作者没有确认。

伦理声明:我们的协议，遵循我们的机构人类研究伦理委员会制定的准则。 1.药物难治性癫痫患者的识别<ol><li>此前创监测，评估在1描述的多学科会议讨论决定是否要继续与SEEG创监测必须经过allpatientswith非侵入性技术，如视频脑电图监测，MRI，PET，ictalSPECT，以及神经心理学研究制作。1,6,7,11,14 </li><li>形成有关的EZ的位置的假设。之前介入开发推定EZincorporating的发病发作区和癫痫（发作）的早期（ 即快速）传播的地区活动的植入前假说。 注:此步骤可与在作出决定追求微创montitoring多学科会议共同完成。 注意:SEEG VS的EZ假设硬膜下网格为基础，SEEG和硬膜下电网监控之间做出选择。标准要考虑可能包括:1）可能的深层次EZ; 2）以前不成功的硬膜下网格监控; 3）双边监督的迹象; 4）非皮损外颞叶癫痫之嫌。还应当指出，在硬膜网格SEEG的额外的好处，包括SEEG的记录和当有力地区域被假设是在EZ邻近刺激临界皮质下区域的能力。 </li><li>开发基于虚拟EZ（ 图1）量身定制的植入策略。1,7,8 注:足够的植入策略必须评估1）解剖病变（如果存在）; 2）结构（多个）最有可能参与inictal发病;和/或3）发作传播的可能途径（S）的功能性网络内。除了解剖考虑，后勤方面的考虑也必须加以考虑。对于由于这个原因，正交轨迹是在一般的优惠，以促进植入和，以后，电极的位置的解释。 </li><li>开发基于虚拟EZ注入策略之后，创建一个使用机器人辅助的计划。首先，创建一个新的相遇，选择"新病人"，然后点击"创建轨迹"，然后选择合适的"切入点"和"终点"，这与期望轨迹一致。 注:根据植入前假说，电极的数量通常之间的八个十二名。轨迹和兴趣点正在使用对比MRI或旋转血管造影典型的计划。这不仅显示脑部问题，但脑血管这些图像允许在无血管走廊轨迹计划，以避免血管损伤，出血。 </li></ol> 2.手术过程<ol><li>苏的前一天rgery，获得14对比，体积T1加权MRI由Kuzniecky 等人所描述的序列。 注:此图片是用于与机器人辅助登记，并且必须有1个mm层厚。然后将图像传送到立体定向神经导航软件，其中轨迹是基于前面讨论注入策略计划作为由Kuzniecky 等人所述。14 </li><li>一旦在手术室，放在手术台上的患者在仰卧位。然后获取气管插管全身麻醉根据麻醉师"协议。 注:当务之急是，他们是普通静脉麻醉和完整的药物麻痹下。然后剃病人头部，与抗生素外科应用预习皮肤，然后将病人的头部在头部神经外科头支架。全身麻醉不同于患者与患者。 </li><li>完成后，定位用的机器人系统连接至框架并完成注册。在机器人辅助设备选择"注册"，然后按照提示完成注册过程。根据面部特征或植入基准标记完成注册使用面的标志性注册。 </li><li>插入（ 图2） <ol><li>使用2.5毫米的钻头从机器人立体定向系统深入的指导协助头骨。将单极电凝探头打开硬脑膜。螺钉植入螺栓插入颅骨，也是由机器人立体定向系统的指导。 </li><li>计算使用下面的测量电极（D3）的最终深度距离:[（目标-杜拉距离）+（D1 - D2）= D3]。使用导航系统测量目标-硬脑膜距离。 注:D1被测量为引导系统到硬脑膜的长度，D2被测量为所述引导系统的长度，以在螺栓的端。的D 1 - D 2不同的是将螺栓的长度。螺栓和靶 - 硬脑膜距离的长度的总和是电极深度的长度。 </li><li>通过插入stylette探针，通过植入螺栓引导创建初始轨迹。然后插入电极并固定到螺栓。这可以防止进一步的位移和脑脊液（CSF）泄漏。 </li><li>放置并连接所有电极后，将绕螺栓帽碘溶液浸泡的纱布。而且，当时包住头部。 </li></ol></li></ol> 3.监测/记录<ol><li>整理的情况之前，将电极连接到脑电图记录机，以保证正常运行。在手术室中的最后一步是术中成像（ 图3）。执行术的X射线或荧光成像在横向和前后头骨。 注:获得这些以确保电极的适当轨迹。这些图像是不是obtained，来确保立体定向安置，而它们确保电极的一般正确轨迹和位置。 </li><li>手术后，转移患者癫痫监测单位监测癫痫发作临床和通过SEEG电极记录electrographically病人。 注:住宿天数不同，这取决于数量，质量和发作期和录音的发作模式。虽然监控患者可有轻微的疼痛，治疗这种对乙酰氨基酚。通常情况下，停留时间的长短是7天（范围为3 - 28天）。 </li><li>去除电极之前，讨论多学科会议关于患者审查录音和假设。 </li><li>记录足够的发作数据之后（步骤3.2）和病人在发布会上进行了讨论，同时等待或去除电极重启患者事先抗癫痫药物。 </li></ol> 4.返回或准备卸下<ol><li>房颤之三足记录数据的发作，病人返回手术室切除SEEG电极。在清醒镇静执行此;通常为2毫克咪达唑仑IV是足够了。 </li><li>麻醉获得足够的镇静后（通常与咪达唑仑[剂量推迟到麻醉师]），去除患者裹头，并切断电极线。通过电极去除或缝线插入报道的疼痛程度临床监测病人的镇静作用。然后预习使用碘化凝胶电极的其余螺栓和尾巴。 </li><li>个别地，通过扭曲其关闭除去每个螺栓帽，其次是电极，最后取出的螺栓。轻轻拉出来沿其插入轴取出电极。然后通过扭动它拆卸螺栓，通常这样做用手指。 </li><li>上移动到下一个电极之前，关闭由螺栓离开缺陷用尼龙缝合线中的一个线圈。重复这些步骤为每个电极。 REM后oving所有电极，覆盖抗生素软膏和一个松散的裹头针脚领域。 </li><li>取出后，获得进一步的成像CT或A / P和侧位X光片，以确保无残留的硬件。 注意:可能切除-如果手术切除被认为是有利于患者的癫痫然后要开颅和切除除去后大致6周计划。该延迟是由于相同的住院作为监视时段期间操作的传染性的担忧。 </li></ol>

