Nicolas Kon Kam King

Nicolas Kon Kam King
National Neuroscience Institute | NNI · Department of Neurosurgery

MBChB FRCS PhD DIC

About

113
Publications
22,442
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1,683
Citations
Additional affiliations
January 2008 - present
National Neuroscience Institute
January 2004 - December 2008

Publications

Publications (113)
Article
Background: Anterior nucleus (AN) deep brain stimulation (DBS) is a palliative treatment for medically refractory epilepsy. The long-term efficacy and the optimal target localization for AN DBS are not well understood. Objective: To analyze the long-term efficacy of AN DBS and its predictors. Methods: We performed a retrospective review of 16...
Article
Full-text available
Introduction: The effect of the variability of electrode placement on outcomes after bilateral deep brain stimulation of subthalamic nucleus has not been sufficiently studied, especially with respect to the sequence of hemisphere implantation. Methodology: We retrospectively analysed the clinical and radiographic data of all the consecutive pati...
Article
Full-text available
An accurate prognostic model is extremely important in severe traumatic brain injury (TBI) for both patient management and research. Clinical prediction models must be validated both internally and externally before they are considered widely applicable. Our aim is to independently externally validate two prediction models, one developed by the CRA...
Article
Segmentation of intracerebral hemorrhage (ICH) helps improve the quality of diagnosis, draft the desired treatment methods, and clinically observe the variations with healthy patients. The clinical utilization of various ICH progression scoring systems has limitations due to the systems’ modest predictive value. This paper proposes a single pipelin...
Article
Chronic subdural haemorrhage (CSDH) is a common neurosurgical entity with complex pathophysiological pathways. The generally favourable surgical outcome may be affected by its associated risks including recurrence rates. We performed a prospective randomized multi-center clinical trial comparing the addition of tranexamic acid (TXA) to standard neu...
Article
Objective Following the outbreak of coronavirus 2019 (COVID-19), there is strong evidence of neurological involvement in these patients. We aimed to determine the clinical characteristics of neurological manifestations in COVID-19. Method A systematic review of studies reporting neurological manifestations published between 1 December, 2019 and 11...
Article
Full-text available
IntroductionDeep brain stimulation of the subthalamic nucleus (STN DBS) has been shown to reduce antiparkinsonian medication in Parkinson’s disease. We aimed to investigate the changes in long-term medication profile with STN DBS.Methods Antiparkinsonian medication data for 56 patients were collected from as early as 3 years before STN DBS up to 10...
Article
Background Deep brain stimulation (DBS) to the subthalamic nucleus (STN) is an effective neurosurgery that overcomes the motor system alternations of patients with advanced Parkinson’s disease. The most challenging aspect of DBS surgery is the accurate identification of STN and its borders. In general, it is performed manually by a neurophysiologis...
Article
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Background In the United States, nearly 25,000 patients annually undergo percutaneous ventriculostomy for the management of increased intracranial pressure with little consensus on extraventricular drain management. To characterize relationships between external ventricular drain management, permanent ventriculoperitoneal shunt placement, and hospi...
Article
Background and Purpose— Selective serotonin reuptake inhibitors (SSRIs) have a well-established association with bleeding complications and conflicting reports on outcome after stroke. We sought to evaluate whether pre–intracerebral hemorrhage (ICH) SSRI use increased ICH risk and post-ICH SSRI use improved ICH outcome. Methods— Through post hoc a...
Article
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This article presents a robotic needle positioning approach with a novel 4-DoF parallel positioner, two back-driveable 2-channel linear/rotational driver, and a machine–body interface. Being more compact and flexible, Ni–Ti alloy wire-based Bowden cable transmission is introduced to connect the positioner and the drivers. For this new mechanism, fo...
Article
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Background: Gliomas consist of a heterogeneous group of tumors. This study aimed to report the incidences of O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation, 1p19q co-deletion, isocitrate dehydrogenase (IDH) gene mutations, and inactivating mutations of alpha-thalassemia/mental retardation syndrome X-linked (ATRX) in high-grade...
