作者感谢所有临床团队每天为UCSD神经血管患者的护理做出贡献。

1. 模拟器设置
<ol><li>在所有程序之前，组装图 1中显示的模拟器并打开。有关完成每次模拟所需的模拟器设备的完整列表，请参阅表 1。</li>
	<li>使用附加笔记本电脑上的软件界面（图 1C）选择患者方案。</li>
	<li>从下拉菜单中选择合适的动脉护套或导管。这不需要物理插入作为模拟的一部分，但将作为股骨访问站点，并允许随后进入系统的电线和导管 （图 1D）。下面讨论了每个方案的具体护套/指南大小。</li>
	<li>根据下面讨论的具体方案（图 1D）选择适当的导管、导线线和/或微系统。</li>
	<li>打开软件界面上的 A （PA） 和 B 平面 （横向） 荧光镜检查。用脚踏板激活荧光镜 （图 1H），用操纵杆 （图 1I）调整患者和图像强化器位置，直到获得正确的 PA 和横向视图。</li>
</ol>2. 第一个患者场景：四容器血管造影
注：此场景描绘了一名 52 岁的男性，头部非对比计算断层扫描 （CT） 扫描中偶然发现左胡萝卜素终点动脉瘤。
<ol><li>从下拉菜单中选择 5 法式股骨护套、0.035 导引线和 4 法式诊断导管作为在此模拟中使用的工具。</li>
	<li>将导线插入模拟器机器（图 1D），直到它在模拟屏幕上注册，从而指示已获得访问权限。推进导线，直到它在下降的胸动脉中可视化，并继续进入主动脉拱门。</li>
	<li>当导线安全地位于主动脉拱门中时，将导管保持到位，并通过模拟股骨护套插入导管到主动脉拱门。</li>
	<li>取出导管，利用荧光喷气技术，轻轻按压对比度注射器（图1E），模拟对比注射，并在导管进入所需的动脉时短暂地使血管不透明。</li>
	<li>接下来，创建一个路线图指南注入对比对比注射器 （图 1E），而荧光检查脚踏板是沮丧的 （图1H）.接下来，重新插入导线，有选择地导管所需的容器，推进导管在电线上。拆下电线，进行后续血管造影。左右内、外骨动脉和左右椎动脉均采用此技术导管。</li>
	<li>使用诊断导管和模拟器对比注射器（图1E），通过压低荧光踏板（图1H），同时注射与注射器对比，执行上述每个循环的血管图。如有必要，获取动脉瘤的高放大度视图。在取出导管之前，检查血管图是否足够。</li>
	<li>获取必要的图像后，从模拟护套中取出诊断导管/导线。不执行胎儿动脉切除术部位的模拟关闭。</li>
</ol>3. 第二个患者方案：卡罗蒂德终点动脉瘤盘绕
注：此场景描绘了一名 52 岁的男性，已知左胡萝卜素末期动脉瘤破裂、严重头痛、非焦球检查以及格拉斯哥科马量表分数为 15。
<ol><li>从下拉菜单中选择 6 法制导管、0.035 指南线和 4 法式诊断导管。</li>
	<li>在导管上插入诊断导管到主动脉拱门中，就像步骤 2.2–2.3 一样。</li>
	<li>通过股骨接入部位（图 1D）在诊断导管上插入导管到主动脉拱门。</li>
	<li>取下导线，通过路线图面粉镜脚踏板注射与对比注射器（图1E）形成对比，而荧光镜脚踏板（图1H）则降低，创建左普通胡萝卜动脉的路线图指南。</li>
	<li>重新插入导管，并选择性地导管左普通胡萝卜动脉和内胡萝卜动脉使用荧光镜和路线图覆盖可视化图像投影监视器（图1B），通过领导与导线和推进诊断导管和导管，一旦获得安全访问。</li>
	<li>当导管在内胡萝卜动脉内时，取出诊断导管和导线，通过压低氟镜踏板（图1H）进行左内胡萝卜素脑循环的血管运行，同时注射与注射器对比（图1E）。</li>
	<li>使用软件界面上的计算选项（图 1C）测量动脉瘤。请记住，第一个线圈的线圈直径应比平均动脉瘤直径宽 1 毫米，请选择合适的线圈。</li>
	<li>从下拉菜单中选择微型箱和微线。</li>
	<li>通过股骨接入站点（图 1D）插入微导管和微线，并在步骤 3.6 获得的路线图指导下，有选择地用微系统导管动脉瘤。</li>
	<li>取出微线，通过股骨接入站点插入先前选择的线圈（图1D），然后缓慢地将其推进动脉瘤。</li>
	<li>线圈完全插入后，通过压低氟镜踏板（图1H）进行诊断脑血管造影，同时注射与注射器对比，并评估母动脉和动脉瘤填充物的腹腔。目标是保持母动脉的痉挛，要么完全栓塞动脉瘤，要么提供圆顶的足够覆盖或假定的破裂点，以适当降低破裂风险。</li>
	<li>在软件接口（图1C）上分离线圈，并拆下线圈线。如有必要，重复步骤 3.11 和 3.12 与额外的线圈，直到获得约 30% 动脉瘤闭塞。</li>
	<li>从模拟护套站点（图 1D）中取出微箱并引导导管。不执行胎儿动脉切除术部位的模拟关闭。</li>
</ol>4. 第三个患者方案：左脑动脉血栓切除术
注：此场景描绘了一名 64 岁的女性，其国家卫生研究院中风量表 （NIHSS） 评分为 12，用于失语症和右侧虚弱，她最后已知是正常 4 小时前。头部CT显示一个超凹腹左中脑动脉（MCA）标志和艾伯塔省中风计划早期CT得分（前科）为10，但没有出血。CT血管图显示了左M1段完全遮挡。
<ol><li>从下拉菜单中选择 6 法制导管、0.035 指南线和 4 法式诊断导管。</li>
	<li>将导管插入左内胡萝卜动脉，执行步骤 3.2–3.6 中描述的左内胡萝卜素脑循环的血管运行。</li>
	<li>从下拉菜单中选择微型箱/微线和支架检索器设备。</li>
	<li>将微型导管和微线插入模拟股骨接入部位（图1D）并插入左内胡萝卜动脉。</li>
	<li>在步骤 3.5 获得的路线图指导下，将微线和微箱推进到左 MCA 中，并小心地经过遮挡区域。此操作过程中的潜在并发症包括血管穿孔和/或使下游血块栓塞。</li>
	<li>取出微线，将支架检索器设备插入模拟股骨接入站点（图 1D），并推进到 MCA 分离到闭塞处。然后，取出微箱，将支架检索器留在闭塞水平。</li>
	<li>打开软件界面上的模拟吸气（图1C），通过拉回微线将支架检索器设备缩回导管。</li>
	<li>从模拟股骨访问站点（图 1D）中取出两个支架检索器。</li>
	<li>通过引导导管进行血管造影，压低氟镜踏板（图1H），同时注射与注射器的对比度，以确保消除遮挡。</li>
	<li>从模拟护套站点（图 1D）中取出导管。不执行胎儿动脉切除术部位的模拟关闭。</li>
</ol>

