Functional Neurosurgery - Science topic

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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

You can make an animal lab in super speciality hospital.

Dear Monika! Please see related articles in Attachment. All the best. Vladimir

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

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

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.

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

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.

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. 

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.

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

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.

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