Yazarlar hiçbir onayları var.

Etik açıklama: Bizim protokol kurumsal insan araştırma etik komitesi tarafından kurulan kuralları takip eder. Tıbben Refrakter Epilepsi Hastalarının 1. Kimlik <ol><li> Olmalı Seeg ile invaziv izleme sürdürmeye olsun ya da olmasın multi-disipliner toplantıda tartışma kararı sonrasında 1 anlatıldığı gibi invazif izleme öncesinde, video-EEG monitorizasyonu, MRI, PET, ictalSPECT ve nöropsikolojik çalışmalar olarak allpatientswith non-invaziv teknikler, değerlendirmek yaptı. 1,6,7,11,14 </li><li> EZ yeri hakkında bir hipotez oluştururlar. Girişim öncesinde iktal başlangıç ​​bölgesi ve epileptik (iktal) erken (yani, hızlı) yayılma bölgeleri EZincorporating düşünülen bir faaliyet pre-implantasyon hipotezini geliştirin. NOT: Bu adım kararı invaziv montitoring sürdürmeye yapılır multi-disipliner toplantısı ile birlikte yapılabilir. NOT: Subdural EZ hipotezine ızgaraları Tabanlı Seeg vs Seeg ve subdural grid izleme arasında karar. ) Olası köklü EZ 1 içerebilir dikkate Kriterleri; 2) Bir önceki başarısız subdural ızgaraları izlenmesi; 3) ikili izleme endikasyonları; 4) Lezyonal olmayan ekstra temporal epilepsi şüphesi olduğunda. Aynı zamanda subdural ızgaralar üzerinde Seeg ek bir yararı kaydetmek ve bir beliğ bölge EZ yakın olduğu hipotez zaman kritik subkortikal alanlarda teşvik etmek Seeg yeteneğini içerir dikkat edilmelidir. </li><li> Hipotez ez (Şekil 1) dayanan bir kişiye özel implantasyon strateji geliştirin. 1,7,8 NOT: Yeterli implantasyon stratejisi 1 değerlendirmek gerekir) anatomik bir lezyon (varsa); 2) yapı (lar) inictal başlamasını katılma olasılığı en yüksek; işlevsel bir ağ içinde nöbet yayılma ve / veya 3) olası yol (lar). anatomik hususlara ek olarak, lojistik hususlar da dikkate alınmalıdır. İçinBu nedenle, dik yörüngeler, daha sonra, elektrot pozisyonları yorumlanmasını implantasyonu kolaylaştırmak ve amacıyla genel tercihli bulunmaktadır. </li><li> Hipotez EZ dayalı bir implantasyon stratejisi geliştirdikten sonra, robotik yardım kullanarak bir plan oluşturun. İlk olarak, &quot;Yeni hasta&quot; seçerek, yeni bir karşılaşma oluşturmak, ardından istenilen yörünge ile gelen uygun &quot;giriş noktası&quot; ve &quot;bitiş noktası&quot; seçeneğini &quot;yörünge oluşturmak&quot; üzerine tıklayın. NOT: pre-implantasyon hipotezine göre, elektrotların sayısı tipik olarak sekiz ve on iki olduğunu. yörüngeleri ve ilgi noktaları genellikle tezat MRG veya dönme anjiyografi kullanılarak planlanmaktadır. Beyin konuyu ancak serebral damarları sadece gösteren bu görüntüler vasküler yaralanma ve kanama önlemek için avasküler koridorlarda yörünge planları için izin verir. </li></ol> 2. Operatif Prosedürü <ol><li> su bir gün öncergery, Kuzniecky ve arkadaşları tarafından tarif edildiği gibi, bir tezat hacimsel T1 MR dizisi elde. 14 NOT: Bu resim robot yardımı ile, kayıt için kullanılacak olan ve 1 mM dilimler olmalıdır. Sonra Kuzniecky ve arkadaşları tarafından tarif edildiği gibi yörüngeleri önce tartışılan implantasyon stratejilere dayalı planlanan olan stereotaktik nöro-navigasyon yazılımı, görüntü aktarmak. 14 </li><li> ameliyathanede kez, sırtüstü pozisyonda cerrahi masaya hastayı. Sonra Anesthesiologists &#39;protokol uyarınca, entübasyonu genel anestezi edinin. NOT: Bunların genel intravenöz anestezi ve tam farmakolojik felç altında zorunludur. Daha sonra hastalar tıraş bir antibiyotik cerrahi uygulama ile cildi hazırlık ve daha sonra bir kafa nöroşirürji kafa tutucu hastanın kafasını yerleştirin. Genel anestezi hastadan hastaya farklılık gösterir. </li><li> tamamlandıktan sonrapozisyonlama çerçevesinin ve tam kayıt robot sistemi takın. Robotik yardım cihazda seçin &quot;kayıt&quot; ve kayıt işlemini tamamlamak için yönergeleri izleyin. yüz özellikleri veya implante referans belirteçler dayalı tam kayıt kullanılarak yüzey dönüm kaydı. </li><li> Yerleştirme (Şekil 