Name: stereo-electro-encephalo-graphy (seeg) with robotic assistance in the presurgical evaluation of medical refractory epilepsy: a technical note
Uploaded: 2016-06-13T13:00:00.000+00:00
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Description: 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

저자는 어떤 승인이 없습니다.

윤리 문 : 우리 프로토콜은 우리의 기관 인간의 연구 윤리위원회가 설정 한 가이드 라인을 따른다. 의학 내화물 간질 환자의 1 식별 <ol><li> 해야 SEEG에 침입 모니터링을 추구하는 여부 멀티 - 징계 회의에서 논의 결정 후 1과 침입 감시하기 전에 비디오 - 뇌파 모니터링, MRI, PET, ictalSPECT 및 신경 심리 연구 등 allpatientswith 비 침습적 기술을 평가 했다. 1,6,7,11,14 </li><li> EZ의 위치에 대해 가설을 형성한다. 개입 이전하여 발작 발병 영역과 간질 (발작)의 초기 (즉, 빠른) 확산의 영역을 EZincorporating 추정 활동의 착상 전 가설을 개발한다. 참고 :이 단계는 결정이 침입 montitoring을 추구하게하는 멀티 - 징계 회의와 함께 수행 할 수 있습니다. 노트: 경막 EZ 가설에 그리드를 기반 SEEG 대, SEEG 및 경막 계통 감시 사이에서 결정. ) 가능한 깊은 앉아 EZ 1을 포함 할 수 있습니다 고려해야 할 기준; 2) 이전의 실패 경막 그리드 모니터링; 3) 양국 간 모니터링을위한 표시; 4) 비 병변 여분의 시간 간질이 의심됩니다. 또한 경막 그리드를 통해 SEEG의 추가 이익을 기록하고 웅변 영역이 EZ 근처에 가정 할 때 중요한 피질 영역을 자극하는 SEEG의 기능이 포함되어 있음을 주목해야한다. </li><li> 가설 EZ (그림 1)에 따라 개별적으로 맞춤형 주입 전략을 개발한다. -1,7,8,8-을 참고 : 적절한 주입 전략 1을 평가해야한다) 해부학 적 병변 (있는 경우); 2) 구조 (들) inictal 발병 참여 가능성이 가장 높은; 기능적 네트워크 내 발작 전파 및 / 또는 3) 가능한 경로 (들). 해부학 적 고려 사항 외에도 물류 사항도 고려되어야한다. 에 대한따라서, 직교 궤적은 이후에, 전극 위치 해석 주입을 용이하게하고 위하여 일반적으로 우선적이다. </li><li> 가정 된 EZ 기초 주입 전략을 개발 한 후, 로봇 지원을 사용 플랜을 생성한다. 첫째, &quot;새 환자&quot;를 선택하여, 새로운 만남을 만든 다음 다음 원하는 궤도에 해당 적절한 &quot;진입 점&quot;과 &quot;끝점&quot;을 선택, &quot;궤도 만들기 &#39;를 클릭합니다. 주 : 착상 가설에 따라 전극의 개수가 전형적 여덟 열두이다. 궤도와 가볼만한 곳은 일반적으로 대조 MRI 또는​​ 회전 혈관 조영술을 이용하여 계획되어 있습니다. 뇌의 문제가 아니라 뇌 혈관뿐만 아니라 보여 이러한 이미지는 혈관 손상과 출혈을 방지하기 무혈성 복도의 궤적 계획을 가능하게합니다. </li></ol> 2. 수술 절차 <ol><li> 스와 전날rgery, Kuzniecky 등에 의해 설명 된대로 대조, 체적 T1 강조 MRI 시퀀스를 얻을 수 있습니다. (14) 참고 :이 이미지는 로봇 도움을 등록에 사용되어야하며, 1mm 조각이 있어야합니다. 그런 다음 Kuzniecky 등에 의해 설명 된 바와 같이 궤도가 이전에 논의 주입 전략을 기반으로 계획되어 정위 신경 네비게이션 소프트웨어로 이미지를 전송합니다. (14) </li><li> 수술실에서되면, 앙와위에서 수술 테이블에 환자를 배치합니다. 그리고 마취 &#39;프로토콜에 따라 기관 내 삽관과 전신 마취를 얻을 수 있습니다. 참고 : 그들은 일반적으로 정맥 마취하고 완전한 약물 마비 받고하는 것이 필수적이다. 그런 다음, 환자의 머리를 면도 항생제 수술 응용 프로그램과 함께 피부 수험 후 머리 신경 외과 헤드 홀더에 환자의 머리를 배치합니다. 전신 마취는 환자에 환자 다르다. </li><li> 완료 한 후위치는 프레임 전체 등록에 로봇 시스템을 연결합니다. 