<ol>
	<li>See, K. W., Chui, K. H., Chan, W. H., Wong, K. C., Chan, Y. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evidence+for+Endovascular+Simulation+Training:+A+Systematic+Review.">Evidence for Endovascular Simulation Training: A Systematic Review.</a> European Journal of Vascular and Endovascular Surgery. 51 (3), 441-451 (2016).</li><li>Pannell, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulator-Based+Angiography+and+Endovascular+Neurosurgery+Curriculum:+A+Longitudinal+Evaluation+of+Performance+Following+Simulator-Based+Angiography+Training.">Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training.</a> Cureus. 8 (8), 756 (2016).</li><li>Liebig, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Metric-Based+Virtual+Reality+Simulation:+A+Paradigm+Shift+in+Training+for+Mechanical+Thrombectomy+in+Acute+Stroke.">Metric-Based Virtual Reality Simulation: A Paradigm Shift in Training for Mechanical Thrombectomy in Acute Stroke.</a> Stroke. 49 (7), 239-242 (2018).</li><li>Spiotta, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+angiography+skill+acquisition+with+a+secondary+curve+catheter:+phase+2+of+a+curriculum-based+endovascular+simulation+program.">Diagnostic angiography skill acquisition with a secondary curve catheter: phase 2 of a curriculum-based endovascular simulation program.</a> Journal of Neurointerventional Surgery. 7 (10), 777-780 (2015).</li><li>Spiotta, A. M., Rasmussen, P. A., Masaryk, T. J., Benzel, E. C., Schlenk, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulated+diagnostic+cerebral+angiography+in+neurosurgical+training:+a+pilot+program.">Simulated diagnostic cerebral angiography in neurosurgical training: a pilot program.</a> Journal of Neurointerventional Surgery. 5 (4), 376-381 (2013).</li><li>Fargen, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experience+with+a+simulator-based+angiography+course+for+neurosurgical+residents:+beyond+a+pilot+program.">Experience with a simulator-based angiography course for neurosurgical residents: beyond a pilot program.</a> Neurosurgery. 73, 46-50 (2013).</li><li>Fargen, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulator+based+angiography+education+in+neurosurgery:+results+of+a+pilot+educational+program.">Simulator based angiography education in neurosurgery: results of a pilot educational program.</a> Journal of Neurointerventional Surgery. 4 (6), 438-441 (2012).</li><li>Cates, C., L&#246;nn, L., Gallagher, A. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective,+randomised+and+blinded+comparison+of+proficiency-based+progression+full-physics+virtual+reality+simulator+training+versus+invasive+vascular+experience+for+learning+carotid+artery+angiography+by+very+experienced+operators.">Prospective, randomised and blinded comparison of proficiency-based progression full-physics virtual reality simulator training versus invasive vascular experience for learning carotid artery angiography by very experienced operators.</a> BMJ Simulation and Technology Enhanced Learning. 2, 1-5 (2016).</li><li>Guo, J., Jin, X., Guo, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+of+the+Operational+Safety+of+a+Vascular+Interventional+Surgical+Robotic+System.">Study of the Operational Safety of a Vascular Interventional Surgical Robotic System.</a> Micromachines. 9 (3), 119 (2018).</li><li>Tedesco, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+endovascular+skills+assessment:+the+future+of+credentialing.">Simulation-based endovascular skills assessment: the future of credentialing.</a> Journal of Vascular Surgery. 47 (5), 1008 (2008).</li></ol>

