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Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor in Fahr's Disease: Case Report. 磁共振引导下聚焦超声丘脑切开术治疗法尔氏病重度震颤:病例报告。
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2025-01-01 Epub Date: 2024-10-21 DOI: 10.1159/000541446
Jean Filo, Martina L Mustroph, Melissa M J Chua, Philip J White, Nathan J McDannold, G Rees Cosgrove

Introduction: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy effectively treats medication-resistant essential tremor (ET). Usually, intracranial calcifications are excluded as no-pass zones because of their low penetrability which may limit the effectiveness of treatment and lead to unintended side effects. This case report illustrates the efficacy of unilateral MRgFUS for tremor control in a patient with extensive basal ganglia calcifications due to Fahr's disease.

Case presentation: A 69-year-old right-handed male with debilitating Fahn-Tolosa-Marin grade 3-4 bilateral hand tremor underwent unilateral left MRgFUS thalamotomy. The treatment involved careful preoperative planning to accommodate his extensive basal ganglia calcifications, element path consideration, and skull density ratio to ensure accurate and effective lesioning. Posttreatment, the patient exhibited complete abolition of tremor on the treated side with minor transient dysarthria and imbalance. Follow-up at 12 weeks posttreatment showed sustained tremor relief and an absence of any adverse effects, validating the procedural adjustments made to accommodate the unique challenges posed by his intracranial calcifications.

Conclusion: MRgFUS can be safely and effectively applied in certain patients with extensive basal ganglia calcifications - in this case, due to Fahr's disease. This case report suggests expanding the application of MRgFUS to patients with extensive intracranial calcifications who previously might not have been considered suitable candidates for MRgFUS.

简介:磁共振引导下聚焦超声(MRgFUS)丘脑切开术能有效治疗药物抵抗性本质性震颤(ET)。通常,颅内钙化因其穿透性低而被排除在禁区之外,这可能会限制治疗效果并导致意外的副作用。本病例报告说明了单侧 MRgFUS 对一名因法尔氏病导致基底节广泛钙化的患者控制震颤的疗效:一名 69 岁的右撇子男性患者因患有法恩-托洛萨-马林 3-4 级双侧手震颤而衰弱不堪,接受了单侧左侧 MRgFUS 丘脑切开术。治疗过程包括仔细的术前规划,以适应其广泛的基底节钙化、元素路径考虑和头骨密度比,从而确保准确有效的病变切除。治疗后,患者接受治疗的一侧震颤完全消失,仅有轻微的一过性构音障碍和失衡。治疗后12周的随访显示震颤持续缓解且无任何不良反应,验证了为应对颅内钙化带来的独特挑战而进行的程序调整:结论: MRgFUS 可以安全有效地应用于某些基底节广泛钙化的患者--在本病例中,钙化是由法尔氏病引起的。本病例报告建议将 MRgFUS 的应用范围扩大到颅内广泛钙化的患者,这些患者以前可能不适合接受 MRgFUS 治疗。
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引用次数: 0
Long-Term Effects of Spinal Cord Stimulation on Pain in Postherpetic Neuralgia. 脊髓刺激对带状疱疹后神经痛患者疼痛的长期影响
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2025-01-01 Epub Date: 2024-11-21 DOI: 10.1159/000542138
Egor D Anisimov, Oleg M Andrushkevich, Vidzhai M Dzhafarov, Evgenia V Amelina, Jamil A Rzaev, Konstantin V Slavin

Introduction: Postherpetic neuralgia (PHN) is a pain syndrome that develops within few months after the acute herpetic outbreak. The pain may be accompanied by specific cutaneous signs in the distribution of affected dermatomes and feel unbearable reaching up to 9-10/10 on visual analog scale (VAS). Despite the introduction of new medications, drug resistance develops in at least 50% of cases. Neuromodulation techniques such as spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) are considered as ones of the last resorts for PHN treatment, especially in pharmacoresistant patients. Recently, several studies with limited number of cases have shown high efficiency of neuromodulation (regression of pain syndrome in more than 82% of cases) after SCS in PHN patients, but these findings require further confirmation and have not been supported by large RCTs.

Methods: Initially, 32 patients diagnosed with chronic drug-resistant PHN underwent a trial of SCS. Based on the trial results, a decision was made whether to implant a permanent SCS system. The condition of all patients implanted with SCS system was assessed using the VAS, SF-36, Patient Global Impression of Change (PGIC), and Medicine Quantification Scale, version III (MQS) questionnaires before the surgery and in the long-term follow-up. We also conducted systematic follow-up of patients who did not pass the test stimulation stage, using them as a control group to track the levels of pain. The hypothesis of normal distribution for quantitative values was tested using Shapiro-Wilk tests.

Results: During the trial period, tonic spinal stimulation was effective in 16 out of 32 (50%) patients with drug-resistant PHN. Among 14 patients with implanted stimulators, a significant pain reduction (more than 50% from the baseline) was observed in 10 patients (71.4%). The pain level in patients with a tonic SCS was statistically lower than in patients receiving conservative therapy. For the entire group of patients with implanted SCS, a significant improvement was also observed in results of SF-36, PGIC, and MQS.

