Name: stereo-electro-encephalo-graphy (seeg) with robotic assistance in the presurgical evaluation of medical refractory epilepsy: a technical note
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伦理声明:我们的协议，遵循我们的机构人类研究伦理委员会制定的准则。 1.药物难治性癫痫患者的识别<ol><li>此前创监测，评估在1描述的多学科会议讨论决定是否要继续与SEEG创监测必须经过allpatientswith非侵入性技术，如视频脑电图监测，MRI，PET，ictalSPECT，以及神经心理学研究制作。1,6,7,11,14 </li><li>形成有关的EZ的位置的假设。之前介入开发推定EZincorporating的发病发作区和癫痫（发作）的早期（ 即快速）传播的地区活动的植入前假说。 注:此步骤可与在作出决定追求微创montitoring多学科会议共同完成。 注意:SEEG VS的EZ假设硬膜下网格为基础，SEEG和硬膜下电网监控之间做出选择。标准要考虑可能包括:1）可能的深层次EZ; 2）以前不成功的硬膜下网格监控; 3）双边监督的迹象; 4）非皮损外颞叶癫痫之嫌。还应当指出，在硬膜网格SEEG的额外的好处，包括SEEG的记录和当有力地区域被假设是在EZ邻近刺激临界皮质下区域的能力。 </li><li>开发基于虚拟EZ（ 图1）量身定制的植入策略。1,7,8 注:足够的植入策略必须评估1）解剖病变（如果存在）; 2）结构（多个）最有可能参与inictal发病;和/或3）发作传播的可能途径（S）的功能性网络内。除了解剖考虑，后勤方面的考虑也必须加以考虑。对于由于这个原因，正交轨迹是在一般的优惠，以促进植入和，以后，电极的位置的解释。 </li><li>开发基于虚拟EZ注入策略之后，创建一个使用机器人辅助的计划。首先，创建一个新的相遇，选择"新病人"，然后点击"创建轨迹"，然后选择合适的"切入点"和"终点"，这与期望轨迹一致。 注:根据植入前假说，电极的数量通常之间的八个十二名。轨迹和兴趣点正在使用对比MRI或旋转血管造影典型的计划。这不仅显示脑部问题，但脑血管这些图像允许在无血管走廊轨迹计划，以避免血管损伤，出血。 </li></ol> 2.手术过程<ol><li>苏的前一天rgery，获得14对比，体积T1加权MRI由Kuzniecky 等人所描述的序列。 注:此图片是用于与机器人辅助登记，并且必须有1个mm层厚。然后将图像传送到立体定向神经导航软件，其中轨迹是基于前面讨论注入策略计划作为由Kuzniecky 等人所述。14 </li><li>一旦在手术室，放在手术台上的患者在仰卧位。然后获取气管插管全身麻醉根据麻醉师"协议。 注:当务之急是，他们是普通静脉麻醉和完整的药物麻痹下。然后剃病人头部，与抗生素外科应用预习皮肤，然后将病人的头部在头部神经外科头支架。全身麻醉不同于患者与患者。 </li><li>完成后，定位用的机器人系统连接至框架并完成注册。在机器人辅助设备选择"注册"，然后按照提示完成注册过程。根据面部特征或植入基准标记完成注册使用面的标志性注册。 </li><li>插入（ 图2） <ol><li>使用2.5毫米的钻头从机器人立体定向系统深入的指导协助头骨。将单极电凝探头打开硬脑膜。螺钉植入螺栓插入颅骨，也是由机器人立体定向系统的指导。 </li><li>计算使用下面的测量电极（D3）的最终深度距离:[（目标-杜拉距离）+（D1 - D2）= D3]。使用导航系统测量目标-硬脑膜距离。 注:D1被测量为引导系统到硬脑膜的长度，D2被测量为所述引导系统的长度，以在螺栓的端。的D 1 - D 2不同的是将螺栓的长度。螺栓和靶 - 硬脑膜距离的长度的总和是电极深度的长度。 </li><li>通过插入stylette探针，通过植入螺栓引导创建初始轨迹。然后插入电极并固定到螺栓。这可以防止进一步的位移和脑脊液（CSF）泄漏。 </li><li>放置并连接所有电极后，将绕螺栓帽碘溶液浸泡的纱布。而且，当时包住头部。 </li></ol></li></ol> 3.监测/记录<ol><li>整理的情况之前，将电极连接到脑电图记录机，以保证正常运行。在手术室中的最后一步是术中成像（ 图3）。执行术的X射线或荧光成像在横向和前后头骨。 注:获得这些以确保电极的适当轨迹。这些图像是不是obtained，来确保立体定向安置，而它们确保电极的一般正确轨迹和位置。 </li><li>手术后，转移患者癫痫监测单位监测癫痫发作临床和通过SEEG电极记录electrographically病人。 注:住宿天数不同，这取决于数量，质量和发作期和录音的发作模式。虽然监控患者可有轻微的疼痛，治疗这种对乙酰氨基酚。通常情况下，停留时间的长短是7天（范围为3 - 28天）。 </li><li>去除电极之前，讨论多学科会议关于患者审查录音和假设。 </li><li>记录足够的发作数据之后（步骤3.2）和病人在发布会上进行了讨论，同时等待或去除电极重启患者事先抗癫痫药物。 </li></ol> 4.返回或准备卸下<ol><li>房颤之三足记录数据的发作，病人返回手术室切除SEEG电极。在清醒镇静执行此;通常为2毫克咪达唑仑IV是足够了。 </li><li>麻醉获得足够的镇静后（通常与咪达唑仑[剂量推迟到麻醉师]），去除患者裹头，并切断电极线。通过电极去除或缝线插入报道的疼痛程度临床监测病人的镇静作用。然后预习使用碘化凝胶电极的其余螺栓和尾巴。 </li><li>个别地，通过扭曲其关闭除去每个螺栓帽，其次是电极，最后取出的螺栓。轻轻拉出来沿其插入轴取出电极。然后通过扭动它拆卸螺栓，通常这样做用手指。 </li><li>上移动到下一个电极之前，关闭由螺栓离开缺陷用尼龙缝合线中的一个线圈。重复这些步骤为每个电极。 REM后oving所有电极，覆盖抗生素软膏和一个松散的裹头针脚领域。 </li><li>取出后，获得进一步的成像CT或A / P和侧位X光片，以确保无残留的硬件。 注意:可能切除-如果手术切除被认为是有利于患者的癫痫然后要开颅和切除除去后大致6周计划。该延迟是由于相同的住院作为监视时段期间操作的传染性的担忧。 </li></ol>