Article
Introduction: Posterior fossa surgery is the established treatment for large cerebellar strokes with brainstem compression. Despite this, there is a paucity of data for long-term outcomes. Methods: A retrospective analysis of patients who underwent posterior fossa surgery for cerebellar haemorrhages and infarcts was performed to compare their di...
Article
Objective: Neurosurgery presents unique surgical challenges arising from delicate neural structures, limited accessibility, and the risk of CSF leakage that can lead to CNS infections. Sutures and staples may have limited applicability in the complex anatomical constraints of cranial and spinal surgeries, especially in trauma settings when time is...
Article
Background: Neurologic disorders impose a heavy burden on healthcare in Singapore. To date, no data on the willingness to pay (WTP) for neurologic treatments has been reported in the local population. Objectives: We aimed to quantify the value of various health domains to neuroscience patients and their caregivers by comparing their WTP for diff...
Article
The use of anticoagulation and antiplatelet agents (ACAP) has steadily increased over recent years. However, the effects of ACAP on traumatic brain injuries (TBI) are not well investigated. The aim of this study was to investigate the effects of pre-injury ACAP use on clinical outcome and mortality in severe TBI. A retrospective case-control study...
Conference Paper
Full-text available
Accurate localization of subthalamic nucleus (STN) is a key prior in deep brain stimulation (DBS) surgery for the patients with advanced Parkinson's disease (PD). Microelectrode recordings (MERs) along with preplanned trajectories are often employed for the STN localization and it remains challenging task. These MER signals are nonstationary and mu...
Article
Purpose The purpose of this study is to navigate an in-house robot under uncertain intraoperative changes of the body surface which is not present in the pre-operative scan in hospital environments and lab environment. Methods The proposed methodology involves the use of a 3D scanner to form a 3D model. The method used in this study is cost effect...
Article
Glioblastoma multiforme (GBM) are malignant brain tumors, associated with poor overall survival (OS). This study aims to predict OS of GBM patients (in days) using a regression framework and assess the impact of tumor shape features on OS prediction. Multi-channel MR image derived texture features, tumor shape, and volumetric features, and patient...
Article
Glioblastoma multiforme (GBM)is a rapidly growing tumor associated with poor prognosis. This study evaluates the effectiveness of thirteen tumor shape features for overall survival (OS)prognosis in GBM patients. Shape features were extracted from the abnormality regions of the GBM tumor visible on the fluid attenuated inversion recovery (FLAIR)and...
Article
This paper presents a disposable fiber Bragg grating (FBG)-based tri-directional force/torque sensor mountable at the end of the tip of the aspiration instruments for detecting instrument-tissue interaction force/torque. The sensor utilizes an inexpensive 3D-printed elastomer with an annular diaphragm which is sensitive to axial force (Fz) and torq...
Article
Full-text available
Purpose This study aims to identify the neuropsychological tests commonly used for assessment in each neurocognitive domain, and quantify the post-operative changes in neurocognitive function in the immediate post-operation and follow-up. Methods With the use of the PubMed, a comprehensive search of the English literature was performed following P...
Article
Full-text available
Background Survivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study was to build a nomogram predictor of 1-year and 3-year mortality for major blunt trauma adult survivors of the index hospitalizatio...
Article
Background Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage (ICH) and is known to be a strong predictor of neurological deterioration as well as poor functional outcome. This study aims to externally validate three risk prediction models of HE (PREDICT, 9-point, and BRAIN scores) in an Asian popula...
Article
Purpose: Surgery for brain metastases aims to reduce mass effect and achieve local control through maximizing resection. There is increasing recognition that awake craniotomy (AC) is especially relevant for resection of brain metastases in eloquent areas. This study seeks to examine the neurological outcomes of using AC for brain metastases resect...
Article
Glioblastoma multiforme (GBM) are aggressive brain tumors, which lead to poor overall survival (OS) of patients. OS prediction of GBM patients provides useful information for surgical and treatment planning. Radiomics research attempts at predicting disease prognosis, thus providing beneficial information for personalized treatment from a variety o...