Conclusion: Our clinical series demonstrates that tonic SCS was effective in 50% of patients with refractory PHN undergoing SCS trial. Significant improvement in pain control obtained during the long-term follow-up in patients treated with tonic SCS improves the quality of life and reduces the need for analgesic medications.

简介带状疱疹后遗神经痛(PHN)是急性带状疱疹爆发后数月内出现的一种疼痛综合征。在受累皮节的分布区,疼痛可能伴有特殊的皮肤症状,疼痛难以忍受,视觉模拟量表(VAS)可达 9-10/10。尽管不断有新药问世,但至少有 50%的病例会产生耐药性。脊髓刺激(SCS)和周围神经刺激(PNS)等神经调控技术被认为是治疗 PHN 的最后手段之一,尤其是对耐药患者。最近,几项病例数量有限的研究显示,PHN 患者接受 SCS 后神经调控的效率很高(82% 以上的病例疼痛综合征消退),但这些研究结果还需要进一步证实,而且尚未得到大型 RCT 研究的支持:方法:最初,32 名被诊断为慢性耐药性 PHN 患者接受了 SCS 试验。根据试验结果,决定是否植入永久性 SCS 系统。在手术前和长期随访中,我们使用 VAS、SF-36、患者整体变化印象(PGIC)和医学量化量表第三版(MQS)问卷对所有植入 SCS 系统的患者进行了病情评估。我们还对未通过刺激试验阶段的患者进行了系统性随访,将其作为对照组,跟踪疼痛程度。我们使用 Shapiro-Wilk 检验对定量值的正态分布假设进行了检验:在试验期间,32 名耐药 PHN 患者中有 16 名(50%)脊髓强直刺激有效。在 14 名植入刺激器的患者中,10 名患者(71.4%)的疼痛明显减轻(比基线减轻 50%以上)。据统计,使用强直性 SCS 的患者的疼痛程度低于接受保守治疗的患者。在所有植入 SCS 的患者中,SF-36、PGIC 和 MQS 的结果也有显著改善:我们的临床系列研究表明,在接受 SCS 试验的难治性 PHN 患者中,50% 的患者接受强直性 SCS 治疗是有效的。在长期随访中,接受强直性脊髓刺激系统治疗的患者在疼痛控制方面取得了显著改善,提高了生活质量,减少了对镇痛药物的需求。
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引用次数: 0
Detailed Images of Deep Brain Stimulation Leads Using Micro-CT. 利用微型计算机断层扫描(Micro-CT)获得脑深部刺激导线的详细图像。
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2025-01-01 Epub Date: 2024-11-08 DOI: 10.1159/000542015
Thomas Billoud, Peter Christoph Reinacher, Moritz Weigt, Dominik von Elverfeldt, Theo Demerath, Martin Pichotka

Introduction: One of the challenges in directional deep brain stimulation (DBS) is to determine the orientation of implanted electrodes relative to targeted regions. Post-operative images must be aligned with a model of the implanted lead, usually a computer-based model provided by the manufacturer. This paper shows that models can alternatively be obtained by capturing images of individual leads using micro-CT, a high-resolution CT technique. Contrary to computer-aided design models, lead models generated this way provide realistic X-ray contrast and finer details.

Methods: We scanned DBS leads from various vendors using a Bruker SkyScan 1276 micro-CT system. To reduce beam-hardening artefacts, samples were scanned at maximum X-ray tube voltage (100 kV) and with copper filtering. Images were made publicly available for download and 3D visualisation.

Conclusion: Detailed images of single DBS leads can be generated using standard micro-CT systems. Their use as reference models could improve lead orientation algorithms, in particular those dedicated to X-ray modalities. Furthermore, the possibility to share models online could broaden access for clinical research.

导言:定向脑深部刺激(DBS)的挑战之一是确定植入电极相对于目标区域的方向。术后图像必须与植入导线的模型(通常是由制造商提供的基于计算机的模型)对齐。本文介绍了另一种方法,即使用微计算机断层扫描(一种高分辨率计算机断层扫描技术)捕捉单个导线的图像来获取模型。与计算机辅助设计模型相反,这种方法生成的导联模型具有逼真的 X 射线对比度和更精细的细节:我们使用布鲁克 SkyScan 1276 微型 CT 系统扫描了来自不同供应商的 DBS 导联。为减少光束硬化伪影,样品在最大 X 射线管电压(100 kV)和铜滤波条件下进行扫描。图像可公开下载并进行三维可视化:结论:使用标准微型计算机断层扫描系统可以生成单个 DBS 导联的详细图像。将其用作参考模型可以改进导联定向算法,特别是那些专门用于 X 射线模式的算法。此外,在线共享模型还能扩大临床研究的使用范围。
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引用次数: 0
Reoperation Rates and Risk Factors after Spinal Cord Stimulation Revision Surgery. 脊髓刺激翻修手术后的再手术率和风险因素。
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2025-01-01 Epub Date: 2024-10-29 DOI: 10.1159/000541445
Samuel H Kim, Christian G Lopez Ramos, Mihir J Palan, Elise Kronquist, Hao Tan, Mohamed Amgad Elsayed Elkholy, Ahmed Raslan

Introduction: Spinal cord stimulation (SCS) is an effective treatment for patients with refractory chronic pain. Despite its efficacy, rates of reoperation after initial implantation of SCS remain high. While revision rates after index SCS surgeries are well reported, less is known about rates and risk factors associated with repeat reoperations. We sought to evaluate patient, clinical, and surgical characteristics associated with repeat reoperation among patients who underwent an initial SCS revision procedure.