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作者什么都没有透露。

在这里，提出利用机器人立体定向援助SEEG插入技术。同时采用基于帧的立体定位等方法最初描述SEEG，机器人辅助SEEG不仅提供类似的安全性，更高的精度和效率。在个案当中，超过76％，这与使用替代技术。6,13其他以往的研究同情本地化EZ文献报道的成功。 正如任何侵​​入颅内程序，SEEG并非没有风险。幸运的是，SEEG插入报道非常低的并发症的危险。15最显着，颅内出血是最严重的并发症10,11。这些结果与当前SEEG文献兼容。对于SEEG利用机器人辅助不仅安全，而且高效，准确，证明是一个很有前途的技术。 虽然技术出众，它提供对手术时间显著的改进，机器人的援助是不完美的。必须落实到一个人的练习之前被认为是一个限制因素是产品收购的初始成本。根据个别情况下，这个数字可以很容易地单独进行改进或时间是合理的。 必须不能掉以轻心另一个关键步骤是正确的登记初始深度的位置和所有后续深度之前的关键特性。如果对精度有术的忧虑所在，手术必须暂停，直至准确的注册可以得到证实。 SEEG插入不仅在当前技术取代了现有的方法，但打开了一个神经外科医生的医疗设备到其他利用率。用于治疗癫痫的激光烧蚀是一个新兴的领域，它已经证明是适合于与机器人SEEG组合。12 我们已经开始到另一种技术与机器人SEEG是利用植入响应神经刺激系统（RNS）SEEG的证明3-D功能解剖，同时使电极精确和准确放置植入RNS时的好处是显然的能力。