AAK此前曾获得科维迪安公司和佩努姆布拉公司的竞争性资助，并与史崔克神经血管公司、科维迪安公司和佩努姆布拉公司进行医生培训的咨询安排.JSP曾担任斯特里克神经血管和飞镖神经科学有限责任公司的医疗顾问。AAK 和 JSP 与这项工作没有直接的经济利益关系。其余作者没有披露本研究所使用的材料或方法，也未披露本文中指定的发现。

血管内手术是一个扩展的领域，为各种病理提供微创治疗方法。然而，与血管损伤相关的重大风险提供了独特的教育挑战。随着模拟培训的进展，受训人员的教育现在允许在模拟真实案例的无风险环境中进行实践。因此，基于血管内模拟的培训已被证明能够持续改善表现指标，如手术时间、荧光检查时间和对比量，在广泛的参与者（如患者、医科学生、居民和外科医生）1，<...

模拟训练是医学受训人员的既定教育工具，在血管内神经外科等高风险领域尤其有益。存在多个虚拟现实培训设备，利用导管为基础的系统，如ANGIO导师模拟器（Simbionix有限公司，机场城，以色列）和VIST-C和VIST G5模拟器（门蒂斯AB，哥德堡，瑞典），与大量的数据表明程序能力培训的效用1。尽管模拟器很有用，但缺乏用于模拟器的分步程序说明。
呈现的是使用ANGIO导师模拟器的详细协议，该系统支持在常见的血管内神经外科手术的能力改进，包括诊断脑血管造影术，机械血栓切除术，动脉瘤线圈栓塞2。此前的工作表明，各级学员在ANGIO导师模拟器上进行了5次模拟血管造影术、5次输血管切除术和10次动脉瘤线圈栓塞手术后，在程序时间、荧光镜和对比剂量以及不良技术事件2方面都取得了显著改善。
以下分步说明分为案例场景，并可轻松集成到医科学生、居民或研究员2的学术培训课程中。然而，应当指出，需要对脑动脉解剖学、血管造影术、中风和动脉瘤治疗进行基本了解，以优化模拟装置的教育潜力。
以下所有程序（即诊断脑血管造影术、胡萝卜素末期动脉瘤线圈、机械血栓切除术）均可由使用 ANGIO 导师模拟器（Simbionix Ltd.） 的单个操作员执行）（图1） 。这种培训设备允许所有技能级别的神经外科受训人员在产前环境中接触到血管内技术，三个患者场景基于先前公布的模拟器血管学培训2课程。为了重现高保真度血管内技术，模拟器利用通过类似于股动脉护套隔膜的端口引入的实际导管和电线。电线和导管与内部滚筒接合，记录旋转和转换运动，这些运动显示在监视器上。模拟器操作员还可以看到设备选择和患者生命体征。