<ol>
	<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. 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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>

作者什么都没有透露。

在这里，提出利用机器人立体定向援助SEEG插入技术。同时采用基于帧的立体定位等方法最初描述SEEG，机器人辅助SEEG不仅提供类似的安全性，更高的精度和效率。在个案当中，超过76％，这与使用替代技术。6,13其他以往的研究同情本地化EZ文献报道的成功。 正如任何侵​​入颅内程序，SEEG并非没有风险。幸运的是，SEEG插入报道非常低的并发症的危险。15最显着，颅内出血是最严重的并发症10,11。这些结果与当前SEEG文献兼容。对于SEEG利用机器人辅助不仅安全，而且高效，准确，证明是一个很有前途的技术。 虽然技术出众，它提供对手术时间显著的改进，机器人的援助是不完美的。必须落实到一个人的练习之前被认为是一个限制因素是产品收购的初始成本。根据个别情况下，这个数字可以很容易地单独进行改进或时间是合理的。 必须不能掉以轻心另一个关键步骤是正确的登记初始深度的位置和所有后续深度之前的关键特性。如果对精度有术的忧虑所在，手术必须暂停，直至准确的注册可以得到证实。 SEEG插入不仅在当前技术取代了现有的方法，但打开了一个神经外科医生的医疗设备到其他利用率。用于治疗癫痫的激光烧蚀是一个新兴的领域，它已经证明是适合于与机器人SEEG组合。12 我们已经开始到另一种技术与机器人SEEG是利用植入响应神经刺激系统（RNS）SEEG的证明3-D功能解剖，同时使电极精确和准确放置植入RNS时的好处是显然的能力。