Methods: We performed a retrospective review of patients who underwent SCS revision surgery performed at a single institution between 2008 and 2022. Patients were stratified by whether they underwent a single revision (SR) or multiple revision (MR) surgeries. Multivariate logistic regression was performed to determine risk factors associated with repeat SCS revision. Kaplan-Meier survival analysis was used to compare rates of devices requiring revision across groups.

Results: A total of 54 patients underwent an initial SCS revision. Of these, 15 (28%) underwent a second revision. The most common indication for revision surgery was lead migration (65%). No significant differences were observed in age, body mass index, comorbidities, lead type, and revision indication among the SR and MR groups. On multivariate adjusted analysis, only cervical lead position was significantly associated with repeat reoperation (OR 7.10, 95% CI [1.14, 44.3], p = 0.036). Time to reoperation after a single and MR SCS surgeries did not differ.

Conclusions: Among patients who undergo SCS reoperation, a substantial portion requires additional revisions. Cervical lead placement may be associated with a higher risk of repeat revision surgery compared to thoracic lead positioning. Consideration of lead positioning in the decision to perform and undergo reoperation may therefore result in lower revision rates and improved clinical outcomes among SCS patients with MRs.

简介脊髓刺激(SCS)是治疗难治性慢性疼痛患者的有效方法。尽管疗效显著,但首次植入 SCS 后的再次手术率仍然很高。尽管对首次 SCS 手术后的翻修率有很多报道,但对与重复再手术相关的比率和风险因素却知之甚少。我们试图评估接受首次 SCS 修正手术的患者中与重复再手术相关的患者、临床和手术特征:我们对 2008 年至 2022 年期间在一家医疗机构接受 SCS 修复手术的患者进行了回顾性研究。根据患者接受的是单次翻修手术(SR)还是多次翻修手术(MR)对患者进行了分层。进行多变量逻辑回归以确定与重复SCS翻修相关的风险因素。采用 Kaplan-Meier 生存分析比较各组需要翻修装置的比率:共有54名患者接受了首次SCS翻修。结果:共有 54 名患者接受了首次 SCS 修复手术,其中 15 人(28%)接受了第二次修复手术。翻修手术最常见的适应症是导联移位(65%)。SR 组和 MR 组在年龄、体重指数、合并症、导联类型和翻修适应症方面均无明显差异。经多变量调整分析,只有颈椎导联位置与再次手术显著相关(OR 7.10,95% CI [1.14,44.3],P = 0.036)。单次SCS手术和MR SCS手术后再次手术的时间没有差异:结论:在接受SCS再次手术的患者中,有相当一部分需要进行额外的翻修。结论:在接受 SCS 再手术的患者中,有相当一部分需要进行额外的翻修。与胸导联定位相比,颈导联定位可能与更高的重复翻修手术风险相关。因此,在决定是否实施和接受再手术时考虑导联定位可能会降低 MR SCS 患者的翻修率并改善临床疗效。
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引用次数: 0
Phantom Safety Assessment of 3 Tesla Magnetic Resonance Imaging in Directional and Sensing Deep Brain Stimulation Devices. 定向和传感脑深部刺激设备中 3 特斯拉磁共振成像的幻影安全评估。
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2025-01-01 Epub Date: 2024-11-27 DOI: 10.1159/000542725
Riccardo Ludovichetti, Clement T Chow, Sriranga Kashyap, Ian Connell, Benson Yang, Simon J Graham, Gavin Elias, Brendan Santyr, Asma Naheed, Diego Martinez, Michael Colditz, Jürgen Germann, Artur Vetkas, Kâmil Uludağ, Andres M Lozano, Alexandre Boutet
<p><strong>Introduction: </strong>Magnetic resonance imaging (MRI) is both a crucial clinical and research tool for patients with deep brain stimulation (DBS) devices. However, safety concerns predominantly related to device heating have limited such imaging. Rigorous safety testing has demonstrated that scanning outside of vendor guidelines may be both safe and feasible, unlocking unique opportunities for advanced imaging in this patient population. Currently, however, 3T MRI safety data including advanced MRI sequences in novel directional and sensing DBS devices is lacking.</p><p><strong>Methods: </strong>An anthropomorphic phantom replicating bilateral DBS system was used to assess the temperature rise at the electrode tips, implantable pulse generator, and cranial loop during acquisition of routine clinical sequences (three dimensional [3D] T1, GRE T2*, T2 FSE) and advanced imaging sequences including functional MRI (fMRI), arterial spin labelling (ASL), and diffusion weighted imaging (DWI). Measures of radiofrequency exposure (specific absorption rate [SAR] and root-mean square value of the MRI effective component of the radiofrequency transmission field [B1+rms]) were also recorded as an indirect measure of heating. Testing involved both a new directional and sensing DBS device (Medtronic: B30015 leads and Percept PC neurostimulator) and a previous-generation DBS device (Medtronic: 3,387 leads and Percept PC neurostimulator) in combination with a state-of-the-art (Siemens MAGNETOM Prisma) and a previous-generation (GE Signa HDxt) 3T MRI scanner.</p><p><strong>Results: </strong>On the state-of-the-art 3T MRI scanner, the new DBS device produced safe temperature rises with clinically used sequences and fMRI but not with other advanced sequences such as DWI and ASL, which also exceeded B1+rms vendor guidelines (i.e., ≤2 μT). When scanned on the previous MRI scanner, the recent DBS device produced overall lower and slower temperature rises compared to the previous DBS model. Among the sequences performed on this scanner, several (3D T1, DWI, T2 FSE, and ASL) exceeded the approved SAR vendor limit (<1 W/kg), but only ASL resulted in an unacceptable temperature rise during scanning of the previous DBS model.</p><p><strong>Conclusion: </strong>These phantom safety data show that both clinically used MRI sequences and research sequences such as fMRI can be successfully acquired on 3T MRI scanners with a novel directional and sensing DBS model. As several of these sequences were obtained outside regulatory-approved vendor guidelines, preemptive safety testing should be done. As directional leads become increasingly common, improving MRI safety knowledge is crucial to expand clinical and research possibilities.</p><p><strong>Introduction: </strong>Magnetic resonance imaging (MRI) is both a crucial clinical and research tool for patients with deep brain stimulation (DBS) devices. However, safety concerns predominantly related to device heating have l