<table>
	<tbody>
		<tr>
			<td>ANGIO Mentor simulator</td>
			<td>Simbionix Ltd., Airport City, Israel</td>
			<td>N/a</td>
			<td>The setup for the ANGIO Mentor simulator includes the simulator housing as pictured in Figure 1: (A), an external monitor for image projection (x-ray, angiography; B), a laptop for interfacing with the Simbionix Software (C), the simulated femoral artery sheath (with an outer guide-catheter, inner diagnostic microcatheter and guidewire shown; D), a contrast syringe (E), an insufflator for balloon inflation (F), a stent delivery device (G; not used in these patient scenarios), foot pedals for fluoroscopy, roadmap guidance, and angiographic runs (H), and the operator control panel on the simulator housing where the operator is able to control patient and image intensifier positioning (I).</td>
		</tr>
	</tbody>
</table>

simulator training for endovascular neurosurgery

模拟培训已成为医学专业的常见做法，尤其是学习在高风险环境中执行的复杂技能。在血管内神经外科领域，对无后果和无风险学习环境的需求导致开发对医学受训人员有价值的模拟设备。本协议的目标是为在学术环境中使用血管内神经外科模拟器提供指导性指南。模拟器为受训人员提供了机会，让他们能够收到关于解剖学知识的现实反馈，以及触觉反馈，表明他们在处理基于导管的系统方面取得了成功，而不会产生负面后果。还讨论了这一特定协议与其他神经血管训练模式的效用。

ANGIO 导师模拟器以前被证明在学术环境中执行模拟诊断血管造影、输卵管切除术和动脉瘤线圈破裂栓塞时，能够提高具有不同神经血管体验的外科受训人员的技能。在这项研究中，在30天内，在一名医科学生、一名神经外科住院生、两名诊断神经放射学研究员和一名血管内神经外科研究员中确定了上述程序的性能指标。经过120分钟的教义指导和对每个程序的单次观察，受训者执?...

Watch this Scientific Journal Video about Simulator Training for Endovascular Neurosurgery at JoVE.com

Simulator Training for Endovascular Neurosurgery

模拟复杂、高风险的程序对医学受训人员的教育至关重要。描述了在受控学术环境中进行基于模拟器的血管内神经外科训练的协议。该议定书包括针对不同层次受训人员的分步指南，并讨论了该模式的优势和局限性。

血管内神经外科模拟器培训

Simulation-based training has become common practice across medical specialties, especially for learning complex skills performed in high-risk ...

simulator-training-for-endovascular-neurosurgery

Research

JoVE Journal

Neuroscience

3.5K 次观看.  University of California. 模拟复杂、高风险的程序对医学受训人员的教育至关重要。描述了在受控学术环境中进行基于模拟器的血管内神经外科训练的协议。该议定书包括针对不同层次受训人员的分步指南，并讨论了该模式的优势和局限性。

视频: Simulator Training for Endovascular Neurosurgery

Focal Cerebral Ischemia Model by Endovascular Suture Occlusion of the Middle Cerebral Artery in the Rat