Article
Purpose: We conducted a single-center retrospective review to investigate the long-term recovery of patients who were severely disabled or vegetative secondary to primary intracerebral hemorrhage upon discharge from hospital from January 2009 to November 2013. Methods: Patients were categorized into two groups based on their Glasgow outcome scal...
Article
Objective: This study seeks to systematically review the selection of features and algorithms for machine learning and automation in deep brain stimulation surgery (DBS) for Parkinson's disease. This will assist in consolidating current knowledge and accuracy levels to allow greater understanding and research to be performed in automating this pro...
Article
Full-text available
We report the development and implementation of an epi-detected spectral-focusing hyperspectral stimulated Raman scattering (SRS) imaging technique for label-free biomolecular subtyping of glioblastomas (GBMs). The hyperspectral SRS imaging technique developed generates SRS image stacks (from 2800 to 3020 cm-1 at 7 cm-1 intervals) within 30 s throu...
Article
Fulltext: https://rdcu.be/MpZB; Robotic systems play an increasingly important role in improving feasibility and effectiveness of minimally invasive neurosurgery (MIN). However, large footprint, bulky size, and complex mechanisms limit the clinical application of existing robotic neurosurgery solutions. This paper proposes a novel skull-mounted rob...
Article
Background: Decisions to limit care, including use of a do-not-resuscitate (DNR) order, are associated with increased risk of death after intracerebral hemorrhage (ICH). Given the value that patient surrogates place on the physician's perception of prognosis, understanding prognostic indicators that influence clinical judgment of outcomes is criti...
Poster
Objective #3263. Sanghani et al. Evaluation of tumor shape features for overall survival prognosis in glioblastoma multiforme patients To study the effectiveness of 13 GBM tumor shape (3D and 2D) features for OS prognosis of GBM patients.
Article
Full-text available
Background: Intraoperative frozen section assessment, to confirm acquisition of pathological tissues, is used in stereotactic brain biopsy to minimise sampling errors. Limitations include the dependence on dedicated neuro-oncology pathologists and an increase in operative duration. We investigated the use of intraoperative fluorescein sodium, and...
Article
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Cathodal-transcranial direct current stimulation induces therapeutic effects in animal ischemia models by preventing the expansion of ischemic injury during the hyperacute phase of ischemia. However, its efficacy is limited by an accompanying decrease in cerebral blood flow. On the other hand, peripheral sensory stimulation can increase blood flow...
Article
Objective: Numerous scores have been developed for prognostication of outcomes in intracerebral hemorrhage (ICH). Prediction models must be validated internally and externally before they are considered widely applicable. We aim to independently externally validate and compare three prediction models (ICH score, ICH grading scale (ICH-GS) and simp...
Article
Objective: Current prognostic models for traumatic brain injury (TBI) available for use are developed from diverse historical datasets. We aim to construct a prognostication tool for severe TBI as it is this group who would benefit the most from an accurate model. Methods: Model development was based on a cohort of 300 patients with severe TBI (...
Article
Full-text available
Introduction Recent advances in surgical imaging include the use of diffusion tensor imaging (DTI) in deep brain stimulation (DBS) and provide a detailed view of the white matter tracts and their connections which are not seen with conventional magnetic resonance imaging. Given that the efficacy of DBS depends on the precise and accurate targeting...
Article
Objective: This study aims to characterize pyramidal tract shift at different regions of brain during glioma resection and its association to head position and tumor location. Methods: From 2008-2013, 14 patients presenting at NNI with high grade glioma (WHO III or IV) underwent preoperative and intraoperative Diffusion Tensor Imaging (DTI) . A...
Article
Background: Thalamic deep brain stimulation (DBS) is an effective strategy for the treatment of essential tremor (ET). With limitations of imaging modalities, targeting largely relies on indirect methods. This study was designed to determine the optimal target for DBS in ET and construct a targeting method based on probabilistic maps. Methods: P...
Article
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Gangliogliomas comprise of less than 1% of all primary brain tumours. Malignant transformation is rare. Correspondingly, secondary gliosarcomas, especially in the absence of previous irradiation exposure is too, exceedingly rare. Recent evidence supports the use of mutant IDH1 testing in suspected adult gangliogliomas as a distinguishing feature be...