2) <ol><li> Robotik stereotaktik sistemden rehberlik yardımı ile kafatası delme 2,5 mm matkap ucu kullanın. duramateri açmak için monopolar coagulator probu yerleştirin. Kafatasının içine implantasyon cıvatasını Vida, aynı zamanda robotik stereotaktik sistem tarafından yönlendirilmelidir. </li><li> [- = D3 (Hedef-Dura Mesafe) + (D2 D1)]: Aşağıdaki ölçümleri kullanılarak elektrot (D3) için nihai derinlik mesafe hesaplamak. Navigasyon sistemini kullanarak hedef dura mesafeyi ölçün. Not: D1 dura yönlendirme sisteminin uzunluğu olarak ölçülür, D2 cıvata sonuna yönlendirme sisteminin uzunluğu ölçülür. D1 - D2 fark cıvatanın uzunluğudur. cıvata ve hedef dura mesafe uzunluğu toplamı elektrot derinliği uzunluğudur. </li><li> implante cıvata tarafından yönlendirilen bir stylette probu, ekleyerek ilk yörünge oluşturun. Sonra elektrot eklemek ve cıvata içine sabitleyin. Bu da deplasman ve beyin omurilik sıvısı (BOS) kaçakları önler. </li><li> yerleştirerek ve tüm elektrotları bağladıktan sonra, cıvata kapakları etrafında iyot solüsyonu batırılmış gazlı bez yerleştirin. Ve, sonra kafasını sarın. </li></ol></li></ol> 3. İzleme / Kayıt <ol><li> davayı sona ermeden önce, düzgün işleyişini sağlamak için EEG kaydı makinesine elektrotlar bağlanır. OR son adım intraoperatif görüntüleme (Şekil 3). lateral ve ön-arka kafatası x-ışınları ya da floroskopi görüntüleme Ameliyat gerçekleştirin. NOT: elektrotların uygun yörüngeleri sağlamak için bu edinin. Bu görüntüler obtaine değildird stereotaktik yerleşimi sağlamak için bunun yerine elektrotlar genel doğru yörünge ve yerleştirilmesini sağlar. </li><li> Ameliyattan sonra, klinik ve elektrografik Seeg elektrot kayıt yoluyla hem nöbet aktivitesi için hastayı izleyin epilepsi takip birimine hasta aktarın. NOT: kalış süresi değişir sayı, kalite ve iktal ve kayıtların interiktal desenleri bağlı. izlenen hastada minör ağrı olabilir iken, asetaminofen ile bu davranın. Tipik olarak, kalış süresi 7 gündür (- 28 gün aralığı 3) &#39;dir. </li><li> elektrotların çıkarılmadan önce, kayıtları ve hipotez gözden geçirilmesi için bir multi-disipliner bir konferansta hastayı ilgili tartışır. </li><li> Yeterli iktal verileri kaydettikten sonra (3.2 adım) ve hasta konferansta tartışıldı, bekleyen YA elektrotların kaldırılması için ise hastaların önceden anti-epileptik ilaçlar yeniden başlatın. </li></ol> OR Temizleme 4. Dönüş <ol><li> AfYeterli iktal verileri kaydetme ter, Seeg elektrotlar giderilmesi için ameliyathaneye hastayı dönün. bilinçli sedasyon altında bu gerçekleştirin; tipik olarak, 2 mg midazolam IV yeterlidir. </li><li> anestezi yeterli sedasyon elde sonra (genellikle midazolam ile [anestezist için dozaj erteleme]), hasta sarmak kafası kaldırmak ve elektrot telleri kesti. elektrot kaldırılması veya sütür ekleme ile bildirilen ağrı düzeyleri ile klinik Hasta sedasyon izleyin. Daha sonra iyotlanmış jel kullanılarak elektrot kalan cıvata ve kuyruk hazırlık. </li><li> Bireysel, elektrodun ardından onu bükerek her cıvata kapağı çıkarın ve son olarak cıvatasını çıkartın. nazikçe yerleştirme ekseni boyunca onları dışarı çekerek elektrotları çıkarın. Sonra dışarı döndürerek cıvatasını çıkartın, tipik parmaklarını kullanarak bunu. </li><li> Bir sonraki elektrot geçmeden önce, naylon sütür bir dikiş ile cıvata ile sol defekti kapatmak. her elektrot için bu adımları tekrarlayın. rem sonraTüm elektrotlar oving, antibiyotik merhem ve gevşek bir kafa şal ile dikiş alanları kapsamaktadır. </li><li> çıkarıldıktan sonra, hiçbir kalıntı donanım sağlamak için daha fazla görüntüleme ya CT veya A / P ve lateral röntgen edinin. NOT: Olası rezeksiyon-Bir cerrahi rezeksiyon hastanın epilepsi yararına olduğuna inanılıyordu sonra kraniotomi ve rezeksiyon çıkarıldıktan sonra yaklaşık 6 hafta için plan. Bu gecikme izleme dönemi aynı yatış sırasında işletme enfeksiyöz kaygıları nedeniyle. </li></ol>