In medically refractory epilepsy there are many non-invasive pre-surgical tools (scalp EEG., magnetic resonance imaging (MRI), functional MRI, single photon emission computed tomography, positron emission topography, and magnetoencephalography). If these non-invasive evaluations fail to sufficiently localize or define the epileptic zone (EZ) then invasive recording may be indicated. Currently, subdural grids or Stereo-electro-encephalo-graphy (SEEG) are the two most prevalent methods of invasive monitoring. SEEG was originally developed in France in the 1950's by Jean Talairach and Jean Bancaud; recently it has mostly been used for invasive monitoring of refractory epilepsy patients in France.2-4 SEEG is the consists of stereotactically inserting intracerebral electrodes into the brain parenchyma to record brain electrical activity for an extended period of time. With the intracerebral electrical recordings many patients are able to have their EZ defined to allow for surgical resection. 
Despite this long history of success SEEG remains relatively rarely used for invasive recording in America. However, SEEG does offer several significant advantages; SEEG allows for 1) recording of deep structures, 2) bihemispheric recordings, 3) another recording option if subdural grids failed, and 4) mapping of epileptic networks in three dimensions, mainly in patients where non-lesional extra-temporal epilepsy is suspected.5-7 All of these benefits are achieved without requiring a large craniotomy. A recent technologic advance in SEEG surgery is the used of robotic guidance. This sophisticated development allows for improved operative times but safer and more accurate surgical implantation of electrodes.Recently published literature reviews the results of using two different techniques for SEEG insertion; a more traditional method utilizing stereotactic frames and a newer technique using robotic assistante for SEEG insertion.1, 8,15 the results were similarly successful with each method. 
With the advent of improved robotic assistance, the SEEG insertion technique has resulted in improved operative times. The robotic system is classified as a supervisory controlled system which means the surgeon plans the operation off line and implicitly specifies the motion the robot must follow to perform the operation.9 The robotic assist results in expedient transitions from one trajectory to the next for the placement of each intracranial electrode.

<table><tbody><tr><td>ROSA</td><td>ROSA</td><td></td><td>robotic implantation system</td></tr><tr><td>electrodes</td><td>adtech</td><td></td><td></td></tr></tbody></table>

stereo-electro-encephalo-graphy (seeg) with robotic assistance in the presurgical evaluation of medical refractory epilepsy: a technical note

SEEG是通过三维录音用于癫痫发作的准确，微创记录的方法和技术。在谁是认为合适的候选人有创记录癫痫病人，监察决定硬膜下格栅与SEEG之间进行。癫痫神经监测侵入患者复杂，难治性癫痫的追求。中创监测的目标是提供切除手术以使癫痫发作自由的希望。 SEEG的优势，包括进入深皮质结构，本地化的致痫区（EZ）时，硬膜下网格都未能做到这一点，并在患者的非皮损额外的时空性癫痫的能力。在这个手稿中，我们提出了SEEG的简要历史回顾和我们的下机器人立体定向无框体验报告。 SEEG插入当务之急步骤规划电极轨迹。为了最有效地记录通过SEEG轨迹发作活动应该基于对那里的癫痫发作起源推测的致痫灶（EZ）假设规划。在EZ假说是基于一个标准的术前后处理包括视频脑电图监测，MRI（磁共振成像），PET（正电子发射断层摄影术），发作SPECT（单光子发射计算机断层扫描），和神经心理学评估。使用EZ嫌疑，SEEG电极可以放在最小侵入性的同时保持准确度和精密度。临床结果表明本地化EZ在难以定位癫痫患者78％的能力。1

最近的研究结果表明，在一个连续的一系列78例谁通过机器人辅助进行SEEG插入有EZ成功的本土化患者76.2％。1这同一项研究显示，谁去拥有EZ手术切除有1级的患者患者67.8％恩格尔扣押自由（ 图4）。发病率是2.5％。永久的发病率被注意到的是1例（1.2％）。每电极，它显示出具有为0.08％的伤口感染和颅内血肿率，每个。 <img alt="图1" src="/files/ftp_upload/53206/53206fig1.jpg" /> 图1. SEEG植入的模式的例子。根据病人提出的假设所有填写个人都是定制的 。在这些例子中，我们显示（从上到下，从左到右）颞部，颞枕部，颞面值ietal枕，额颞，额顶叶，孤芳自赏，perisylvian，和额叶和双颞侧插入计划。黑点代表SEEG电极，在正交时尚植入入口点。黑线代表电极轨迹。经许可后转载，克利夫兰诊疗中心医疗艺术与摄影。版权所有2011 - 2013年保留所有权利。 <a href="https://www.jove.com/files/ftp_upload/53206/53206fig1large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图2" src="/files/ftp_upload/53206/53206fig2.jpg" /> 图2.方法深度植入电极。1）颅骨上钻有一个2.5毫米的钻头，通过立体定向系统的指导。2）单极电凝探头插入和硬脑膜被打开; 3）植入螺栓被拧紧入颅，还摹<html>通过立体定向系统4）用于电极的最终深度距离（D3）uided被计算和测定:[（靶杜拉距离+ D1） - D 2 = D 3]。最初，轨迹由一个stylette探针，通过植入螺栓引导创建。5）的深度电极的最后位置，并且其固定到螺栓，防止位移和脑脊液泄漏。经许可后转载，克利夫兰诊疗中心医疗艺术与摄影。版权所有2011-2013。保留所有权利。 <a href="https://www.jove.com/files/ftp_upload/53206/53206fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图3" src="/files/ftp_upload/53206/53206fig3.jpg" /> 图3.术手术AP颅骨X线，获得确认的电极位置对应于预先计划的轨迹。tp_upload / 53206 / 53206fig3large.jpg"目标="_空白"&gt;点击此处查看该图的放大版本。 <img alt="图4" src="/files/ftp_upload/53206/53206fig4.jpg" /> 图4.患者的预后的经历SEEG监测七十六名患者都能够有自己的EZ本地化;此外那些接受切除后SEEG 67％的患者经历1恩格尔级扣押的自由。 <a href="https://www.jove.com/files/ftp_upload/53206/53206fig4large.jpg" target="_blank">请点击此处查看该图的放大版本。</a>

