsive neurostimulation (RNS) for intractable epilepsy involves placement of electrodes onto or into the brain that detect seizure activity and then deliver a current to abort a seizure before it spreads. Successful RNS treatment can deliver hundreds of stimulations per day, which are generally unnoticeable to patients. Uncommonly, RNS electrodes may result in stimulation of brain regions or peripheral structures that causes uncomfortable sensory or motor effects, a phenomenon we refer to as stimulation-triggered signs or symptoms (STS). Occurrence of STS may limit the ability to use RNS to full capacity to reduce seizures. In this case series, we describe STS in six out of 58 (10.3%) RNS patients at our institution. To eliminate or minimize STS, we developed a protocol for modification of RNS parameters. Modifying RNS stimulation was associated with reduced STS in all six patients, five had adjustment of stimulation settings, one of lead position. Five out of six patients were able to undergo further optimization of RNS for improved seizure control after reduction of symptoms. One patient had recurrent STS that prevented further increase of RNS stimulation current. This study may help other medical teams in identifying and reducing STS in patients with epilepsy receiving RNS devices.
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Affiliation(s)
- Alison M Hixon
- Medical Scientist Training Program, University of Colorado, Fitzsimons Building, 13001 East 17th Place, Aurora, CO 80045, USA.
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado, 12700 East 19th Ave, Aurora, CO 80045, USA.
| | - Danielle McDermott
- Department of Neurology, University of Colorado, 12700 East 19th Ave, Aurora, CO 80045, USA.
| | - Samuel Destefano
- Department of Neurology, University of Colorado, 12700 East 19th Ave, Aurora, CO 80045, USA.
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska, 42nd and Emile, Omaha, NE 68198, USA.
| | - Lora Kahn
- Department of Neurosurgery, Ochsner Medical Center, 1514 Jefferson Hwy 7th Floor, New Orleans, LA 70121, USA.
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado, 12700 East 19th Ave, Aurora, CO 80045, USA.
| | - Cornelia Drees
- Department of Neurology, University of Colorado, 12700 East 19th Ave, Aurora, CO 80045, USA.
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Drees C, McDermott D, Sillau S, Abosch A, Ojemann S, Schwarz S, Brown MG. Seizure outcome with responsive neurostimulation (RNS) comparing strip versus depth leads. Epilepsy Behav 2020; 112:107402. [PMID: 32911300 DOI: 10.1016/j.yebeh.2020.107402] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/02/2020] [Accepted: 08/02/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to compare seizure outcomes and complication rates in patients treated with only responsive neurostimulation (RNS) strip leads with those treated with only RNS depth leads. METHODS A retrospective cohort study was performed using the institutional epilepsy surgery database. Included was any patient implanted with the RNS system between August 2015 and May 2018 with either two depth (2D) or two strip (2S) leads connected to the device and at least 6 months follow-up. Excluded were those with a combination of active depth and strip leads. Data extracted from the charts comprised demographic information, duration of epilepsy, presence of a magnetic resonance imaging (MRI) lesion, prior resective surgery, clinically disabling seizures at baseline and follow-up, prior invasive monitoring, location (mesial temporal or neocortical) and number of seizure foci, unilateral or bilateral RNS lead placement, and postoperative complications. RESULTS Of 48 screened patients, 34 met study inclusion criteria. Of these, 15 were treated with 2D leads and 19 with 2S leads. Groups 2D and 2S were comparable with respect to age at onset, duration of epilepsy, baseline seizure frequency, and exposure time to RNS. After adjustment for patient age and duration of epilepsy, seizure frequency in 2S patients was noted to be decreased by 83% (p = 0.046), while it was reduced by 51% (p = 0.080) in 2D patients. The complication rate was not significantly different between the two groups. CONCLUSION In our small retrospective population, patients with RNS strip leads experienced a significantly greater seizure reduction than patients with RNS depth leads, without a difference in complication rate.