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	<li>Serletis, D., Bulacio, J., Bingaman, W., Gonzalez-Martinez, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+stereotactic+approach+for+mapping+epileptic+networks:+a+prospective+study+of+200+patients.">The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients.</a> J Neurosurg. 121, 1239-1246 (2014).</li><li>Bancaud, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epilepsy+after+60+years+of+age.+Experience+in+a+functional+neurosurgical+department.">Epilepsy after 60 years of age. Experience in a functional neurosurgical department.</a> Sem Hop. 46, 3138-3140 (1970).</li><li>Bancaud, J., 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=Functional+stereotaxic+exploration+(SEEG)+of+epilepsy.">Functional stereotaxic exploration (SEEG) of epilepsy.</a> Electroencephalogr Clin Neurophysiol. 28, 85-86 (1970).</li><li>Talairach, J., Bancaud, J., Bonis, A., Szikla, G., Trottier, S., Vignal, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+therapy+for+frontal+epilepsies.">Surgical therapy for frontal epilepsies.</a> Adv Neurol. 57, 707-732 (1992).</li><li>Vadera, S., Mullin, J., Bulacio, J., Najm, I., Bingaman, W., Gonzalez-Martinez, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereo+electroencephalography+following+subdural+grid+placement+for+difficult+to+localize+epilepsy.">Stereo electroencephalography following subdural grid placement for difficult to localize epilepsy.</a> Neurosurgery. 72, 723-729 (2013).</li><li>Munari, C., 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=Stereo-electroencephalography+methodology:+advantages+and+limits.">Stereo-electroencephalography methodology: advantages and limits.</a> Acta Neurol Scand Suppl. 152, 56-69 (1994).</li><li>Gonzalez-Martinez, J., Bulacio, J., Alexopoulos, A., Jehi, L., Bingaman, W., Najm, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereoelectroencephalography+in+the+"difficult+to+localize"+refractory+focal+epilepsy+early+experience+from+a+North+American+epilepsy+center.">Stereoelectroencephalography in the "difficult to localize" refractory focal epilepsy early experience from a North American epilepsy center.</a> Epilepsia. 54, 323-330 (2013).</li><li>Gonzalez-Martinez, J., 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=Stereotactic+placement+of+depth+electrodes+in+medically+intractable+epilepsy.+Technicalnote.">Stereotactic placement of depth electrodes in medically intractable epilepsy. Technicalnote.</a> J Neurosurg. 120, 639-664 (2014).</li><li>Nathoo, N., Lu, M. C., Vogelbaum, M., Barnett, G. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+Touch+with+Robotics:+Neurosurgery+for+the+Future.">In Touch with Robotics: Neurosurgery for the Future.</a> Neurosurgery. 56, 421-433 (2005).</li><li>De Almeida, A. 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Indications, results, complications and therapeutic applications in a series of 100 consecutive cases.</a> Stereotact Funct Neurosurg. 77, 29-32 (2001).</li><li>Kuzniecky, R. I., 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=Multimodality+MRI+in+mesial+temporal+sclerosis:+relative+sensitivity+and+specificity.">Multimodality MRI in mesial temporal sclerosis: relative sensitivity and specificity.</a> Neurology. 49 (3), 774-778 (1997).</li><li>Cardinale, F., 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=Stereoelectroencephalography:+surgical+methodology,+safety,+and+stereotacticapplication+accuracy+in+500+procedures.">Stereoelectroencephalography: surgical methodology, safety, and stereotacticapplication accuracy in 500 procedures.</a> Neurosurgery. 72 (3), 353-366 (2013).</li></ol>

Yazarlar ifşa hiçbir şey yok.

İşte robotik stereotaktik yardım kullanan Seeg yerleştirme tekniği sunulmaktadır. Seeg başlangıçta çerçeve tabanlı stereotaksiyi diğer yöntemler kullanılarak tarif ederken, robot yardımlı Seeg benzer güvenlik fakat üstün doğruluk ve verimlilik sadece sunmaktadır. Diğer önceki çalışmalar, alternatif teknikler kullanılarak. 6,13 ile kederini olduğu durumlarda 76 üzerinden% içinde EZ lokalize edebiyat raporları başarı. herhangi bir invazif...