Stroke is the leading cause of disability and the third leading cause of death in adults worldwide1. In human stroke, there exists a highly variable clinical state; in the development of animal models of focal ischemia, however, achieving reproducibility of experimentally induced infarct volume is essential. The rat is a widely used animal model for stroke due to its relatively low animal husbandry costs and to the similarity of its cranial circulation to that of humans2,3. In humans, the middle cerebral artery (MCA) is most commonly affected in stroke syndromes and multiple methods of MCA occlusion (MCAO) have been described to mimic this clinical syndrome in animal models. Because recanalization commonly occurs following an acute stroke in the human, reperfusion after a period of occlusion has been included in many of these models. In this video, we demonstrate the transient endovascular suture MCAO model in the spontaneously hypertensive rat (SHR). A filament with a silicon tip coating is placed intraluminally at the MCA origin for 60 minutes, followed by reperfusion. Note that the optimal occlusion period may vary in other rat strains, such as Wistar or Sprague-Dawley. Several behavioral indicators of stroke in the rat are shown. Focal ischemia is confirmed using T2-weighted magnetic resonance images and by staining brain sections with 2,3,5-triphenyltetrazolium chloride (TTC) 24 hours after MCAO.

Surgical induction of ischemic brain damage in the rat is a widely used model for stroke research. Here we demonstrate the induction of focal cerebral ischemia by occlusion of the middle cerebral artery. Visualization of the resulting infarct by histological staining and magnetic resonance imaging is also shown.

焦距脑缺血模型大鼠大脑中动脉的血管内缝合闭塞

Stroke is the leading cause of disability and the third leading cause of death in adults worldwide1. In human stroke, there exists a highly variable ...

科研

神经科学

MPI CyberMotion Simulator: Implementation of a Novel Motion Simulator to Investigate Multisensory Path Integration in Three Dimensions

Path integration is a process in which self-motion is integrated over time to obtain an estimate of one's current position relative to a starting point 1. Humans can do path integration based exclusively on visual 2-3, auditory 4, or inertial cues 5. However, with multiple cues present, inertial cues - particularly kinaesthetic - seem to dominate 6-7. In the absence of vision, humans tend to overestimate short distances (&lt;5 m) and turning angles (&lt;30&deg;), but underestimate longer ones 5. Movement through physical space therefore does not seem to be accurately represented by the brain.
Extensive work has been done on evaluating path integration in the horizontal plane, but little is known about vertical movement (see 3 for virtual movement from vision alone). One reason for this is that traditional motion simulators have a small range of motion restricted mainly to the horizontal plane. Here we take advantage of a motion simulator 8-9 with a large range of motion to assess whether path integration is similar between horizontal and vertical planes. The relative contributions of inertial and visual cues for path navigation were also assessed.
16 observers sat upright in a seat mounted to the flange of a modified KUKA anthropomorphic robot arm. Sensory information was manipulated by providing visual (optic flow, limited lifetime star field), vestibular-kinaesthetic (passive self motion with eyes closed), or visual and vestibular-kinaesthetic motion cues. Movement trajectories in the horizontal, sagittal and frontal planes consisted of two segment lengths (1st: 0.4 m, 2nd: 1 m; &plusmn;0.24 m/s2 peak acceleration). The angle of the two segments was either 45&deg; or 90&deg;. Observers pointed back to their origin by moving an arrow that was superimposed on an avatar presented on the screen.
Observers were more likely to underestimate angle size for movement in the horizontal plane compared to the vertical planes. In the frontal plane observers were more likely to overestimate angle size while there was no such bias in the sagittal plane. Finally, observers responded slower when answering based on vestibular-kinaesthetic information alone. Human path integration based on vestibular-kinaesthetic information alone thus takes longer than when visual information is present. That pointing is consistent with underestimating and overestimating the angle one has moved through in the horizontal and vertical planes respectively, suggests that the neural representation of self-motion through space is non-symmetrical which may relate to the fact that humans experience movement mostly within the horizontal plane.

An efficient way to gain insight into how humans navigate themselves in three dimensions is described. The method takes advantage of a motion simulator capable of moving observers in ways unattainable by traditional simulators. Results confirm that movement in the horizontal plane is underestimated, while vertical movement is overestimated.

MPI Cyber​​Motion模拟器：一种新型的运动模拟器的执行情况调查三个维度的多感官的路径积分

Path integration is a process in which self-motion is integrated over time to obtain an estimate of one's current position relative to a starting point 1. ...