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Affiliation(s)
- Cornelia Drees
- Department of Neurology, University of Colorado Anschutz, Research Complex II, 12700 East 19th Avenue, 5018, Aurora, CO 80045, United States.
| | - Danielle McDermott
- Department of Neurology, University of Colorado Anschutz, Research Complex II, 12700 East 19th Avenue, 5018, Aurora, CO 80045, United States
| | - Stefan Sillau
- Department of Neurology, University of Colorado Anschutz, Research Complex II, 12700 East 19th Avenue, 5018, Aurora, CO 80045, United States
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, 988437 Nebraska Medical Center, Omaha, NE 68198-8437, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz, Academic Office One, 12631 East 17th Avenue, 5001, Aurora, CO 80045, United States
| | - Saul Schwarz
- Department of Neurosurgery, Colorado Kaiser Permanente, Medical Office Building, 2045 Franklin St, Ste 200, Denver, CO 80205, United States
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz, Research Complex II, 12700 East 19th Avenue, 5018, Aurora, CO 80045, United States
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16
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Kern DS, Uy D, Rhoades R, Ojemann S, Abosch A, Thompson JA. Discrete changes in brain volume after deep brain stimulation in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 2020; 91:928-937. [PMID: 32651244 DOI: 10.1136/jnnp-2019-322688] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/06/2020] [Accepted: 06/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS), targeting the subthalamic nucleus (STN) and globus pallidus interna, is a surgical therapy with class 1 evidence for Parkinson's disease (PD). Bilateral DBS electrodes may be implanted within a single operation or in separate staged surgeries with an interval of time that varies patient by patient. In this study, we used the variation in the timing of implantation from the first to the second implantation allowing for examination of potential volumetric changes of the basal ganglia in patients with PD who underwent staged STN DBS. METHODS Thirty-two patients with a mean time interval between implantations of 141.8 (±209.1; range: 7-700) days and mean duration of unilateral stimulation of 244.7 (±227.7; range: 20-672) days were included in this study. Using volumetric analysis of whole hemisphere and subcortical structures, we observed whether implantation or stimulation affected structural volume. RESULTS We observed that DBS implantation, but not the duration of stimulation, induced a significant reduction of volume in the caudate, pallidum, putamen and thalamus ipsilateral to the implanted hemisphere. These findings were not dependent on the trajectory of the implanted electrode nor on first surgery pneumocephalus (0.07%: %Δ for intracranial volume between first and second surgery). In addition, unique regional atrophy differences were evident in each of the structures. CONCLUSION Our results demonstrate that DBS implantation surgery may affect hemisphere volume at the level of subcortical structures connected to the surgical target.
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Affiliation(s)
- Drew S Kern
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel Uy
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Modern Human Anatomy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Remy Rhoades
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA .,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Modern Human Anatomy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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17
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Gault JM, Thompson JA, Maharajh K, Hosokawa P, Stevens KE, Olincy A, Liedtke EI, Ojemann A, Ojemann S, Abosch A. Striatal and Thalamic Auditory Response During Deep Brain Stimulation for Essential Tremor: Implications for Psychosis. Neuromodulation 2020; 23:478-488. [PMID: 32022409 DOI: 10.1111/ner.13101] [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: 05/15/2019] [Revised: 12/04/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The P50, a positive auditory-evoked potential occurring 50 msec after an auditory click, has been characterized extensively with electroencephalography (EEG) to detect aberrant auditory electrophysiology in disorders like schizophrenia (SZ) where 61-74% have an auditory gating deficit. The P50 response occurs in primary auditory cortex and several thalamocortical regions. In rodents, the gated P50 response has been identified in the reticular thalamic nucleus (RT)-a deep brain structure traversed during deep brain stimulation (DBS) targeting of the ventral intermediate nucleus (VIM) of the thalamus to treat essential tremor (ET) allowing for interspecies comparison. The goal was to utilize the unique opportunity provided by DBS surgery for ET to map the P50 response in multiple deep brain structures in order to determine the utility of intraoperative P50 detection for facilitating DBS targeting of auditory responsive subterritories. MATERIALS AND METHODS We developed a method to assess P50 response intraoperatively with local field potentials (LFP) using microelectrode recording during routine clinical electrophysiologic mapping for awake DBS surgery in seven ET patients. Recording sites were mapped into a common stereotactic space. RESULTS Forty significant P50 responses of 155 recordings mapped to the ventral thalamus, RT and CN head/body interface at similar rates of 22.7-26.7%. P50 response exhibited anatomic specificity based on distinct positions of centroids of positive and negative responses within brain regions and the fact that P50 response was not identified in the recordings from either the internal capsule or the dorsal thalamus. CONCLUSIONS Detection of P50 response intraoperatively may guide DBS targeting RT and subterritories within CN head/body interface-DBS targets with the potential to treat psychosis and shown to modulate schizophrenia-like aberrancies in mouse models.