Watch this Scientific Journal Video about Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note at JoVE.com

Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes.

立体声电Encephalo-造影（SEEG）随着医学难治性癫痫的术前评估机器人辅助:技术说明

SEEG is a method and technique which is used for accurate, invasive recording of seizure activity via three dimensional recordings. In epilepsy patients ...

stereo-electro-encephalo-graphy-seeg-with-robotic-assistance

Nanyang Technological University

Research

JoVE Journal

Medicine

Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

17.1K 次观看.  Cleveland Clinic. Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes. 

视频: Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

Performing Behavioral Tasks in Subjects with Intracranial Electrodes

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in different areas of their brain for the localization of their seizure focus and eloquent areas. After implantation, the patient must remain in the hospital until the pathological area of brain is found and possibly resected. During this time, these patients offer a unique opportunity to the research community because any number of behavioral paradigms can be performed to uncover the neural correlates that guide behavior. Here we present a method for recording brain activity from intracranial implants as subjects perform a behavioral task designed to assess decision-making and reward encoding. All electrophysiological data from the intracranial electrodes are recorded during the behavioral task, allowing for the examination of the many brain areas involved in a single function at time scales relevant to behavior. Moreover, and unlike animal studies, human patients can learn a wide variety of behavioral tasks quickly, allowing for the ability to perform more than one task in the same subject or for performing controls. Despite the many advantages of this technique for understanding human brain function, there are also methodological limitations that we discuss, including environmental factors, analgesic effects, time constraints and recordings from diseased tissue. This method may be easily implemented by any institution that performs intracranial assessments; providing the opportunity to directly examine human brain function during behavior.

Patients implanted with intracranial electrodes provide a unique opportunity to record neurological data from multiple areas of the brain while the patient performs behavioral tasks. Here, we present a method of recording from implanted patients that can be reproducible at other institutions with access to this patient population.

执行任务的行为与颅内电极主题

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in ...

科研

行为学

Recording Human Electrocorticographic (ECoG) Signals for Neuroscientific Research and Real-time Functional Cortical Mapping