로봇 보조 장치에서 선택 &quot;등록&quot;및 등록 절차를 완료하려면 지시를 따릅니다. 얼굴 특징 또는 이식 기준 마커를 기반으로 전체 등록하여 표면 랜드 마크 등록. </li><li> 삽입 (그림 2) <ol><li> 로봇 정위 시스템에서지도 지원을 두개골을 드릴 2.5 mm 드릴 비트를 사용합니다. 뇌경막을 엽니 다 극성 coagulator 프로브를 삽입합니다. 두개골에 주입 볼트 나사, 또한 로봇 정위 시스템에 의해 유도. </li><li> [- = D3 (대상-두라 거리) + (D2 D1)] : 다음 측정을 사용하여 전극 (D3)의 최종 깊이 거리를 계산합니다. 네비게이션 시스템을 이용하여 타겟 경질의 거리를 측정한다. 주 : D1이 경질로 안내 장치의 길이로서 측정하고, D2는 볼트의 단부까지 안내 장치의 길이로서 측정되는. D1 - D2 차이 볼트의 길이이다. 볼트 및 타깃 경질 거리의 길이의 합은 상기 전극의 깊이의 길이이다. </li><li> 주입 된 볼트에 의해 유도 stylette 프로브를 삽입하여 초기 궤적을 만듭니다. 다음에 전극을 삽입하고 볼트로 고정합니다. 이것은 더 변위 및 뇌척수액 (CSF) 누수를 방지 할 수 있습니다. </li><li> 배치하고 모든 전극을 연결 한 후, 볼트 캡 주위에 요오드 용액을 적신 거즈를 배치합니다. 그리고, 다음 머리를 정리. </li></ol></li></ol> 3. 모니터링 / 녹화 <ol><li> 사건을 마무리하기 전에 적절한 작동을 보장하기 위해 뇌파 기록 장치에 전극을 연결합니다. 수술실의 마지막 단계는 수술 중 영상 (그림 3)입니다. 측면과 전후방 두개골 X 선 또는 형광 투시 영상 수술 중을 수행합니다. 참고 : 전극의 적절한 궤적을 보장하기 위해 이러한를 얻습니다. 이러한 이미지는 obtaine 없습니다d를, 정위 배치를 보장하기 위해 오히려 그들은 전극의 일반 올바른 궤도와 위치를 확인합니다. </li><li> 수술 후 임상 적 및 electrographically SEEG 전극 기록을 통해 모두 발작 활동에 대한 환자 모니터 간질 감시 부에 환자를 전송합니다. 참고 : 투숙 기간이 달라집니다 수, 품질, 발작과 녹음의 간기 패턴에 따라 달라집니다. 모니터링 된 환자는 약간의 통증이있을 수 있지만, 아세트 아미노펜과이 취급합니다. 일반적으로, 체류 기간 7 일 (- 이십팔일 범위 3)입니다. </li><li> 전극을 제거하기 전에, 녹음 및 가설을 검토하기 위해 멀티 - 징계 회의에 환자에 대하여 논의한다. </li><li> 충분한 발작 데이터를 기록 후 (3.2 단계) 환자는 회의에서 논의 된, 대기 또는 전극을 제거하는 동안 환자의 이전에 항 간질 약물을 다시 시작합니다. </li></ol> 또는 제거 4. 반환 <ol><li> AF충분한 발작 데이터를 기록 운은 SEEG 전극의 제거를 위해 수술실에 환자를 반환합니다. 수면 마취하에이를 수행; 일반적으로 2 mg을 미다 졸람의 IV는 충분하다. </li><li> 마취가 충분히 진정을 구한 후 (일반적으로 미다 졸람과 [마취에 투여 연기), 환자 포장하여 머리 제거하고 전극 와이어를 잘라. 전극 제거 또는 봉합 삽입으로보고 고통 수준에 의해 임상 적으로 환자의 진정 작용을 모니터링합니다. 이어서 요오드화 겔을 사용하는 전극의 나머지 볼트와 꼬리 수험. </li><li> 개별적으로, 전극 다음에, 그것을 떨어져 왜곡하여 각 볼트 캡을 제거하고 마지막으로 볼트를 제거합니다. 부드럽게 자신의 삽입 축 방향을 잡아 당겨 전극을 제거합니다. 그런 다음 그것을 왜곡하여 볼트를 제거, 일반적으로 손가락을 사용하여이 작업을 수행. </li><li> 다음 전극으로 이동하기 전에, 나일론 봉합사의 한 스티치와 볼트에 의해 왼쪽 결함을 닫습니다. 각 전극에 대해 이러한 단계를 반복합니다. REM 수면 후모든 전극 oving, 항생제 연고와 느슨한 머리 랩과 스티치 영역을 커버한다. </li><li> 제거 후, ​​잔류 하드웨어 없도록 추가 영상 중 CT 또는 A / P 및 측면 엑스레이을 구하십시오. 참고 : 가능한 절제-경우 수술 적 절제가 환자의 간질에 도움이 될 것으로 생각 된 후 개두술과 절제 제거 후 약 육주 계획. 이 지연은 모니터링 기간과 동일한 입원시에 동작의 감염성 문제에 기인한다. </li></ol>