Article
Full-text available
Background: The thalamus has been a surgical target for the treatment of various movement disorders. Commonly used therapeutic modalities include ablative and nonablative procedures. A major clinical side effect of thalamic surgery is the appearance of speech problems. Objective: This review summarizes the data on the development of speech probl...
Article
Full-text available
The advance of thrombolytic therapy has been hampered by the lack of optimization of the therapy during the hyperacute phase of focal ischemia. Here, we investigate neurovascular dynamics using a custom-designed hybrid electrocorticography (ECoG)-functional photoacoustic microscopy (fPAM) imaging system during the hyperacute phase (first 6 h) of ph...
Article
Background The use of fluorescein fluorescence-guided stereotactic needle biopsy has been shown to improve diagnostic accuracy and to expedite operative procedure in the stereotactic needle biopsy of high-grade gliomas. We developed a device (Fluoropen) for detecting fluorescence in brain tumor tissues obtained by fluorescein fluorescence-guided st...
Article
Introduction: Spontaneous primary intracerebral hemorrhage (ICH) accounts for approximately 25% of all strokes in Singapore. Incidence of recurrent ICH is not well studied, and previous studies have reported inconsistent findings in the rate and risk factors associated with ICH recurrences. We aimed to study the incidence of recurrent ICHs in Sing...
Article
Full-text available
OBJECTIVE The authors explored the feasibility of seizure detection and prediction using signals recorded from the anterior thalamic nucleus, a major target for deep brain stimulation (DBS) in the treatment of epilepsy. METHODS Using data from 5 patients (13 seizures in total), the authors performed a feasibility study and analyzed the performance...
Article
Background: The prevalence of asymptomatic unruptured intracranial aneurysms (AUIA) in a Southeast Asian population has not been previously studied. Knowing the disease burden and population at risk can assist us in making informed decisions when managing AUIAs. We aimed to determine if the local prevalence of AUIAs differed from other populations...
Article
OBJECTIVE The ventral intermediate nucleus (VIM) of the thalamus is not visible on structural MRI. Therefore, direct VIM targeting methods for stereotactic tremor surgery are desirable. The authors previously described a direct targeting method for visualizing the VIM and its structural connectivity using deterministic tractography. In this combine...
Article
Full-text available
Background: The ventral intermediate nucleus of the thalamus is not readily visible on structural magnetic resonance imaging. Therefore, a method for its visualization for stereotactic targeting is desirable. Objective: The objective of this study was to define a tractography-based methodology for the stereotactic targeting of the ventral interm...
Chapter
Previous work has been demonstrated that tracking features describing the dynamic and time-varying patterns in brain monitoring signals provide additional predictive information beyond that derived from static features based on snapshot measurements. To achieve more accurate predictions of outcomes of patients with traumatic brain injury (TBI), we...
Article
Introduction: Traumatic brain injury (TBI) is a global concern associated with high mortality and morbidity. Costs to individuals and society are extensive due to poor recovery, long-term disability and the young age group affected. Statins have emerged as potential therapeutic agents in TBI. This study aimed to investigate the protective effect o...
Article
Full-text available
Background: The study of the most cited works in a particular field gives an indication of the important advances, developments, and discoveries that have had the highest impact in that discipline. Our aim was to identify the most cited works in essential tremor (ET) and dystonia. Methods: A bibliometric search was performed using the ISI Web of...
Article
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Background: Intracerebral hemorrhage (ICH) accounts for 10-15% of all first time strokes and with incidence twice as high in the Asian compared to Western population. This study aims to investigate gender differences in ICH patient outcomes in a multi-ethnic Asian population. Method: Data for 1,192 patients admitted for ICH were collected over a...
Data
Intracerebral Hemorrhage data set from National Neuroscience Institute, Singapore. (XLSX)
Chapter
Full-text available
Neuropsychiatric disorders that are refractory to best medical management continue to pose a signifi cant challenge. Advances in molecular neuroscience and neuroimaging have started to reveal how dysfunction in specifi c limbic networks mediates these disorders. This knowledge, along with concurrent advances in neurosurgical techniques, has lead to...