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Functional Neurosurgery - Science topic

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Dear Neurosurgeons,
Please fill out this survey on research productivity during the pandemic.
Thank you for your time.
#neurosurgery #research #productivity #pandemic #covid #collaboration
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done
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Looking for information on Clinical Neuropsychology Postdoctoral positions that focuses on Pre/ Intraoperative/ Post-Operative Brain Mapping and Cortical Stimulation in the United States / France/ Europe/ Australia.
Also looking for information on Centers/ Hospitals and names of Clinical Neuropsychologist who routinely perform these protocols (Brain Mapping and Cortical Stimulation) for Awake Brain Surgeries in US, France/ Europe and Australia.
Any information on any of the above would be greatly appreciated.
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You may wish to contact David Loring PhD, ABPP, FAAN at Emory University Brain Health Center. He would likely be aware of such fellowships. http://neurology.emory.edu/faculty/neuropsychology/loring_david.html
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Hi. I want to start an animal (rat) experiment for functional neurosurgery. Please suggest a topic.
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You can make an animal lab in super speciality hospital.
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Dear Colleagues,
Perhaps you could help me find answers to several questions on the neural organization of alphabet and number recitation:
1. Could recitation of numbers and letters rely on phonological long-term memory without accessing lexical information? Alternatively, could lexical information be accessed only for numbers (since they are words) but not letters (that are not words)?
2. Several neuroimaging studies (including clinical reports) have shown a dissociation between letter and number sequencing (recitation, reading and writing). Why do you think this is the case?
3. A patient could not recite the alphabet but could sing it upon electrical brain stimulation. Any suggestions why this happened?
Help with any of the questions will be greatly appreciated!
Thank you!
Monika
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Dear Monika! Please see related articles in Attachment. All the best. Vladimir
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Does anyone know literature on the rate of postsurgical unexpected language deficits in epilepsy and/or brain tumor patients?
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Hi Monika,
in people with brain tumours, the closest article I can think of to answer to your question is the meta-analysis by De Witt Hamer et al. 2012:
Hamer, P. C. D. W., Robles, S. G., Zwinderman, A. H., Duffau, H., & Berger, M. S. (2012). Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. Journal of Clinical Oncology, 30(20), 2559-2565.
Regards,
Adrià
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Greetings everyone. I am just trying to figure out how  routinely intraoperative neuropsychological and brain mapping protocols are performed at highly specialised neurosurgical units/ centres . Please do feel free to share where were you trained  to competently carry out these advance protocols?  And what are the usual techniques/ protocols that you perform?
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Dear Vgneswaran,
At UCLA neo-surgical language mapping is pretty common. There are 2-3 pre-operative language fMRIs a week, 1-2 Wada tests a month, and about one intraopeartive language mapping a month. As far as I know, all patient undergo pre- and post-surgical evaluations.
As to brain mapping protocols, 3 lexico-semantic tasks are used in fMRI: object naming, auditory responsive naming, and reading. We use the Montreal protocol for the Wada test. The protocol consists of object naming, and following simple instructions (e.g., "Wiggle your toes"). The two tasks are used during the encoding phase for memory and language assessment. During the recovery phase, we use additional language tests: simple language comprehension tasks (e.g., "Does the stone sink in water?"), auditory responsive naming, repetition, and grammar tasks. During intraoperative mapping we typically use object naming, and less commonly reading, auditory responsive naming, and spontaneous speech. 
Together with my UCLA co-workers, I have been working on augmenting the three language mapping techniques with grammar production and comprehension tests. We got some interesting results. We hope to add those to standard language mapping in the near future.
I am not very familiar with protocols used at neuropsychological evaluations but I could contact you with neuropsychologists working at UCLA.
Hopefully this answers your question. Please let me know if I can be of any further assistance.
Best,
Monika
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I would greatly appreciate information on what stereotaxic coordinates are used to successfully target the mouse ventral hippocampus and what volume is optimal for infusion without getting spread outside of the brain. I know that spread can sometimes depend on the properties of what is being infused, but a rough idea as to where to start will greatly help.
Thank you!
Best,
Yas
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One can refer to a Mouse stereotaxic Atlas,
But more practical will be to formalin fix the mouse skull and take sections coronal and sagittal and take measurements.  Infusions into solid brain tissue will always spread unless you use a double barrel push-pull cannula. Injections in micro litre are possible and you have to make sure that the solution is already at the tip.  Always after you complete your experiments inject a dye in the same volume and examine postmortem.
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To what extend the white spot can affect the vision of mouse and do you have better practice to minimize the occurrence of them?
P.S: I keep the eye covered with animal eye gel, try to minimize the direct light from the lamp, but sometimes the white spot becomes so obvious within 1hr that it almost occupy most of the eye.
Many Thanks!
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Hi Janet, the white spot usually disappears gradually during the recovery stage. I later find a complete wetting of the cornea during the whole surgery dramatically diminishes the chance of having white spots. In addition, it is good to avoid a direct surgical lighting towards the eyes.