Extinction Training During the Reconsolidation Window Prevents Recovery of Fear

Fear is maladaptive when it persists long after circumstances have become safe. It is therefore crucial to develop an approach that persistently prevents the return of fear. Pavlovian fear-conditioning paradigms are commonly employed to create a controlled, novel fear association in the laboratory. After pairing an innocuous stimulus (conditioned stimulus, CS) with an aversive outcome (unconditioned stimulus, US) we can elicit a fear response (conditioned response, or CR) by presenting just the stimulus alone1,2 . Once fear is acquired, it can be diminished using extinction training, whereby the conditioned stimulus is repeatedly presented without the aversive outcome until fear is no longer expressed3. This inhibitory learning creates a new, safe representation for the CS, which competes for expression with the original fear memory4. Although extinction is effective at inhibiting fear, it is not permanent. Fear can spontaneously recover with the passage of time. Exposure to stress or returning to the context of initial learning can also cause fear to resurface3,4.
Our protocol addresses the transient nature of extinction by targeting the reconsolidation window to modify emotional memory in a more permanent manner. Ample evidence suggests that reactivating a consolidated memory returns it to a labile state, during which the memory is again susceptible to interference5-9. This window of opportunity appears to open shortly after reactivation and close approximately 6hrs later5,11,16, although this may vary depending on the strength and age of the memory15. By allowing new information to incorporate into the original memory trace, this memory may be updated as it reconsolidates10,11. Studies involving non-human animals have successfully blocked the expression of fear memory by introducing pharmacological manipulations within the reconsolidation window, however, most agents used are either toxic to humans or show equivocal effects when used in human studies12-14. Our protocol addresses these challenges by offering an effective, yet non-invasive, behavioral manipulation that is safe for humans.
By prompting fear memory retrieval prior to extinction, we essentially trigger the reconsolidation process, allowing new safety information (i.e., extinction) to be incorporated while the fear memory is still susceptible to interference. A recent study employing this behavioral manipulation in rats has successfully blocked fear memory using these temporal parameters11. Additional studies in humans have demonstrated that introducing new information after the retrieval of previously consolidated motor16, episodic17, or declarative18 memories leads to interference with the original memory trace14. We outline below a novel protocol used to block fear recovery in humans.

Conditioned fear can be diminished through an inhibitory process called extinction, but can resurface under conditions such as the passage of time or exposure to stress. Our protocol presents a novel way of preventing fear recovery by introducing extinction during the reconsolidation window (the re-storage phase of a reactivated memory).

灭绝培训在彭兰霞窗口无法还原的恐惧

Fear is maladaptive when it persists long after circumstances have become safe. It is therefore crucial to develop an approach that persistently prevents ...

Exposure of the Pig CNS for Histological Analysis: A Manual for Decapitation, Skull Opening, and Brain Removal

Pigs have become increasingly popular in large-animal translational neuroscience research as an economically and ethically feasible substitute to non-human primates. The large brain size of the pig allows the use of conventional clinical brain imagers and the direct use and testing of neurosurgical procedures and equipment from the human clinic. Further macroscopic and histological analysis, however, requires postmortem exposure of the pig central nervous system (CNS) and subsequent brain removal. This is not an easy task, as the pig CNS is encapsulated by a thick, bony skull and spinal column. The goal of this paper and instructional video is to describe how to expose and remove the postmortem pig brain and the pituitary gland in an intact state, suitable for subsequent macroscopic and histological analysis.

The goal of this paper and instructional video is to describe how to expose and remove the postmortem pig brain and pituitary gland in an intact state, suitable for subsequent macroscopic and histological analysis.

猪中枢神经系统的组织学分析的曝光：一个手册斩首，颅骨打开，并去除脑

Pigs have become increasingly popular in large-animal translational neuroscience research as an economically and ethically feasible substitute to ...

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs must be tailored specifically to the lesion, with surgical resection being the gold standard for small, accessible lesions. Pre-operative embolization of AVMs can reduce nidal blood flow and remove high-risk AVM features such as intranidal or venous aneurysms, thereby simplifying a challenging neurosurgical procedure. Herein, we describe our approach for the staged endovascular embolization and open resection of AVMs, and highlight the advantages of having a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team. This includes planning the craniotomy and resection to immediately follow the final embolization stage, thereby using a single session of anesthesia for aggressive embolization, and rapid resection. Finally, we provide a representative case of a 22-year-old female with an unruptured right frontal AVM diagnosed during a seizure workup, who was successfully treated via staged embolizations followed by open surgical resection.