简介 核磁共振成像是使用脑深部刺激(DBS)设备的患者的重要临床和研究工具。然而,主要与设备加热有关的安全问题限制了此类成像。严格的安全性测试表明,在供应商指南之外进行扫描既安全又可行,这为该患者群体的高级成像提供了独特的机会。然而,目前还缺乏包括新型定向和传感 DBS 设备高级 MRI 序列在内的 3T MRI 安全性数据。方法 使用一个复制双侧 DBS 系统的拟人化模型来评估常规临床序列(3D T1、GRE T2*、T2 FSE)和高级成像序列(包括功能磁共振成像(fMRI)、动脉自旋标记(ASL)和弥散加权成像(DWI))采集过程中电极尖端、植入式脉冲发生器和颅骨环路的温升。此外,还记录了射频暴露的测量值 specific absorption rate (SAR) 和射频传输场 MRI 有效分量的均方根值(B1+rms),作为加热的间接测量值。测试包括新型定向传感 DBS 设备(美敦力:B30015 导联和 Percept PC 神经刺激器)和上一代 DBS 设备(美敦力:3387 导联和 Percept PC 神经刺激器),并结合最先进的(西门子 MAGNETOM Prisma)和上一代(通用电气 Signa HDxt)3T MRI 扫描仪进行。结果 在最先进的 3T MRI 扫描仪上,新型 DBS 设备在使用临床常用序列和 fMRI 时产生了安全的温度升高,但在使用 DWI 和 ASL 等其他先进序列时却没有产生安全的温度升高,这些序列也超过了 B1+rms 供应商指南(即≤2μT)。在以前的磁共振成像扫描仪上扫描时,与以前的 DBS 型号相比,最近的 DBS 设备产生的温升总体较低且较慢。在该扫描仪上进行的序列中,有几个序列(3D T1、DWI、T2 FSE 和 ASL)超过了供应商批准的 SAR 限制 (
{"title":"Phantom Safety Assessment of 3 Tesla Magnetic Resonance Imaging in Directional and Sensing Deep Brain Stimulation Devices.","authors":"Riccardo Ludovichetti, Clement T Chow, Sriranga Kashyap, Ian Connell, Benson Yang, Simon J Graham, Gavin Elias, Brendan Santyr, Asma Naheed, Diego Martinez, Michael Colditz, Jürgen Germann, Artur Vetkas, Kâmil Uludağ, Andres M Lozano, Alexandre Boutet","doi":"10.1159/000542725","DOIUrl":"10.1159/000542725","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Magnetic resonance imaging (MRI) is both a crucial clinical and research tool for patients with deep brain stimulation (DBS) devices. However, safety concerns predominantly related to device heating have limited such imaging. Rigorous safety testing has demonstrated that scanning outside of vendor guidelines may be both safe and feasible, unlocking unique opportunities for advanced imaging in this patient population. Currently, however, 3T MRI safety data including advanced MRI sequences in novel directional and sensing DBS devices is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An anthropomorphic phantom replicating bilateral DBS system was used to assess the temperature rise at the electrode tips, implantable pulse generator, and cranial loop during acquisition of routine clinical sequences (three dimensional [3D] T1, GRE T2*, T2 FSE) and advanced imaging sequences including functional MRI (fMRI), arterial spin labelling (ASL), and diffusion weighted imaging (DWI). Measures of radiofrequency exposure (specific absorption rate [SAR] and root-mean square value of the MRI effective component of the radiofrequency transmission field [B1+rms]) were also recorded as an indirect measure of heating. Testing involved both a new directional and sensing DBS device (Medtronic: B30015 leads and Percept PC neurostimulator) and a previous-generation DBS device (Medtronic: 3,387 leads and Percept PC neurostimulator) in combination with a state-of-the-art (Siemens MAGNETOM Prisma) and a previous-generation (GE Signa HDxt) 3T MRI scanner.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;On the state-of-the-art 3T MRI scanner, the new DBS device produced safe temperature rises with clinically used sequences and fMRI but not with other advanced sequences such as DWI and ASL, which also exceeded B1+rms vendor guidelines (i.e., ≤2 μT). When scanned on the previous MRI scanner, the recent DBS device produced overall lower and slower temperature rises compared to the previous DBS model. Among the sequences performed on this scanner, several (3D T1, DWI, T2 FSE, and ASL) exceeded the approved SAR vendor limit (&lt;1 W/kg), but only ASL resulted in an unacceptable temperature rise during scanning of the previous DBS model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;These phantom safety data show that both clinically used MRI sequences and research sequences such as fMRI can be successfully acquired on 3T MRI scanners with a novel directional and sensing DBS model. As several of these sequences were obtained outside regulatory-approved vendor guidelines, preemptive safety testing should be done. As directional leads become increasingly common, improving MRI safety knowledge is crucial to expand clinical and research possibilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Magnetic resonance imaging (MRI) is both a crucial clinical and research tool for patients with deep brain stimulation (DBS) devices. However, safety concerns predominantly related to device heating have l","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"42-54"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11797914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stereotactic Frame-Based Targeting of the Posterior Fossa: A Systematic Workflow for the Leksell G Frame. 基于立体定向框架的后窝定位:Leksell G框架的系统工作流程。
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2024-12-13 DOI: 10.1159/000543013
Anton Fomenko, Artur Vetkas, Benjamin Davidson, Newton Cho, Suneil K Kalia