Neuroimaging studies of human cognitive, sensory, and motor processes are usually based on noninvasive techniques such as electroencephalography (EEG), magnetoencephalography or functional magnetic-resonance imaging. These techniques have either inherently low temporal or low spatial resolution, and suffer from low signal-to-noise ratio and/or poor high-frequency sensitivity. Thus, they are suboptimal for exploring the short-lived spatio-temporal dynamics of many of the underlying brain processes. In contrast, the invasive technique of electrocorticography (ECoG) provides brain signals that have an exceptionally high signal-to-noise ratio, less susceptibility to artifacts than EEG, and a high spatial and temporal resolution (i.e., &lt;1 cm/&lt;1 millisecond, respectively). ECoG involves measurement of electrical brain signals using electrodes that are implanted subdurally on the surface of the brain. Recent studies have shown that ECoG amplitudes in certain frequency bands carry substantial information about task-related activity, such as motor execution and planning1, auditory processing2 and visual-spatial attention3. Most of this information is captured in the high gamma range (around 70-110 Hz). Thus, gamma activity has been proposed as a robust and general indicator of local cortical function1-5. ECoG can also reveal functional connectivity and resolve finer task-related spatial-temporal dynamics, thereby advancing our understanding of large-scale cortical processes. It has especially proven useful for advancing brain-computer interfacing (BCI) technology for decoding a user's intentions to enhance or improve communication6 and control7. Nevertheless, human ECoG data are often hard to obtain because of the risks and limitations of the invasive procedures involved, and the need to record within the constraints of clinical settings. Still, clinical monitoring to localize epileptic foci offers a unique and valuable opportunity to collect human ECoG data. We describe our methods for collecting recording ECoG, and demonstrate how to use these signals for important real-time applications such as clinical mapping and brain-computer interfacing. Our example uses the BCI2000 software platform8,9 and the SIGFRIED10 method, an application for real-time mapping of brain functions. This procedure yields information that clinicians can subsequently use to guide the complex and laborious process of functional mapping by electrical stimulation.
Prerequisites and Planning:
Patients with drug-resistant partial epilepsy may be candidates for resective surgery of an epileptic focus to minimize the frequency of seizures. Prior to resection, the patients undergo monitoring using subdural electrodes for two purposes: first, to localize the epileptic focus, and second, to identify nearby critical brain areas (i.e., eloquent cortex) where resection could result in long-term functional deficits. To implant electrodes, a craniotomy is performed to open the skull. Then, electrode grids and/or strips are placed on the cortex, usually beneath the dura. A typical grid has a set of 8 x 8 platinum-iridium electrodes of 4 mm diameter (2.3 mm exposed surface) embedded in silicon with an inter-electrode distance of 1cm. A strip typically contains 4 or 6 such electrodes in a single line. The locations for these grids/strips are planned by a team of neurologists and neurosurgeons, and are based on previous EEG monitoring, on a structural MRI of the patient's brain, and on relevant factors of the patient's history. Continuous recording over a period of 5-12 days serves to localize epileptic foci, and electrical stimulation via the implanted electrodes allows clinicians to map eloquent cortex. At the end of the monitoring period, explantation of the electrodes and therapeutic resection are performed together in one procedure.
In addition to its primary clinical purpose, invasive monitoring also provides a unique opportunity to acquire human ECoG data for neuroscientific research. The decision to include a prospective patient in the research is based on the planned location of their electrodes, on the patient's performance scores on neuropsychological assessments, and on their informed consent, which is predicated on their understanding that participation in research is optional and is not related to their treatment. As with all research involving human subjects, the research protocol must be approved by the hospital's institutional review board. The decision to perform individual experimental tasks is made day-by-day, and is contingent on the patient's endurance and willingness to participate. Some or all of the experiments may be prevented by problems with the clinical state of the patient, such as post-operative facial swelling, temporary aphasia, frequent seizures, post-ictal fatigue and confusion, and more general pain or discomfort.
At the Epilepsy Monitoring Unit at Albany Medical Center in Albany, New York, clinical monitoring is implemented around the clock using a 192-channel Nihon-Kohden Neurofax monitoring system. Research recordings are made in collaboration with the Wadsworth Center of the New York State Department of Health in Albany. Signals from the ECoG electrodes are fed simultaneously to the research and the clinical systems via splitter connectors. To ensure that the clinical and research systems do not interfere with each other, the two systems typically use separate grounds. In fact, an epidural strip of electrodes is sometimes implanted to provide a ground for the clinical system. Whether research or clinical recording system, the grounding electrode is chosen to be distant from the predicted epileptic focus and from cortical areas of interest for the research. Our research system consists of eight synchronized 16-channel g.USBamp amplifier/digitizer units (g.tec, Graz, Austria). These were chosen because they are safety-rated and FDA-approved for invasive recordings, they have a very low noise-floor in the high-frequency range in which the signals of interest are found, and they come with an SDK that allows them to be integrated with custom-written research software. In order to capture the high-gamma signal accurately, we acquire signals at 1200Hz sampling rate-considerably higher than that of the typical EEG experiment or that of many clinical monitoring systems. A built-in low-pass filter automatically prevents aliasing of signals higher than the digitizer can capture. The patient's eye gaze is tracked using a monitor with a built-in Tobii T-60 eye-tracking system (Tobii Tech., Stockholm, Sweden). Additional accessories such as joystick, bluetooth Wiimote (Nintendo Co.), data-glove (5th Dimension Technologies), keyboard, microphone, headphones, or video camera are connected depending on the requirements of the particular experiment.
Data collection, stimulus presentation, synchronization with the different input/output accessories, and real-time analysis and visualization are accomplished using our BCI2000 software8,9. BCI2000 is a freely available general-purpose software system for real-time biosignal data acquisition, processing and feedback. It includes an array of pre-built modules that can be flexibly configured for many different purposes, and that can be extended by researchers' own code in C++, MATLAB or Python. BCI2000 consists of four modules that communicate with each other via a network-capable protocol: a Source module that handles the acquisition of brain signals from one of 19 different hardware systems from different manufacturers; a Signal Processing module that extracts relevant ECoG features and translates them into output signals; an Application module that delivers stimuli and feedback to the subject; and the Operator module that provides a graphical interface to the investigator.
A number of different experiments may be conducted with any given patient. The priority of experiments will be determined by the location of the particular patient's electrodes. However, we usually begin our experimentation using the SIGFRIED (SIGnal modeling For Realtime Identification and Event Detection) mapping method, which detects and displays significant task-related activity in real time. The resulting functional map allows us to further tailor subsequent experimental protocols and may also prove as a useful starting point for traditional mapping by electrocortical stimulation (ECS).
Although ECS mapping remains the gold standard for predicting the clinical outcome of resection, the process of ECS mapping is time consuming and also has other problems, such as after-discharges or seizures. Thus, a passive functional mapping technique may prove valuable in providing an initial estimate of the locus of eloquent cortex, which may then be confirmed and refined by ECS. The results from our passive SIGFRIED mapping technique have been shown to exhibit substantial concurrence with the results derived using ECS mapping10.
The protocol described in this paper establishes a general methodology for gathering human ECoG data, before proceeding to illustrate how experiments can be initiated using the BCI2000 software platform. Finally, as a specific example, we describe how to perform passive functional mapping using the BCI2000-based SIGFRIED system.