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저자는 공개 아무것도 없어.

여기에 로봇 정위 지원을 활용 SEEG 삽입의 기술을 제공됩니다. SEEG 원래 프레임 기반 stereotaxis의 다른 방법을 사용하여 설명되었지만, 로봇 보조 SEEG 유사한 안전하지만 우수한 정확도와 효율성뿐만 아니라 제공합니다. 다른 이전의 연구는 다른 기술을 사용하여. 6,13-을 함께 동정 인 경우 76 % 이상,에 EZ 현지화의 문헌보고 성공. 어떤 침략 두개 절차와 마찬가?...

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

SEEG는 입체 녹화 통해 발작 활동의 정확한 침입 기록하는데 사용되는 방법 및 기술이다. 침략 녹음에 적합한 후보를 판단되는 간질 환자에서 모니터링 할 수있는 결정은 SEEG 대 경막 그리드 사이에 이루어집니다. 간질에 대한 침략 neuromonitoring 복잡한 의학적 내화물 간질 환자에서 추진된다. 침입 모니터링의 목표는 발작 자유를 허용하는 희망 resective 수술을 제공하는 것입니다. SEEG의 장점은 깊은 대뇌 피질의 구조에 대한 액세스는 간질 영역 경막 그리드 그렇게하지 ​​못했다 (EZ), 비 병변 여분의 시간 간질 환자에서 지역화 할 수있는 능력을 포함한다. 이 논문에서 우리는 SEEG의 간결한 역사의 개요를 제시하고 로봇에서 틀 정위와 우리의 경험을보고하고자한다. SEEG 삽입의 필수 단계는 전극 궤도를 계획하고있다. 가장 효율적으로 기록하기 위해SEEG 궤적을 통해 발작 활동은 발작 활동이 추정 간질 존 (EZ)를 비롯 곳의 가설에 기초하여 계획하여야한다. EZ 가설은 비디오 EEG 모니터링, MRI (자기 공명 영상), PET (양전자 방출 단층 촬영), 발작 SPECT (단일 광자 방출 전산화 단층 촬영), 및 신경 정신 학적 평가를 포함하는 표준화 된 수술 후 처리에 기초한다. 의심 EZ를 사용 SEEG 전극 최소 침습적 아직 정확도와 정밀도를 유지 배치 될 수있다. 임상 결과는 간질 환자를 국산화하기 어려운의 78 %에 EZ을 지역화 할 수있는 능력을 보여 주었다. (1)

최근 결과는 로봇 지원을 통해 SEEG 삽입을 시행 한 78 명의 환자 중 하나 연속 시리즈에서 환자의 76.2 %에서 EZ의 성공적인 현지화를 가지고 있음을 나타냅니다. (1) 그 같은 연구는 한 학년 1 EZ의 수술 적 절제를 위하여 계속 환자의 보여 주었다 환자의 67.8 %에서 엥겔 발작 자유 (그림 4). 이환은 2.5 %이다. 발견 된 영구 사망률은 1 명 (1.2 %)이다. 전극마다, ...