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 border="0" cellpadding="0" cellspacing="0" width="573">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">ROSA</td>
			<td style="width:71px;">ROSA</td>
			<td style="width:119px;"></td>
			<td style="width:167px;">robotic implantation system</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">electrodes</td>
			<td style="width:71px;">adtech</td>
			<td style="width:119px;"></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是通过三维录音用于癫痫发作的准确，微创记录的方法和技术。在谁是认为合适的候选人有创记录癫痫病人，监察决定硬膜下格栅与SEEG之间进行。癫痫神经监测侵入患者复杂，难治性癫痫的追求。中创监测的目标是提供切除手术以使癫痫发作自由的希望。 SEEG的优势，包括进入深皮质结构，本地化的致痫区（EZ）时，硬膜下网格都未能做到这一点，并在患者的非皮损额外的时空性癫痫的能力。在这个手稿中，我们提出了SEEG的简要历史回顾和我们的下机器人立体定向无框体验报告。 SEEG插入当务之急步骤规划电极轨迹。为了最有效地记录通过SEEG轨迹发作活动应该基于对那里的癫痫发作起源推测的致痫灶（EZ）假设规划。在EZ假说是基于一个标准的术前后处理包括视频脑电图监测，MRI（磁共振成像），PET（正电子发射断层摄影术），发作SPECT（单光子发射计算机断层扫描），和神经心理学评估。使用EZ嫌疑，SEEG电极可以放在最小侵入性的同时保持准确度和精密度。临床结果表明本地化EZ在难以定位癫痫患者78％的能力。1

最近的研究结果表明，在一个连续的一系列78例谁通过机器人辅助进行SEEG插入有EZ成功的本土化患者76.2％。1这同一项研究显示，谁去拥有EZ手术切除有1级的患者患者67.8％恩格尔扣押自由（ 图4）。发病率是2.5％。永久的发病率被注意到的是1例（1.2％）。每电极，它显示出具有为0.08％的伤口感染和颅内血肿率，每个。 <img alt="图1" src="/files/ftp_upload/53206/53206fig1.jpg" /> 图1. SEEG植入的模式的例子。根据病人提出的假设所有填写个人都是定制的 。在这些例子中，我们显示（从上到下，从左到右）颞部，颞枕部，颞面值ietal枕，额颞，额顶叶，孤芳自赏，perisylvian，和额叶和双颞侧插入计划。黑点代表SEEG电极，在正交时尚植入入口点。黑线代表电极轨迹。经许可后转载，克利夫兰诊疗中心医疗艺术与摄影。版权所有2011 - 2013年保留所有权利。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53206/53206fig1large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图2" src="/files/ftp_upload/53206/53206fig2.jpg" /> 图2.方法深度植入电极。1）颅骨上钻有一个2.5毫米的钻头，通过立体定向系统的指导。2）单极电凝探头插入和硬脑膜被打开; 3）植入螺栓被拧紧入颅，还摹<html>通过立体定向系统4）用于电极的最终深度距离（D3）uided被计算和测定:[（靶杜拉距离+ D1） - D 2 = D 3]。最初，轨迹由一个stylette探针，通过植入螺栓引导创建。5）的深度电极的最后位置，并且其固定到螺栓，防止位移和脑脊液泄漏。经许可后转载，克利夫兰诊疗中心医疗艺术与摄影。版权所有2011-2013。保留所有权利。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53206/53206fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图3" src="/files/ftp_upload/53206/53206fig3.jpg" /> 图3.术手术AP颅骨X线，获得确认的电极位置对应于预先计划的轨迹。tp_upload / 53206 / 53206fig3large.jpg"目标="_空白"&gt;点击此处查看该图的放大版本。 <img alt="图4" src="/files/ftp_upload/53206/53206fig4.jpg" /> 图4.患者的预后的经历SEEG监测七十六名患者都能够有自己的EZ本地化;此外那些接受切除后SEEG 67％的患者经历1恩格尔级扣押的自由。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53206/53206fig4large.jpg" target="_blank">请点击此处查看该图的放大版本。</a>

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.

立体声电Encephalo-造影（SEEG）随着医学难治性癫痫的术前评估机器人辅助:技术说明

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

Nanyang Technological University

Research

JoVE Journal

Medicine

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

17.0K 次观看.  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. 

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

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.

在的鼠标Aortocaval瘘的技术方面

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

科研

医学

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.