Recording Human Electrocorticographic ECoG Signals for Neuroscientific Research and Real-time Functional Cortical Mapping

We present a method for collecting electrocorticographic signals for research purposes from humans who are undergoing invasive epilepsy monitoring. We show how to use the BCI2000 software platform for data collection, signal processing and stimulus presentation. Specifically, we demonstrate SIGFRIED, a BCI2000-based tool for real-time functional brain mapping.

神经科学的研究和实时功能皮层映射记录人力Electrocorticographic（ECOG）信号

Neuroimaging studies of human cognitive, sensory, and motor processes are usually based on noninvasive techniques such as electroencephalography (EEG), ...

神经科学

Technical Aspects of the Mouse Aortocaval Fistula

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta and inferior vena cava (IVC) are exposed. The proximal infrarenal aorta and the distal aorta are dissected for clamp placement and needle puncture, respectively. Special attention is paid to avoid dissection between the aorta and the IVC. After clamping the aorta, a 25 G needle is used to puncture both walls of the aorta into the IVC. The surrounding connective tissue is used for hemostatic compression. Successful creation of the AVF will show pulsatile arterial blood flow in the IVC. Further confirmation of successful AVF can be achieved by post-operative Doppler ultrasound.

The goal is to produce an arteriovenous fistula that is simple and reproducible. This method does not use sutures or glue adhesive. Therefore the samples can be used with the least amount of foreign materials for analysis.

在的鼠标Aortocaval瘘的技术方面

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

医学

Operative Technique and Nuances for the Stereoelectroencephalographic (SEEG) Methodology Utilizing a Robotic Stereotactic Guidance System

The SEEG methodology has gained favor in North America over the last decade as a means of localizing the epileptogenic zone (EZ) prior to epilepsy surgery. Recently, the application of a robotic stereotactic guidance system for implantation of SEEG electrodes has become more popular in many epilepsy centers. The technique for the use of the robot requires extreme precision in the pre-surgical planning phase and then the technique is streamlined during the operative portion of the methodology, as the robot and surgeon work in concert to implant the electrodes. Herein is detailed precise operative methodology of using the robot to guide implantation of SEEG electrodes. A major limitation of the procedure, namely its heavy reliance on the ability to register the patient to a preoperative volumetric magnetic resonance image (MRI), is also discussed. Overall, this procedure has been shown to have a low morbidity rate and an extremely low mortality rate. The use of a robotic stereotactic guidance system for the implantation of SEEG electrodes is an efficient, fast, safe, and accurate alternative to conventional manual implantation strategies.

Operative Technique and Nuances for the Stereoelectroencephalographic SEEG Methodology Utilizing a Robotic Stereotactic Guidance System

The SEEG methodology is simplified and made faster with a stereotactic robot. Careful attention must be paid to the registration of the preoperative volumetric MRI to the patient prior to use of the robot in the OR. The robot streamlines the procedure, leading to decreased operative times and accurate implantations.

利用机器人立体定向引导系统的立体脑电图（SEEG）方法的操作技术和细微差别

The SEEG methodology has gained favor in North America over the last decade as a means of localizing the epileptogenic zone (EZ) prior to epilepsy ...