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Affiliation(s)
- Judith M Gault
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Keeran Maharajh
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Karen E Stevens
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Ann Olincy
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Erin I Liedtke
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Alex Ojemann
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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18
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Thompson JA, Oukal S, Bergman H, Ojemann S, Hebb AO, Hanrahan S, Israel Z, Abosch A. Semi-automated application for estimating subthalamic nucleus boundaries and optimal target selection for deep brain stimulation implantation surgery. J Neurosurg 2018:1-10. [PMID: 29775152 DOI: 10.3171/2017.12.jns171964] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDeep brain stimulation (DBS) of the subthalamic nucleus (STN) has become standard care for the surgical treatment of Parkinson's disease (PD). Reliable interpretation of microelectrode recording (MER) data, used to guide DBS implantation surgery, requires expert electrophysiological evaluation. Recent efforts have endeavored to use electrophysiological signals for automatic detection of relevant brain structures and optimal implant target location.The authors conducted an observational case-control study to evaluate a software package implemented on an electrophysiological recording system to provide online objective estimates for entry into and exit from the STN. In addition, they evaluated the accuracy of the software in selecting electrode track and depth for DBS implantation into STN, which relied on detecting changes in spectrum activity.METHODSData were retrospectively collected from 105 MER-guided STN-DBS surgeries (4 experienced neurosurgeons; 3 sites), in which estimates for entry into and exit from the STN, DBS track selection, and implant depth were compared post hoc between those determined by the software and those determined by the implanting neurosurgeon/neurophysiologist during surgery.RESULTSThis multicenter study revealed submillimetric agreement between surgeon/neurophysiologist and software for entry into and exit out of the STN as well as optimal DBS implant depth.CONCLUSIONSThe results of this study demonstrate that the software can reliably and accurately estimate entry into and exit from the STN and select the track corresponding to ultimate DBS implantation.
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Affiliation(s)
- John A Thompson
- 1Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Hagai Bergman
- 2Department of Medical Neurobiology, The Hebrew University-Hadassah Medical School.,3Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Steven Ojemann
- 1Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Adam O Hebb
- 4Colorado Neurological Institute, Englewood, Colorado; and
| | - Sara Hanrahan
- 4Colorado Neurological Institute, Englewood, Colorado; and
| | - Zvi Israel
- 3Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Aviva Abosch
- 1Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
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19
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Brown MG, Drees C, Nagae LM, Thompson JA, Ojemann S, Abosch A. Curative and palliative MRI-guided laser ablation for drug-resistant epilepsy. J Neurol Neurosurg Psychiatry 2018; 89:425-433. [PMID: 29084870 DOI: 10.1136/jnnp-2017-316003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/30/2022]
Abstract
Epilepsy is a common neurological disorder occurring in 3% of the US adult population. It is characterised by seizures resulting from aberrant hypersynchronous neural activity. Approximately one-third of newly diagnosed epilepsy cases fail to become seizure-free in response to antiseizure drugs. Optimal seizure control, in cases of drug-resistant epilepsy, often requires neurosurgical intervention targeting seizure foci, such as the temporal lobe. Advances in minimally invasive ablative surgical approaches have led to the development of MRI-guided laser interstitial thermal therapy (LITT). For refractory epilepsy, this surgical intervention offers many advantages over traditional approaches, including real-time lesion monitoring, reduced morbidity, and in some reports increased preservation of cognitive and language processes. We review the use of LITT for epileptic indications in the context of its application as a curative (seizure freedom) or palliative (seizure reduction) measure for both lesional and non-lesional forms of epilepsy. Furthermore, we address the use of LITT for a variety of extratemporal lobe epilepsies. Finally, we describe clinical outcomes, limitations and future applications of LITT for epilepsy.