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 üç boyutlu kayıtları ile nöbet aktivitesi, doğru invaziv kayıt için kullanılan bir yöntem ve bir tekniktir. invaziv kayıtlar için uygun adaylar görülen epilepsi hastalarında, izlemek için karar Seeg karşı subdural grid arasında yapılır. Epilepsi için İnvaziv nörolojik karmaşık, ilaca dirençli epilepsi hastalarında takip edilmektedir. invaziv izleme amacı nöbet özgürlüğü sağlayan umudu ile rezektif cerrahi sunmaktır. Seeg avantajları derin kortikal yapılarda erişimi, Epileptojenik bölge subdural ızgaraları bunu başarısız olmuş (EZ) ve non-lezyonel ekstra temporal epilepsilerde olan hastalarda lokalize bir yeteneği vardır. Bu yazıda, Seeg bir özlü tarihsel bir bakış sunmak ve robot altında çerçevesiz stereotaksi ile bizim deneyim hakkında rapor. Seeg yerleştirilmesi bir zorunluluk adım elektrot yörüngelerini planlıyor. en etkili kayıt içinSeeg yörüngeleri aracılığıyla iktal aktivite nöbet aktivitesi kabul epileptojenik bölge (EZ) nereden geldiğine bir hipoteze dayalı planlanmalıdır. EZ hipotezi, video-EEG monitorizasyonu, MRG (manyetik rezonans görüntüleme), PET (pozitron emisyon tomografisi), iktal SPECT (Tek foton emisyon bilgisayarlı tomografi) ve nöropsikolojik değerlendirme de dahil olmak üzere standart preoperatif değerlendirmenin dayanmaktadır. şüpheli EZ kullanarak, Seeg elektrotlar minimal invaziv henüz doğruluğu ve kesinliği korumak yerleştirilebilir. Klinik sonuçlar epileptik hasta lokalize zor% 78&#39;inde EZ lokalize etmek yeteneğini gösterdi. 1

Son sonuçlar robot yardımı aracılığıyla Seeg ekleme uygulanan 78 hastadan biri ardışık seride hastaların% 76.2 olarak EZ başarılı lokalizasyonu sahip olduğunu göstermektedir. 1 Aynı çalışma vardı grade 1 EZ cerrahi rezeksiyon için gitti hastaların gösterdi hastaların% 67.8 Engel nöbet özgürlüğü (Şekil 4). Morbidite oranı% 2.5. fark Kalıcı morbidite 1 hastada (% 1.2) &#39;dir. elektrot başına olarak, her% 0.08 bir yara enfek...

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.

Tıbbi Refrakter Epilepsi Cerrahi öncesi Değerlendirilmesi Robotik Yardım ile stereo-Elektro-Ensefalo-Graphy (Seeg): Bir Teknik Not

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

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Medicine

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

17.0K Görüntüleme.  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. 

Video: 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.

İntrakraniyal Elektrotlarla Bireylerde Davranış Görevler Sahne

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

Davranış

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.

Nörobilimsel Araştırma ve Gerçek-zamanlı Fonksiyonel Kortikal Haritalama İnsan elektrokortikografik (ECoG) Sinyaller Kayıt

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

Nörobilim

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.

Fare Aortocaval Fistül Teknik Yönleri

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

Tıp

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.

Robotik stereotaktik rehberlik sistemi kullanan stereoelektroensefalografik (SEEG) metodoloji için operatif teknik ve nüanslar

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.

Stereotaktik Elektroensefalografi kullanarak Derin KORTİKAL Fonksiyonu ve subkortikal yapıları incelenmesi: Ön Singulat Korteks Dersler

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.

Epilepsi Cerrahisi 3D Multimodalite Görüntü Entegrasyonu ve Bilgisayar destekli Planlama Bir Boru Hattı

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.

Epilepsi Hastalarında Beyin uyarılabilmenin Bağlantı ile ilgili değerlendirmek için bir Multimodal imaging- ve Uyarım tabanlı Yöntemi

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.

İlaca dirençli Temporal Lob Epilepsi Hastalarında Foramen Ovale Elektrot Kayıtları Ağ Analizi

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.

Epilepside Klinik İnceleme için Eşzamanlı Elektroensefalogram ve Fonksiyonel Manyetik Rezonans Görüntüleme için Ekipman Kurulumu ve Artefakt Giderimi

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

Biyomühendislik

<meta charset="utf8"></head><body>MEG ve HD-EEG'nin Pediatrik Epilepsi Lokalizasyonuna Entegre Edilmesi

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>Yazar Gündemi: Yeni Biyobelirteçler ve Gelişmiş Lokalizasyon Yoluyla Çocuklarda Pediatrik Epilepsi Cerrahisinin İlerletilmesi

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.

İlaca Dirençli Epilepsili Çocukların Precerrahi Değerlendirmesinde Elektromanyetik Kaynak Görüntüleme

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