Investigating the Function of Deep Cortical and Subcortical Structures Using Stereotactic Electroencephalography: Lessons from the Anterior Cingulate Cortex

Stereotactic Electroencephalography (SEEG) is a technique used to localize seizure foci in patients with medically intractable epilepsy. This procedure involves the chronic placement of multiple depth electrodes into regions of the brain typically inaccessible via subdural grid electrode placement. SEEG thus provides a unique opportunity to investigate brain function. In this paper we demonstrate how SEEG can be used to investigate the role of the dorsal anterior cingulate cortex (dACC) in cognitive control. We include a description of the SEEG procedure, demonstrating the surgical placement of the electrodes. We describe the components and process required to record local field potential (LFP) data from consenting subjects while they are engaged in a behavioral task. In the example provided, subjects play a cognitive interference task, and we demonstrate how signals are recorded and analyzed from electrodes in the dorsal anterior cingulate cortex, an area intimately involved in decision-making. We conclude with further suggestions of ways in which this method can be used for investigating human cognitive processes.

Stereotactic Electroencephalography (SEEG) is an operative technique used in epilepsy surgery to help localize seizure foci. It also affords a unique opportunity to investigate brain function. Here we describe how SEEG can be used to investigate cognitive processes in human subjects.

调查深皮层的功​​能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

Stereotactic Electroencephalography (SEEG) is a technique used to localize seizure foci in patients with medically intractable epilepsy. This procedure ...

A Pipeline for 3D Multimodality Image Integration and Computer-assisted Planning in Epilepsy Surgery

Epilepsy surgery is challenging and the use of 3D multimodality image integration (3DMMI) to aid presurgical planning is well-established. Multimodality image integration can be technically demanding, and is underutilised in clinical practice. We have developed a single software platform for image integration, 3D visualization and surgical planning. Here, our pipeline is described in step-by-step fashion, starting with image acquisition, proceeding through image co-registration, manual segmentation, brain and vessel extraction, 3D visualization and manual planning of stereoEEG (SEEG) implantations. With dissemination of the software this pipeline can be reproduced in other centres, allowing other groups to benefit from 3DMMI. We also describe the use of an automated, multi-trajectory planner to generate stereoEEG implantation plans. Preliminary studies suggest this is a rapid, safe and efficacious adjunct for planning SEEG implantations. Finally, a simple solution for the export of plans and models to commercial neuronavigation systems for implementation of plans in the operating theater is described. This software is a valuable tool that can support clinical decision making throughout the epilepsy surgery pathway.

We describe the steps to use our custom designed software for image integration, visualization and planning in epilepsy surgery.

管道在癫痫手术3D多模图像集成和计算机辅助规划

Epilepsy surgery is challenging and the use of 3D multimodality image integration (3DMMI) to aid presurgical planning is well-established. Multimodality ...

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases.

Resting-state functional-connectivity MRI has identified abnormalities in patients with a wide range of neuropsychiatric disorders, including epilepsy due to malformations of cortical development. Transcranial Magnetic Stimulation in combination with EEG can demonstrate that patients with epilepsy have cortical hyperexcitability in regions with abnormal connectivity.

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Equipment Setup and Artifact Removal for Simultaneous Electroencephalogram and Functional Magnetic Resonance Imaging for Clinical Review in Epilepsy

Simultaneous electroencephalogram and functional magnetic resonance imaging (EEG-fMRI) is a unique combined technique that provides synergy in the understanding and localization of seizure onset in epilepsy. However, reported experimental protocols for EEG-fMRI recordings fail to address details about conducting such procedures on epilepsy patients. In addition, these protocols are limited solely to research settings. To fill the gap between patient monitoring in an epilepsy monitoring unit (EMU) and conducting research with an epilepsy patient, we introduce a unique EEG-fMRI recording protocol of epilepsy during the interictal period. The use of an MR conditional electrode set, which can also be used in the EMU for a simultaneous scalp EEG and video recording, allows an easy transition of EEG recordings from the EMU to the scanning room for concurrent EEG-fMRI recordings. Details on the recording procedures using this specific MR conditional electrode set are provided. In addition, the study explains step-by-step EEG processing procedures to remove the imaging artifacts, which can then be used for clinical review. This experimental protocol promotes an amendment to the conventional EEG-fMRI recording for enhanced applicability in both clinical (i.e., EMU) and research settings. Furthermore, this protocol provides the potential to expand this modality to postictal EEG-fMRI recordings in the clinical setting.