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.

의료 내화물 간질의 수술 전 평가에서 로봇 지원으로 스테레오 전기 Encephalo-그래피로 (SEEG) : A 기술 참고

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

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

17.1K 조회수.  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. 

비디오: 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.

두개 내 전극 피사체에 행동 작업 수행

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

연구

행동분석학

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.

Neuroscientific 연구 및 실시간 기능성 두피 매핑을위한 인적 Electrocorticographic (ECoG) 신호를 녹음하기

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

신경과학

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.

마우스 Aortocaval 누관의 기술적 측면

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

의학

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.

로봇 정위 유도 시스템을 활용한 입체뇌파(SEEG) 방법론에 대한 수술 기술 및 뉘앙스

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.

정위 뇌파를 사용하여 깊은 피질의 기능 및 피질 하 구조 조사 : 전방에 cingulate 피질 수업

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.

간질 수술에 3D Multimodality 이미지 통합 및 컴퓨터 지원 계​​획에 대한 파이프 라인

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.

간질 환자의 뇌 흥분을 연결 관련 평가하는 멀티 모달 Imaging- 및 자극 기반 방법

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.

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.

간질의 임상 검토를 위한 동시 뇌파도 및 기능적 자기 공명 영상을 위한 장비 설정 및 아티팩트 제거

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

생체공학

<meta charset="utf8"></head><body>소아 간질 국소화에서 MEG와 HD-EEG의 통합

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>저자 스포트라이트: 새로운 바이오마커 및 향상된 지역화를 통한 소아 소아 간질 수술 발전

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.

약물 내성 간질이 있는 소아의 수술 전 평가에서 전자기 소스 이미징

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

의료 내화물 간질의 수술 전 평가에서 로봇 지원으로 스테레오 전기 Encephalo-그래피로 (SEEG) : A 기술 참고

요약

더 많은 비디오 탐색

이 비디오의 챕터

두개 내 전극 피사체에 행동 작업 수행

Neuroscientific 연구 및 실시간 기능성 두피 매핑을위한 인적 Electrocorticographic (ECoG) 신호를 녹음하기

마우스 Aortocaval 누관의 기술적 측면

로봇 정위 유도 시스템을 활용한 입체뇌파(SEEG) 방법론에 대한 수술 기술 및 뉘앙스

정위 뇌파를 사용하여 깊은 피질의 기능 및 피질 하 구조 조사 : 전방에 cingulate 피질 수업

간질 수술에 3D Multimodality 이미지 통합 및 컴퓨터 지원 계획에 대한 파이프 라인

간질 환자의 뇌 흥분을 연결 관련 평가하는 멀티 모달 Imaging- 및 자극 기반 방법

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

간질의 임상 검토를 위한 동시 뇌파도 및 기능적 자기 공명 영상을 위한 장비 설정 및 아티팩트 제거

약물 내성 간질이 있는 소아의 수술 전 평가에서 전자기 소스 이미징

의료 내화물 간질의 수술 전 평가에서 로봇 지원으로 스테레오 전기 Encephalo-그래피로 (SEEG) : A 기술 참고

요약

더 많은 비디오 탐색

이 비디오의 챕터

두개 내 전극 피사체에 행동 작업 수행

Neuroscientific 연구 및 실시간 기능성 두피 매핑을위한 인적 Electrocorticographic (ECoG) 신호를 녹음하기

마우스 Aortocaval 누관의 기술적 측면

로봇 정위 유도 시스템을 활용한 입체뇌파(SEEG) 방법론에 대한 수술 기술 및 뉘앙스

정위 뇌파를 사용하여 깊은 피질의 기능 및 피질 하 구조 조사 : 전방에 cingulate 피질 수업

간질 수술에 3D Multimodality 이미지 통합 및 컴퓨터 지원 계​​획에 대한 파이프 라인

간질 환자의 뇌 흥분을 연결 관련 평가하는 멀티 모달 Imaging- 및 자극 기반 방법

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

간질의 임상 검토를 위한 동시 뇌파도 및 기능적 자기 공명 영상을 위한 장비 설정 및 아티팩트 제거

약물 내성 간질이 있는 소아의 수술 전 평가에서 전자기 소스 이미징

간질 수술에 3D Multimodality 이미지 통합 및 컴퓨터 지원 계획에 대한 파이프 라인