Thanks for putting forward a possible cause by the hypotension. The cardiac output diminishes for sure when the mouse is anesthetized. 
Good luck to your research!
Jiahao
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I have been practicing placing back the craniotomy flap on the open dura and the temporalis flap and never had a problem in the immediate post operative period and or the late period. I am aware of the various options and do practice the placement of the free flap in the parietes of the abdomen. A surprising comment made by a colleague, suggested that the same may have a complication of sinking flap. On surveying the literature I couldnt find any study suggesting the same. I wonder if I missed on any such study. I would like help on this issue.
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Dear Dr Ito
Many thanks for your participation.
Would it be surprising if I said that there has been no CSF leak inspite of keeping the the dura open in my practice. And that is precisely the question - why should we need to a tight dural closure.  I would appreciate if you could give relevant reference.
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An interesting paper has been published on Journal of Neurosurgical Sciences.
The title is: Is there still a role for lesioning in functional neurosurgery: the Italian experience of delivering focused ultrasound high energy through a 1,5 tesla MR apparatus
Is there still a role for lesioning in functional neurosurgery?
Is neuromodulation a real "no lesion" treatment?
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Yes.  Decidedly yes. There are many patients with diseases whose conditions are not amenable to implanted electrodes for whom an ablative procedure can be very helpful.  There are, for example, elderly patients whose underlying cardiovascular disease mandates anticoagulant therapy that cannot be discontinued who may be candidates for radiosurgical treatment of a movement disorder, and patients with gelastic seizures from hypothalamic hamartomas that cannot be safely resected for whom an ablative or neuromodulatory radiosurgical procedure can improve seizure control.  Obsessive compulsive disorder and medial temporal lobe epilepsy have been successfully treated with Gamma Knife radiosurgery and musicians' dystonia is yet another condition that has been shown to be successfully treated by ablative neurosurgical procedures. 
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I will use it for functional and stereotactic surgery planning.
I use a CRW frame with which I use a very simple software for planning, and I am in need of a more sophisticated and low priced software.
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Take a look at Osirix. There is a free open source version with many plug-ins available. I have not used it for stereotactic planning, but I believe this functionality is available.
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Patient specific information acquired preoperatively may contribute to target planning, e.g. in thalamus neurosurgery. Information on thalamo-cortical connectivity patterns may refine target volumes, or information on the precise course of white matter pathways (subthalamic zone) may be used for designating new target locations. Is this technique ready to be applied in the neurosurgical practice?
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Hello Andras and Reese
May I generate some debate on this topic? Just because a clinical protocol is common practice in the US does not mean it is the logical thing to do! One could argue that invasive multi track mapping with MER is a relic of a bygone era when the pioneers of functional neurosurgery could not see the target they were aiming for, let alone verify the anatomical location of their intervention.
In the 21st century, MRI can be used for intraoperative verification and not just preoperative surgical planning. MRI-verified DBS has MANY advantages over microelectrode (MER) mapping including:
1. There is more published data linking lead location on MRI to long term clinical outcome , both in optimising improvement in UPDRS scores (e.g.: Wodarg 2012, Aviles-Olmos 2014) and in minimising adverse effects, for example dysarthria (Tripoliti 2014). Even if particular MER signals could be linked to good long term clinical outcome (I am not aware of any paper that has done so convincingly) there is no way of replicating recordings in subsequent patients.
2. MRI-verfied DBS carries significantly less risk of haemorrhage causing stroke or death (Zrinzo 2011)
3. MRI-verified procedures can be performed under GA and patients do not have to stop medication completely prior to surgery making for quicker recovery and less perioperative complications (Nakajima 2011)
4. Shorter operative times with MRI-verified DBS allow us to perform two complete bilateral DBS implants with IPG in one day with time to spare at Queen Square (london, UK)
5. MRI-verified surgery is significantly less expensive - to the tune of 'buy one get one free" (McClelland 2011)
After being rather provocative, I would add that there is no "BEST" way to perform DBS. Each surgeon should adapt his/her technique to the local infrastructure, personal training and experience. It would be a real pity if every DBS service around the world performed surgery in exactly the same way!
Best wishes to both!
Ludvic
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A pseudomeningocels extending over the T9 & T10 vertebrae with cross-section attached.
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Dear All,
Most of the pseudomeningocells are asymptomathic. It is frequently seen after Chiari malformation repair. Most of them are spontaneously getting smaller and smaller and dissapaire. If there is differnce in volum in first and second MR sections in favor of growing. This means that there is ball valve mechanism which CSF enter the meningocell cavity and traps there. Operation indicate these rare cases.
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An operation on the unforgiving spinal cord in a patient suffering severe pain for 7 years, and he is pain-free now with no deficit. This is probably the first of such kind of operation in our country.
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we have done 7 cases so far for intractable Post Brachial plexus pain and all patients are happy at average followup of 1 year and without pain