Introduction: Cerebellar deep brain stimulation (DBS) is gaining traction as a potential treatment for movement disorders and stroke, and there is renewed interest in the cerebellum as a target for neuromodulation. Despite the safety and accuracy of frame-based approaches to the posterior fossa, unconventional stereotactic frame placement may be necessary to allow for low posterior fossa trajectories. Current literature lacks a comprehensive protocol detailing inverted frame placement and targeting.

Methods: Preoperative imaging was acquired prone. An inverted Leksell G frame was applied along with an open-topped CT fiducial box, followed by a prone CT with the scanner set to the "legs first, nose up" configuration. Target coordinates were extracted from navigation software after image fusion. Intraoperatively, the patient was positioned prone, and the stereotactic arc was mounted in the lateral-right orientation, with inverted arc supports. Confirmatory stereotaxy to a scalp staple was performed, and the DBS leads were then inserted.

Conclusion: Our standardized protocol provides a flexible platform for posterior fossa DBS, allowing for low trajectories and multiple electrodes. Unlike conventional upright frame placement, an inverted frame permits an unobstructed view of suboccipital entry sites and incision placement. A conventional frame and regular planning software are sufficient, with no additional mathematical calculations required.

小脑深部脑刺激(DBS)作为一种潜在的运动障碍和中风的治疗方法正在获得关注,小脑作为神经调节的靶点重新引起了人们的兴趣。尽管基于框架的后窝入路安全性和准确性高,但可能需要非传统的立体定向框架放置,以允许低后窝轨迹。目前的文献缺乏一个全面的协议,详细说明倒置框架的放置和目标。方法术前俯卧成像。倒置Leksell G框架与开放式CT基准盒一起应用,然后是俯卧CT,扫描仪设置为“腿先,鼻子朝上”的配置。图像融合后,从导航软件中提取目标坐标。术中,患者俯卧,立体定向弧线安装在右侧侧向,并使用倒弧支撑。对头皮钉进行确认性立体定位,然后插入DBS导联。结论:我们的标准化方案为后颅窝DBS提供了灵活的平台,允许低轨迹和多个电极。与传统的直立框架放置不同,倒置框架允许不受阻碍地观察枕下进入部位和切口放置。一个常规的框架和常规的规划软件就足够了,不需要额外的数学计算。
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引用次数: 0
Disruption Driving Innovation: Optimising Efficiency in Functional Neurosurgery. 破坏驱动创新:优化功能神经外科的效率。
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2024-11-28 DOI: 10.1159/000542110
Ludvic Zrinzo, Harith Akram, Jonathan Hyam, Joseph Candelario-Mckeown, Ranjit Rangnekar, Ashley Nwanze, San San Xu, Thomas Foltynie, Patricia Limousin, Marie T Krüger

Introduction: Rising NHS waiting lists are a major problem following the COVID-19 pandemic. In our institution, surgical waiting time for elective functional neurosurgical procedures, such as deep brain stimulation (DBS) and radiofrequency ablation (RFA), reached >1.5 years by the end of 2022. During 2023, reduced operating room availability, intraoperative MRI (iMRI) suite closure for refurbishment, and ongoing strikes threatened to increase waiting times further.

Methods: Our previous surgical workflow for DBS and RFA procedures was examined. Several aspects were identified, and changes implemented to increase efficiency. Procedure numbers, waiting times, lead placement accuracy, and complication rates before and after these changes were compared.