Surgery is the gold standard for accessible arteriovenious malformations (AVMs), and pre-operative embolization can simplify this procedure. We describe our approach for staged endovascular embolization and open resection of AVMs, and provide a representative clinical example highlighting the advantages of a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team.

脑动静脉畸形的综合血管内和开放性手术治疗

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs ...

A Protocol for the Administration of Real-Time fMRI Neurofeedback Training

Neurologic disorders are characterized by abnormal cellular-, molecular-, and circuit-level functions in the brain. New methods to induce and control neuroplastic processes and correct abnormal function, or even shift functions from damaged tissue to physiologically healthy brain regions, hold the potential to dramatically improve overall health. Of the current neuroplastic interventions in development, neurofeedback training (NFT) from functional Magnetic Resonance Imaging (fMRI) has the advantages of being completely non-invasive, non-pharmacologic, and spatially localized to target brain regions, as well as having no known side effects. Furthermore, NFT techniques, initially developed using fMRI, can often be translated to exercises that can be performed outside of the scanner without the aid of medical professionals or sophisticated medical equipment. In fMRI NFT, the fMRI signal is measured from specific regions of the brain, processed, and presented to the participant in real-time. Through training, self-directed mental processing techniques, that regulate this signal and its underlying neurophysiologic correlates, are developed. FMRI NFT has been used to train volitional control over a wide range of brain regions with implications for several different cognitive, behavioral, and motor systems. Additionally, fMRI NFT has shown promise in a broad range of applications such as the treatment of neurologic disorders and the augmentation of baseline human performance. In this article, we present an fMRI NFT protocol developed at our institution for modulation of both healthy and abnormal brain function, as well as examples of using the method to target both cognitive and auditory regions of the brain.

The ability to induce and/or control neural plasticity may be critical in future treatments for neurologic disorders and the recovery from brain injury. In this paper, we present a protocol on the use of neurofeedback training with functional magnetic resonance imaging to modulate human brain function.

实时 fMRI 神经训练管理协议

Neurologic disorders are characterized by abnormal cellular-, molecular-, and circuit-level functions in the brain. New methods to induce and control ...

Fiber Connections of the Supplementary Motor Area Revisited: Methodology of Fiber Dissection, DTI, and Three Dimensional Documentation

The purpose of this study is to show the methodology for the examination of the white matter connections of the supplementary motor area (SMA) complex (pre-SMA and SMA proper) using a combination of fiber dissection techniques on cadaveric specimens and magnetic resonance (MR) tractography. The protocol will also describe the procedure for a white matter dissection of a human brain, diffusion tensor tractography imaging, and three-dimensional documentation. The fiber dissections on human brains and the 3D documentation were performed at the University of Minnesota, Microsurgery and Neuroanatomy Laboratory, Department of Neurosurgery. Five postmortem human brain specimens and two whole heads were prepared in accordance with Klingler's method. Brain hemispheres were dissected step by step from lateral to medial and medial to lateral under an operating microscope, and 3D images were captured at every stage. All dissection results were supported by diffusion tensor imaging. Investigations on the connections in line with Meynert's fiber tract classification, including association fibers (short, superior longitudinal fasciculus I and frontal aslant tracts), projection fibers (corticospinal, claustrocortical, cingulum, and frontostriatal tracts), and commissural fibers (callosal fibers) were also conducted.

The purpose of this study is to show each step of the fiber dissection technique on human cadaveric brains, the 3D documentation of these dissections, and the diffusion tensor imaging of the anatomically dissected fiber pathways.

补充电机区的光纤连接重新审视：光纤解剖，DTI和三维文档的方法

The purpose of this study is to show the methodology for the examination of the white matter connections of the supplementary motor area (SMA) complex ...