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

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.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency Oscillations (HFOs) have emerged as potential presurgical biomarkers for the identification of the EZ in addition to Interictal Epileptiform Discharges (IEDs) and ictal activity. Although they are promising to localize the EZ, they are not yet suited for the diagnosis or monitoring of epilepsy in clinical practice. Primary barriers remain: the lack of a formal and global definition for HFOs; the consequent heterogeneity of methodological approaches used for their study; and the practical difficulties to detect and localize them noninvasively from scalp recordings. Here, we present a methodology for the recording, detection, and localization of interictal HFOs from pediatric patients with refractory epilepsy. We report representative data of HFOs detected noninvasively from interictal scalp EEG and MEG from two children undergoing surgery.
The underlying generators of HFOs were localized by solving the inverse problem and their localization was compared to the Seizure Onset Zone (SOZ) as this was defined by the epileptologists. For both patients, Interictal Epileptogenic Discharges (IEDs) and HFOs were localized with source imaging at concordant locations. For one patient, intracranial EEG (iEEG) data were also available. For this patient, we found that the HFOs localization was concordant between noninvasive and invasive methods. The comparison of iEEG with the results from scalp recordings served to validate these findings. To our best knowledge, this is the first study that presents the source localization of scalp HFOs from simultaneous EEG and MEG recordings comparing the results with invasive recordings. These findings suggest that HFOs can be reliably detected and localized noninvasively with scalp EEG and MEG. We conclude that the noninvasive localization of interictal HFOs could significantly improve the presurgical evaluation for pediatric patients with epilepsy.

High Frequency Oscillations (HFOs) have emerged as presurgical biomarkers for the identification of the epileptogenic zone in pediatric patients with medically refractory epilepsy. A methodology for the noninvasive recording, detection, and localization of HFOs with simultaneous scalp electroencephalography (EEG) and magnetoencephalography (MEG) is presented.

同时用脑磁图和脑电图为小儿癫痫的生物标志物检测发作间期高频振动

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

机器人手术中的紧急脱位: 一个模拟课程

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Assessment of Static Graviceptive Perception in the Roll-Plane using the Subjective Visual Vertical Paradigm

Vestibular disorders are among the most common syndromes in medicine. In recent years, new vestibular diagnostic systems have been introduced that allow the examination of all semicircular canals in the clinical setting. Assessment methods of the otolithic system, which is responsible for the perception of linear acceleration and perception of gravity, are far less in clinical use. There are several experimental approaches for measuring the perception of gravity. The most frequently used method is the determination of the subjective visual vertical. This is usually measured with the head in an upright position. We present here an assessment method for testing otolith function in the roll plane. The subjective visual vertical is measured in the head upright position as well as with head inclination of &#177; 15&#176; and &#177; 30&#176; in the roll plane. This extended functional paradigm is an easy-to-perform clinical test of otolith function and ensures increased information content for the detection of impaired graviceptive perception.

The perception of gravity is commonly determined by the subjective visual vertical in the head upright position. The additional assessment at head tilts of &#177; 15&#176; and &#177; 30&#176; in the roll plane ensures increased information content for the detection of impaired graviceptive perception.

使用主观视觉垂直范式对卷平面中的静态视觉感知的评估

Vestibular disorders are among the most common syndromes in medicine. In recent years, new vestibular diagnostic systems have been introduced that allow ...

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained using laser Doppler flowmetry (LDF). This paper demonstrates a closed skull preparation that allows cerebral blood flow to be assessed without penetrating the skull or installing a chamber or cerebral window. To evaluate autoregulatory mechanisms, a model of controlled blood pressure reduction via graded hemorrhage can be utilized while simultaneously employing LDF. This enables the real time tracking of the relative changes in the blood flow in response to reductions in arterial blood pressure produced by the withdrawal of circulating blood volume. This paradigm is a valuable approach to study cerebral blood flow autoregulation during reductions in arterial blood pressure and, with minor modifications in the protocol, is also valuable as an experimental model of hemorrhagic shock. In addition to evaluating autoregulatory responses, LDF can be used to monitor the cortical blood flow when investigating metabolic, myogenic, endothelial, humoral, or neural mechanisms that regulate cerebral blood flow and the impact of various experimental interventions and pathological conditions on cerebral blood flow.

This article demonstrates the use of laser Doppler flowmetry to evaluate the ability of the cerebral circulation to autoregulate its blood flow during reductions in arterial blood pressure.

使用激光多普勒流测量测量大鼠脑血流自动调节的评估

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained ...

Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training physicians&#39; wire-skills as well as improving planning of interventional procedures. The aim of this study was to develop a manufacturing process of patient-specific 3D-printed models for cardiovascular interventions.
To create a 3D-printed elastic phantom, different 3D-printing materials were compared to porcine biological tissues (i.e., aortic tissue) in terms of mechanical characteristics. A fitting material was selected based on comparative tensile tests and specific material thicknesses were defined. Anonymized contrast-enhanced CT-datasets were collected retrospectively. Patient-specific volumetric models were extracted from these datasets and subsequently 3D-printed. A pulsatile flow loop was constructed to simulate the intraluminal blood flow during interventions. Models&#39; suitability for clinical imaging was assessed by x-ray imaging, CT, 4D-MRI and (Doppler) ultrasonography. Contrast medium was used to enhance visibility in x-ray-based imaging. Different catheterization techniques were applied to evaluate the 3D-printed phantoms in physicians&#39; training as well as for pre-interventional therapy planning.
Printed models showed a high printing resolution (~30 &#181;m) and mechanical properties of the chosen material were comparable to physiological biomechanics. Physical and digital models showed high anatomical accuracy when compared to the underlying radiological dataset. Printed models were suitable for ultrasonic imaging as well as standard x-rays. Doppler ultrasonography and 4D-MRI displayed flow patterns and landmark characteristics (i.e., turbulence, wall shear stress) matching native data. In a catheter-based laboratory setting, patient-specific phantoms were easy to catheterize. Therapy planning and training of interventional procedures on challenging anatomies (e.g., congenital heart disease (CHD)) was possible.
Flexible patient-specific cardiovascular phantoms were 3D-printed, and the application of common clinical imaging techniques was possible. This new process is ideal as a training tool for catheter-based (electrophysiological) interventions and can be used in patient-specific therapy planning.

Here we present development of a mock circulation setup for multimodal therapy evaluation, pre-interventional planning, and physician-training on cardiovascular anatomies. With the application of patient-specific tomographic scans, this setup is ideal for therapeutic approaches, training, and education in individualized medicine.

干预规划和培训的3D打印心血管幻影的开发与评估

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training ...

Repetitive Blood Sampling from the Subclavian Vein of Conscious Rat

Rats are widely used in pharmacokinetics (PK) and toxicokinetic (TK) studies that need to collect a certain amount of blood at specific time points to detect drug exposure. The rat blood sampling method determines the quality of the plasma and further affects the precision of the test results. The subclavian vein blood collection method described in this protocol collects blood samples repeatedly in the conscious state of animals to meet the needs of PK and TK tests. The skills of restraint handling and appropriate procedure of needle incision ensure the success rate of blood collection. It is easy to operate while ensuring the quality of plasma and at the same time catering to animal welfare. However, this method requires skilled operation, and an improper one may cause animal weakness, pain, lameness, and even mortality. The current method has been used in the testing facility for a 4-week oral toxicity study in Sprague Dawley (SD) rats with TK. The maximum amount of blood collected within 24 h did not exceed 20% of the animal's total blood. The animals' body weight was more than 200 g for males and females. The data showed that the animals' bodyweight increased steadily every week, and the clinical observation was normal after repetitive sample collection.

The present protocol describes a simple and efficient method for collecting blood from the subclavian vein in rats. It enables rapid, timely, and easily identifiable sampling without anesthesia and obtains high-quality blood through repetitive sample collection.

意识大鼠锁骨下静脉的重复血液采样

Rats are widely used in pharmacokinetics (PK) and toxicokinetic (TK) studies that need to collect a certain amount of blood at specific time points to ...

Robotic Taj Mahal Hepatectomy for Hilar Cholangiocarcinoma

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In this study, a 32-year-old male patient with Bismuth Type IVa hilar cholangiocarcinoma underwent radical robotic resection of hepatic S4b, S5, and S1 (Taj Mahal hepatectomy) combined with regional lymphadenectomy, hilar bile duct reconstruction, and hepaticojejunostomy by the robotic surgical system. Postoperative pathological examination showed moderately-differentiated adenocarcinoma of the hilar bile duct. The surgical margins of the liver and bile ducts were negative. Recovery was smooth and the patient was discharged on the 17th postoperative day. The robotic surgical system and associated multiple instruments along with flexible and precise movements is suitable for the local hepatectomy around the porta hepatis, and delicate reconstruction of the hilar bile duct with a smaller diameter. This first clinical application study found that robotic Taj Mahal hepatectomy for hilar cholangiocarcinoma is safe and feasible and needs more experience for the evaluation of its long-term outcomes.

Robotic resection of hepatic S4b, S5, and S1 using the Taj Mahal procedure is feasible and safe for selected patients with hilar cholangiocarcinoma. The step-by-step details for this surgery are presented here.

机器人泰姬陵肝切除术治疗肺门胆管癌

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In ...