Results: Prior to 2023, an average of 0.8 new procedures were performed per surgical list. Introduction of a new workflow in 2023 allowed an average of 1.6 new procedures per surgical list (100% increase in productivity). In 2023, 95 DBS and 31 RFA procedures were performed on 79 surgical lists. This represents a 52% increase over "pre-pandemic" activity in 2019 (74 DBS, 9 RFA) on 102 available surgical lists. Mean (SD) targeting accuracy (0.8 [0.4] mm) was comparable to previous years (0.9[0.3] mm). In 2023, there were no infections requiring hardware removal and only one asymptomatic haemorrhage following an RFA procedure. The surgical waiting time was reduced from >1.5 years to <4 months by the end of 2023.

Conclusion: Changes in surgical workflow, with neurosurgeons working in parallel, maximise surgical efficiency and productivity, significantly increasing the number of DBS and RFA procedures without compromising accuracy and safety.

导言:COVID-19大流行后,NHS等待名单增加是一个主要问题。截至2022年底,我院选择性功能性神经外科手术(如深部脑刺激(DBS)和射频消融(RFA))的手术等待时间达到150年半。在2023年,手术室可用性减少,术中MRI (iMRI)套件关闭以进行翻新,以及持续的罢工可能会进一步增加等待时间。方法:回顾我们以前的DBS和RFA手术流程。确定了几个方面,并实施了更改以提高效率。比较这些改变前后的手术次数、等待时间、导联放置准确性和并发症发生率。结果:在2023年之前,平均每个手术清单进行0.8个新手术。2023年,新工作流程的引入使每个手术清单平均增加1.6个新程序(生产率提高100%)。2023年,在79个手术名单上进行了95例DBS和31例RFA手术。这比2019年102个可用手术名单上的“大流行前”活动(74个DBS, 9个RFA)增加了52%。平均(SD)瞄准精度(0.8 [0.4]mm)与前几年(0.9[0.3]mm)相当。在2023年,没有感染需要移除硬体,只有一例RFA手术后无症状出血。结论:手术工作流程的改变,神经外科医生并行工作,最大限度地提高了手术效率和生产力,显著增加了DBS和RFA手术的数量,同时又不影响准确性和安全性。
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引用次数: 0
Subthalamic Deep Brain Stimulation under General Anaesthesia for Parkinson's Disease: Institutional Experience and Outcomes. 全身麻醉下的眼下深部脑刺激治疗帕金森病:机构经验与成果。
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2024-11-27 DOI: 10.1159/000542791
Pedro Roldán, Alejandra Mosteiro, Jordi Rumià Arboix, Daniel Asín, Almudena Sánchez-Gómez, Francesc Valldeoriola, Marta García-Orellana, Nicolás de Riva, Ricard Valero

Introduction: Direct targeting in deep brain stimulation (DBS) has remarkably impacted the patient's experience throughout the surgery and the overall logistics of the procedure. When the individualised plan is co-registered with a 3D image acquired intraoperatively, the electrodes can be safely placed under general anaesthesia. How this applies to a general practice scenery (outside clinical trials and in a moderate caseload centre) has been scarcely reported.

Methods: Prospective single-centre study of patients treated with asleep subthalamic DBS for Parkinson's disease between January 2021 and December 2022. Clinical, motor, medication-dependence, and quality-of-life outcomes were evaluated after optimal programming (6 months). Wilcoxon test was used to compare pre- versus post-repeated measures. Surgical-related parameters were also analysed.

Results: Eighty-nine patients primarily operated for DBS were included in the study. Intraoperative electrode replacement was not necessary. Mean surgical duration was 217 (SD 44) minutes, including the implantation of the generator; and mean length of stay was 3 (SD 1) days. There was one surgical-related complication (delayed infection). Significant and clinically relevant improvement was seen in UPRS III (mean decrease 62%) (p < 0.001) and PDQ-8 (50% increase) (p < 0.001) after 6 months. Daily doses of medication were decreased by a mean of 68%, p < 0.001).

Conclusion: DBS can be safely performed under general anaesthesia in a pragmatic clinical environment, provided a multidisciplinary committee for patient selection and a dedicated surgical and anaesthetic team are available. The effectiveness in ameliorating motor symptoms, the ability to reduce the drug load, and the improvement in quality of life demonstrated in clinical trials could be reproduced under more generalised conditions as in our centre. The need for a team learning curve and the progressive evolution in, and adaptation to, trajectory planning software, anaesthetic management, intraoperative imaging, DBS device upgrades, and programming schemes should be contemplated in the transition process to direct targeting.