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

This manuscript describes a streamlined protocol for the management of patients with acute ischemic stroke, which aims at the minimization of time from hospital admission to reperfusion. Rapid restoration of cerebral blood flow is essential for the outcomes of patients with acute ischemic stroke. Endovascular treatment (EVT) has become the standard of care to accomplish this in patients with acute stroke due to large vessel occlusion (LVO). To achieve reperfusion of ischemic brain regions as fast as possible, all in-hospital time delays have to be carefully avoided. Therefore, management of patients with acute ischemic stroke was optimized with an interdisciplinary standard operating procedure (SOP). Stroke neurologists, diagnostic as well as interventional neuroradiologists, and anesthesiologists streamlined all necessary processes from patient admission and diagnosis to EVT of eligible patients. Target times for every step were established. Actually achieved times were prospectively recorded along with clinical data and imaging scores for all endovascularly treated stroke patients. These data were regularly analyzed and discussed in interdisciplinary team meetings. Potential issues were evaluated and all staff involved was trained to adhere to the SOP. This streamlined patient management approach and enhanced interdisciplinary collaboration reduced time from patient admission to reperfusion significantly and was accompanied by a beneficial effect on clinical outcomes.

The outcome of patients with acute ischemic stroke depends on swift restoration of cerebral blood flow. This protocol aims at optimizing the management of such patients by minimizing peri-procedural timings and rendering the time from hospital admission to reperfusion as short as possible.

急性缺血性中风血管内治疗的优化管理

This manuscript describes a streamlined protocol for the management of patients with acute ischemic stroke, which aims at the minimization of time from ...

Real-Time fMRI Brain Mapping in Animals

Dynamic fMRI responses vary largely according to the physiological conditions of animals either under anesthesia or in awake states. We developed a real-time fMRI platform to guide experimenters to monitor fMRI responses instantaneously during acquisition, which can be used to modify the physiology of animals to achieve desired hemodynamic responses in animal brains. The real-time fMRI set-up is based on a 14.1T preclinical MRI system, enabling the real-time mapping of dynamic fMRI responses in the primary forepaw somatosensory cortex (FP-S1) of anesthetized rats. Instead of a retrospective analysis to investigate confounding sources leading to the variability of fMRI signals, the real-time fMRI platform provides a more effective scheme to identify dynamic fMRI responses using customized macro-functions and a common neuroimage analysis software in the MRI system. Also, it provides immediate troubleshooting feasibility and a real-time biofeedback stimulation paradigm for brain functional studies in animals.

Animal brain functional mapping can benefit from the real-time functional magnetic resonance imaging (fMRI) experimental set-up. Using the latest software implemented in the animal MRI system, we established a real-time monitoring platform for small animal fMRI.

动物实时功能磁共振成像大脑映射

Dynamic fMRI responses vary largely according to the physiological conditions of animals either under anesthesia or in awake states. We developed a ...

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI)

The endovascular filament perforation model to mimic subarachnoid hemorrhage (SAH) is a commonly used model - however, the technique can cause a high mortality rate as well as an uncontrollable volume of SAH and other intracranial complications such as stroke or intracranial hemorrhage. In this protocol, a standardized SAH mouse model is presented, induced by endovascular filament perforation, combined with magnetic resonance imaging (MRI) 24 h after operation to ensure the correct bleeding site and exclude other relevant intracranial pathologies. Briefly, C57BL/6J mice are anesthetized with an intraperitoneal ketamine/xylazine (70 mg/16 mg/kg body weight) injection and placed in a supine position. After midline neck incision, the common carotid artery (CCA) and carotid bifurcation are exposed, and a 5-0 non-absorbable monofilament polypropylene suture is inserted in a retrograde fashion into the external carotid artery (ECA) and advanced into the common carotid artery. Then, the filament is invaginated into the internal carotid artery (ICA) and pushed forward to perforate the anterior cerebral artery (ACA). After recovery from surgery, mice undergo a 7.0 T MRI 24 h later. The volume of bleeding can be quantified and graded via postoperative MRI, enabling a robust experimental SAH group with the option to perform further subgroup analyses based on blood quantity.

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging MRI

Here we present a standardized SAH mouse model, induced by endovascular filament perforation, combined with magnetic resonance imaging (MRI) 24 h after operation to ensure the correct bleeding site and exclude other relevant intracranial pathologies.

蛛网膜下腔出血结合磁共振成像（MRI）的血管内穿孔模型

The endovascular filament perforation model to mimic subarachnoid hemorrhage (SAH) is a commonly used model - however, the technique can cause a high ...