This article details simultaneous electroencephalogram and functional magnetic resonance imaging (EEG-fMRI) recording procedures that can be used in both clinical and research settings. EEG processing procedures to remove imaging artifacts for clinical review are also included. This study focuses on the example of epilepsy during the interictal period.

同步脑电图和功能性磁共振成像的设备设置和伪影去除，用于癫痫临床审查

Simultaneous electroencephalogram and functional magnetic resonance imaging (EEG-fMRI) is a unique combined technique that provides synergy in the ...

生物工程

<meta charset="utf8"></head><body>将 MEG 和 HD-EEG 整合到儿科癫痫定位中

Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy

For children with drug-resistant epilepsy (DRE), seizure freedom relies on the delineation and resection (or ablation/disconnection) of the epileptogenic zone (EZ) while preserving the eloquent brain areas. The development of a reliable and noninvasive localization method that provides clinically useful information for the localization of the EZ is, therefore, crucial to achieving successful surgical outcomes. Electric and magnetic source imaging (ESI and MSI) have been increasingly utilized in the presurgical evaluation of these patients showing promising findings in the delineation of epileptogenic as well as eloquent brain areas. Moreover, the combination of ESI and MSI into a single solution, namely electromagnetic source imaging (EMSI), performed on simultaneous high-density electroencephalography (HD-EEG) and magnetoencephalography (MEG) recordings has shown higher source localization accuracy than either modality alone. Despite these encouraging findings, such techniques are performed in only a few tertiary epilepsy centers, are rarely recorded simultaneously, and are underutilized in pediatric cohorts. This study illustrates the experimental setup for recording simultaneous MEG and HD-EEG data as well as the methodological framework for analyzing these data aiming to localize the irritative zone, the seizure onset zone, and eloquent brain areas in children with DRE. More specifically, the experimental setups are presented for (i) recording and localizing interictal and ictal epileptiform activity during sleep and (ii) recording visual-, motor-, auditory-, and somatosensory-evoked responses and mapping relevant eloquent brain areas (i.e., visual, motor, auditory, and somatosensory) during visuomotor task, as well as auditory and somatosensory stimulations. Detailed steps of the data analysis pipeline are further presented for performing EMSI as well as individual ESI and MSI using equivalent current dipole (ECD) and dynamic statistical parametric mapping (dSPM).

<meta charset="utf8"></head><body>作者聚焦:通过新型生物标志物和增强定位推进儿童癫痫手术

Magnetoencephalography (MEG) and high-density electroencephalography (HD-EEG) are rarely recorded simultaneously, although they yield confirmatory and complementary information. Here, we illustrate the experimental setup for recording simultaneous MEG and HD-EEG and the methodology for analyzing these data aiming to localize epileptogenic and eloquent brain areas in children with drug-resistant epilepsy.

电磁源显像在儿童耐药性癫痫术前评估中的应用

For children with drug-resistant epilepsy (DRE), seizure freedom relies on the delineation and resection (or ablation/disconnection) of the epileptogenic ...

立体声电Encephalo-造影（SEEG）随着医学难治性癫痫的术前评估机器人辅助:技术说明

摘要

探索更多视频

此视频中的章节

执行任务的行为与颅内电极主题

神经科学的研究和实时功能皮层映射记录人力Electrocorticographic（ECOG）信号

在的鼠标Aortocaval瘘的技术方面

利用机器人立体定向引导系统的立体脑电图（SEEG）方法的操作技术和细微差别

调查深皮层的功能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

管道在癫痫手术3D多模图像集成和计算机辅助规划

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

同步脑电图和功能性磁共振成像的设备设置和伪影去除，用于癫痫临床审查

电磁源显像在儿童耐药性癫痫术前评估中的应用

立体声电Encephalo-造影（SEEG）随着医学难治性癫痫的术前评估机器人辅助:技术说明

摘要

探索更多视频

此视频中的章节

执行任务的行为与颅内电极主题

神经科学的研究和实时功能皮层映射记录人力Electrocorticographic（ECOG）信号

在的鼠标Aortocaval瘘的技术方面

利用机器人立体定向引导系统的立体脑电图（SEEG）方法的操作技术和细微差别

调查深皮层的功​​能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

管道在癫痫手术3D多模图像集成和计算机辅助规划

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

同步脑电图和功能性磁共振成像的设备设置和伪影去除，用于癫痫临床审查

电磁源显像在儿童耐药性癫痫术前评估中的应用

调查深皮层的功能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训