导言:脑深部刺激(DBS)术中的直接定位技术极大地改善了患者在整个手术过程中的体验以及整个手术的后勤工作。当个性化计划与术中获得的三维图像共同注册时,电极就可以在全身麻醉下安全放置。如何将这一方法应用于普通实践场景(在临床试验之外,在一个病例量适中的中心),目前还鲜有报道:方法:对 2021 年 1 月至 2022 年 12 月间接受睡眠眼下动眼神经 DBS 治疗的帕金森病患者进行前瞻性单中心研究。在最佳疗程(6 个月)结束后,对临床、运动、药物依赖性和生活质量进行评估。采用 Wilcoxon 检验比较重复前和重复后的测量结果。同时还分析了手术相关参数:研究共纳入 89 名主要接受 DBS 手术的患者。术中无需更换电极。平均手术时间为 217 分钟(标清 44 分钟),包括植入发生器;平均住院时间为 3 天(标清 1 天)。发生了一起手术相关并发症(延迟感染)。UPRS III 有了显著的临床改善(平均下降 62%)(p 结论:DBS 可在全麻下安全进行:在务实的临床环境中,只要有一个多学科委员会负责挑选患者,并有一个专门的手术和麻醉团队,就可以在全身麻醉下安全地进行 DBS 治疗。临床试验中证明的改善运动症状的有效性、减少药物负荷的能力和生活质量的改善,可以在更广泛的条件下重现,就像在我们中心一样。在向直接靶向过渡的过程中,应考虑到团队学习曲线的需要,以及轨迹规划软件、麻醉管理、术中成像、DBS 设备升级和编程方案的逐步发展和适应。
{"title":"Subthalamic Deep Brain Stimulation under General Anaesthesia for Parkinson's Disease: Institutional Experience and Outcomes.","authors":"Pedro Roldán, Alejandra Mosteiro, Jordi Rumià Arboix, Daniel Asín, Almudena Sánchez-Gómez, Francesc Valldeoriola, Marta García-Orellana, Nicolás de Riva, Ricard Valero","doi":"10.1159/000542791","DOIUrl":"10.1159/000542791","url":null,"abstract":"<p><strong>Introduction: </strong>Direct targeting in deep brain stimulation (DBS) has remarkably impacted the patient's experience throughout the surgery and the overall logistics of the procedure. When the individualised plan is co-registered with a 3D image acquired intraoperatively, the electrodes can be safely placed under general anaesthesia. How this applies to a general practice scenery (outside clinical trials and in a moderate caseload centre) has been scarcely reported.</p><p><strong>Methods: </strong>Prospective single-centre study of patients treated with asleep subthalamic DBS for Parkinson's disease between January 2021 and December 2022. Clinical, motor, medication-dependence, and quality-of-life outcomes were evaluated after optimal programming (6 months). Wilcoxon test was used to compare pre- versus post-repeated measures. Surgical-related parameters were also analysed.</p><p><strong>Results: </strong>Eighty-nine patients primarily operated for DBS were included in the study. Intraoperative electrode replacement was not necessary. Mean surgical duration was 217 (SD 44) minutes, including the implantation of the generator; and mean length of stay was 3 (SD 1) days. There was one surgical-related complication (delayed infection). Significant and clinically relevant improvement was seen in UPRS III (mean decrease 62%) (p < 0.001) and PDQ-8 (50% increase) (p < 0.001) after 6 months. Daily doses of medication were decreased by a mean of 68%, p < 0.001).</p><p><strong>Conclusion: </strong>DBS can be safely performed under general anaesthesia in a pragmatic clinical environment, provided a multidisciplinary committee for patient selection and a dedicated surgical and anaesthetic team are available. The effectiveness in ameliorating motor symptoms, the ability to reduce the drug load, and the improvement in quality of life demonstrated in clinical trials could be reproduced under more generalised conditions as in our centre. The need for a team learning curve and the progressive evolution in, and adaptation to, trajectory planning software, anaesthetic management, intraoperative imaging, DBS device upgrades, and programming schemes should be contemplated in the transition process to direct targeting.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dorsal Column Spinal Cord Stimulation Attenuates Brain-Spine Connectivity through Locomotion- and Visuospatial-Specific Area Activation in Progressive Freezing of Gait. 背柱脊髓刺激通过运动和视觉空间特异性区域激活,减弱渐进性步态冻结的脑脊柱连通性
IF 1.9 4区 医学 Q3 NEUROIMAGING Pub Date : 2024-11-18 DOI: 10.1159/000541986
Ajmal Zemmar, David H Aguirre-Padilla, Irene E Harmsen, Julianne Baarbé, Can Sarica, Kazuaki Yamamoto, Talyta Grippe, Ghazaleh Darmani, Amitabh Bhattacharya, Zhongcan Chen, Kelly E Gartner, Nelleke van Wouwe, Paula Azevedo, Artur Vetkas, Darcia Paul, Nardin Samuel, Gianluca Sorrento, Brendan Santyr, Nathan Rowland, Suneil Kalia, Robert Chen, Alfonso Fasano, Andres M Lozano

Introduction: Freezing of gait (FOG) is a clinical phenomenon with major life impairments and significant reduction in quality of life for affected patients. FOG is a feature of Parkinson's disease and a hallmark of primary progressive FOG, currently reclassified as Progressive Supranuclear Palsy-progressive gait freezing (PSP-PGF). The pathophysiology of FOG and particularly PGF, which is a rare degenerative disorder with a progressive natural history of gait decline, is poorly understood. Mechanistically, changes in oscillatory activity and synchronization in frontal cortical regions, the basal ganglia, and the midbrain locomotor region have been reported, indicating that dysrhythmic oscillations and coherence could play a causal role in the pathophysiology of FOG. Deep brain stimulation and spinal cord stimulation (SCS) have been tested as therapeutic neuromodulation avenues for FOG with mixed outcomes.

Methods: We analyzed gait and balance in 3 patients with PSP-PGF who received percutaneous thoracic SCS and utilized magnetoencephalography (MEG), electroencephalography, and electromyography to evaluate functional connectivity between the brain and spine.