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Affiliation(s)
- Mesha-Gay Brown
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cornelia Drees
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lidia M Nagae
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
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20
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Nagae LM, Honce JM, Nyberg E, Ojemann S, Abosch A, Drees CN. Imaging of Laser Therapy in Epilepsy. J Neuroimaging 2017; 27:292-299. [PMID: 28370739 DOI: 10.1111/jon.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE MR-guided laser interstitial thermal therapy (MRgLITT) is an increasingly popular neuroablative method for the surgical treatment of epilepsy patients. This article intends to demonstrate the utility and pitfalls of imaging in the context of patient care with MRgLITT. MATERIAL AND METHODS A retrospective review of the medical records and imaging database with six illustrative cases selected to demonstrate the use of imaging throughout patient management with MRgLITT in diverse clinical situations and pathologies. A review of the knowledge in the literature was applied to the relevant points discussed. RESULTS Imaging findings were described in the setting of laser therapy in nonlesional epilepsy, mesial temporal sclerosis, dual pathology, periventricular nodular heterotopia, and schizencephaly. Discussion of imaging principles, potential pitfalls, as well as its use in the patient work-up and follow-up, is shown. CONCLUSIONS MRgLITT is an alternative minimally invasive therapy for refractory epilepsy, which is becoming widely sought for. Imaging plays a crucial role prior to, during, and after the procedure.
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Affiliation(s)
- Lidia M Nagae
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Justin M Honce
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Eric Nyberg
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Denver School of Medicine, Aurora, CO
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Denver School of Medicine, Aurora, CO
| | - Cornelia N Drees
- Department of Neurology, Epilepsy Section, University of Colorado Denver School of Medicine, Aurora, CO
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21
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Davis RA, Epstein CH, Klepitskaya O, Sharp CS, Ojemann S, Abosch A, Heru AM. Disambiguating the Psychiatric Sequelae of Parkinson's Disease, Deep Brain Stimulation, and Life Events: Case Report and Literature Review. Am J Psychiatry 2017; 174:11-15. [PMID: 28041000 DOI: 10.1176/appi.ajp.2016.15121583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rachel A Davis
- From the Departments of Psychiatry, Neurology, and Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Christen H Epstein
- From the Departments of Psychiatry, Neurology, and Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Olga Klepitskaya
- From the Departments of Psychiatry, Neurology, and Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Christopher S Sharp
- From the Departments of Psychiatry, Neurology, and Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Steven Ojemann
- From the Departments of Psychiatry, Neurology, and Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Aviva Abosch
- From the Departments of Psychiatry, Neurology, and Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Alison M Heru
- From the Departments of Psychiatry, Neurology, and Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora
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22
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Yingling CD, Ojemann S, Dodson B, Harrington MJ, Berger MS. Identification of motor pathways during tumor surgery facilitated by multichannel electromyographic recording. J Neurosurg 1999; 91:922-7. [PMID: 10584836 DOI: 10.3171/jns.1999.91.6.0922] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of this study was to determine the usefulness of electromyographic (EMG) recording in locating motor pathways near the central sulcus or internal capsule during surgery. METHODS Multichannel EMG recordings were compared with visual observation of contralateral body movement that was elicited by direct cortical or subcortical stimulation used to identify motor pathways before and during tumor resection. The EMG recordings were more sensitive than visual observation alone in identifying motor responses: in 30% of cases, responses were identified by EMG recording alone at some point during the operation and, in 9% of cases, EMG responses were the only responses observed. Additionally, EMG recordings often detected seizure activity resulting from electrical stimulation of the cortex that could not be appreciated on visual inspection. No new motor deficits were seen postoperatively in 88% of the patients in this series. CONCLUSIONS Using EMG recording in addition to motor pathway mapping results in greater sensitivity, allowing the use of lower stimulation levels and facilitating detection of stimulation-induced seizure activity.
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Affiliation(s)
- C D Yingling
- Department of Neurological Surgery, University of California at San Francisco 94143, USA.
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