Results: Gait and balance did not worsen over a 13-month period. This observation was accompanied by decreased beta-band spectral power in the whole brain and particularly in the basal ganglia. This was accompanied by increased functional connectivity in and between the sensorimotor cortices, basal ganglia, temporal cortex, and cerebellum, and a surge in corticomuscular coherence when SCS was paired with visual cues.

Conclusion: Our results suggest synergistic activity between brain and spinal circuits upon SCS for FOG in PGF, which may have implications for future brain-spine interfaces and closed-loop neuromodulation for patients with FOG.

导言:步态冻结(FOG)是一种临床现象,会严重影响患者的生活,并显著降低其生活质量。步态冻结是帕金森病的特征之一,也是原发性进行性步态冻结(PPGF)的标志,目前被重新归类为进行性核上性麻痹-进行性步态冻结(PSP-PGF)。步态冻结是一种罕见的退行性疾病,具有渐进性步态衰退的自然病史,但人们对步态冻结的病理生理学,尤其是步态冻结的病理生理学知之甚少。从机理上讲,额叶皮质区、基底神经节和中脑运动区的振荡活动和同步性的变化已被报道,这表明节律失调的振荡和一致性可能在 FOG 的病理生理学中起着因果作用。DBS和SCS已作为治疗FOG的神经调控途径进行了测试,但结果不一:我们分析了三名接受经皮胸椎脊髓刺激(SCS)的 PSP-PGF 患者的步态和平衡能力,并利用脑磁图(MEG)、脑电图(EEG)和肌电图(EMG)评估大脑和脊柱之间的功能连接:结果:在 13 个月的时间里,步态和平衡没有恶化。与此同时,全脑尤其是基底神经节的 beta 波段频谱功率有所下降。与此同时,感觉运动皮层、基底神经节、颞叶皮层和小脑内部及之间的功能连通性增强,并且当 SCS 与视觉线索配对时,皮质肌肉连贯性激增:我们的研究结果表明,在SCS治疗PGF的FOG时,大脑和脊髓回路之间会产生协同活动,这可能对未来的脑脊接口和FOG患者的闭环神经调控产生影响。
{"title":"Dorsal Column Spinal Cord Stimulation Attenuates Brain-Spine Connectivity through Locomotion- and Visuospatial-Specific Area Activation in Progressive Freezing of Gait.","authors":"Ajmal Zemmar, David H Aguirre-Padilla, Irene E Harmsen, Julianne Baarbé, Can Sarica, Kazuaki Yamamoto, Talyta Grippe, Ghazaleh Darmani, Amitabh Bhattacharya, Zhongcan Chen, Kelly E Gartner, Nelleke van Wouwe, Paula Azevedo, Artur Vetkas, Darcia Paul, Nardin Samuel, Gianluca Sorrento, Brendan Santyr, Nathan Rowland, Suneil Kalia, Robert Chen, Alfonso Fasano, Andres M Lozano","doi":"10.1159/000541986","DOIUrl":"10.1159/000541986","url":null,"abstract":"<p><strong>Introduction: </strong>Freezing of gait (FOG) is a clinical phenomenon with major life impairments and significant reduction in quality of life for affected patients. FOG is a feature of Parkinson's disease and a hallmark of primary progressive FOG, currently reclassified as Progressive Supranuclear Palsy-progressive gait freezing (PSP-PGF). The pathophysiology of FOG and particularly PGF, which is a rare degenerative disorder with a progressive natural history of gait decline, is poorly understood. Mechanistically, changes in oscillatory activity and synchronization in frontal cortical regions, the basal ganglia, and the midbrain locomotor region have been reported, indicating that dysrhythmic oscillations and coherence could play a causal role in the pathophysiology of FOG. Deep brain stimulation and spinal cord stimulation (SCS) have been tested as therapeutic neuromodulation avenues for FOG with mixed outcomes.</p><p><strong>Methods: </strong>We analyzed gait and balance in 3 patients with PSP-PGF who received percutaneous thoracic SCS and utilized magnetoencephalography (MEG), electroencephalography, and electromyography to evaluate functional connectivity between the brain and spine.</p><p><strong>Results: </strong>Gait and balance did not worsen over a 13-month period. This observation was accompanied by decreased beta-band spectral power in the whole brain and particularly in the basal ganglia. This was accompanied by increased functional connectivity in and between the sensorimotor cortices, basal ganglia, temporal cortex, and cerebellum, and a surge in corticomuscular coherence when SCS was paired with visual cues.</p><p><strong>Conclusion: </strong>Our results suggest synergistic activity between brain and spinal circuits upon SCS for FOG in PGF, which may have implications for future brain-spine interfaces and closed-loop neuromodulation for patients with FOG.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
2024 Biennial Meeting of the American Society for Stereotactic and Functional Neurosurgery. Nashville, TN, June 1-4, 2024. 2024 年美国立体定向和功能神经外科学会双年会。2024 年 6 月 1-4 日,田纳西州纳什维尔。
IF 1.7 4区 医学 Q3 NEUROIMAGING Pub Date : 2024-09-17 DOI: 10.1159/000541197
Kim Santos
None.
无。
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引用次数: 0
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Stereotactic and Functional Neurosurgery
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