Rigid Cranial Fixation for Robot-Assisted Stereoelectroencephalography in Toddlers: Technical Considerations

2019 ◽  
Author(s):  
Hepzibha Alexander ◽  
Islam Fayed ◽  
Chima O Oluigbo
Keyword(s):  
Cranial Bone ◽  
Pediatric Epilepsy ◽  
Bone Thickness ◽  
Fixation Technique ◽  
Depth Electrodes ◽  
Concurrent Use ◽  
Pin Fixation ◽  
Computed Tomography Scans ◽  
Stereotactic Navigation ◽  
Neurosurgical Robot

Abstract BACKGROUND Stereoelectroencephalography (sEEG) using depth electrodes has become a mainstay of pediatric epilepsy surgery. This technique relies on rigid cranial fixation using skull pins, which forms the basis for accurate stereotactic navigation. The use of cranial fixation pins poses the threat of traumatic skull injuries in young children because of inadequate cranial bone thickness. OBJECTIVE To describe a rigid cranial fixation technique involving the integrated Gel Head Ring from the DORO QR3 multipurpose skull clamp set (Pro Med Instruments) with superimposed pin fixation in children below the age of 36 mo undergoing sEEG. METHODS Patients were placed in the supine position and the head was fixed using a DORO skull clamp with 3 pediatric cranial pins. The head was supported on the integrated Gel Head Ring, and a pin pressure of 20 pounds was applied. The DORO skull clamp set was then attached to the ROSA neurosurgical robot support telescopic arm for stereotactic navigation. RESULTS We present an illustrative series of 2 patients below the age of 3 yr with medically refractory epilepsy who underwent sEEG using our modified cranial fixation technique. Head position and reference registration were stable throughout the surgeries. Postoperative volumetric computed tomography scans of the head showed accurate placement of sEEG depth electrodes and did not reveal any fractures or epidural hematoma. No other complications related to cranial fixation were noted. CONCLUSION Concurrent use of rigid and nonrigid cranial fixation using the DORO skull clamp set provides safe and effective cranial fixation in infants and toddlers undergoing sEEG.

scholarly journals A New Predictive Modality of Cranial Bone Thickness

1999 ◽  
Vol 42 (6) ◽  
pp. 651-657 ◽  
Author(s):  
Mohammed M. Elahi ◽  
Kenneth L. Watkin ◽  
M Suheil Hakim ◽  
Melvin D. Schloss ◽  
M Lucie Lessard
Keyword(s):  
Cranial Bone ◽  
Bone Thickness

scholarly journals Localized, time-dependent responses of rat cranial bone to repeated mild traumatic brain injuries

2021 ◽  
Author(s):  
Larissa K Dill ◽  
Natalie A Sims ◽  
Ali Shad ◽  
Chidozie Anyaegbu ◽  
Andrew Warnock ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Bone Structure ◽  
Regions Of Interest ◽  
Cranial Bone ◽  
Micro Computed Tomography ◽  
Bone Thickness ◽  
Injury Site ◽  
Microstructural Alterations ◽  
Closed Head ◽  
Weight Drop

While it is well-established that bone responds dynamically to mechanical loading, the effects of mild traumatic brain injury (mTBI) on cranial bone composition are unclear. We hypothesized that repeated mTBI (rmTBI) would change the microstructure of cranial bones, without gross skull fractures. To address this, young adult female Piebald Viral Glaxo rats received sham, 1x, 2x or 3x closed-head mTBIs delivered at 24h intervals, using a weight drop device custom built for reproducible impact. Skull bones were collected at 2 or 10 weeks after the final injury/sham procedure, imaged by micro computed tomography and analyzed at predetermined regions of interest. In the interparietal bone, proximal to the injury site, modest increases in bone thickness was observed at 2 weeks, particularly following 3x mTBI. By 10 weeks, 2x mTBI induced a robust increase in the volume and thickness of the interparietal bone, alongside a corresponding decrease in the volume of marrow cavities in the diploe region. In contrast, neither parietal nor frontal skull samples were affected by rmTBI. Our findings demonstrate time- and location-dependent effects of rmTBI on cranial bone structure, highlighting a need to consider microstructural alterations to cranial bone when assessing the consequences of rmTBI.

Magnetoencephalography-guided resection of epileptogenic foci in children

2014 ◽  
Vol 14 (5) ◽  
pp. 532-537 ◽  
Author(s):  
Gregory W. Albert ◽  
George M. Ibrahim ◽  
Hiroshi Otsubo ◽  
Ayako Ochi ◽  
Cristina Y. Go ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Csf Leak ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Invasive Monitoring ◽  
Mri Findings ◽  
Resective Surgery ◽  
Depth Electrodes ◽  
Additional Surgery ◽  
Sick Children

Object Resective surgery is increasingly used in the management of pediatric epilepsy. Frequently, invasive monitoring with subdural electrodes is required to adequately map the epileptogenic focus. The risks of invasive monitoring include the need for 2 operations, infection, and CSF leak. The aim of this study was to evaluate the feasibility and outcomes of resective epilepsy surgery guided by magnetoencephalography (MEG) in children who would have otherwise been candidates for electrode implantation. Methods The authors reviewed the records of patients undergoing resective epilepsy surgery at the Hospital for Sick Children between 2001 and 2010. They identified cases in which resections were based on MEG data and no intracranial recordings were performed. Each patient's chart was reviewed for presentation, MRI findings, MEG findings, surgical procedure, pathology, and surgical outcome. Results Sixteen patients qualified for the study. All patients had localized spike clusters on MEG and most had abnormal findings on MRI. Resection was carried out in each case based on the MEG data linked to neuronavigation and supplemented with intraoperative neuromonitoring. Overall, 62.5% of patients were seizure free following surgery, and 20% of patients experienced an improvement in seizures without attaining seizure freedom. In 2 cases, additional surgery was performed subsequently with intracranial monitoring in attempts to obtain seizure control. Conclusions MEG is a viable alternative to invasive monitoring with intracranial electrodes for planning of resective surgery in carefully selected pediatric patients with localization-related epilepsy. Good candidates for this approach include patients who have a well-delineated, localized spike cluster on MEG that is concordant with findings of other preoperative evaluations and patients with prior brain pathologies that make the implantation of subdural and depth electrodes somewhat problematic.

Ultrasound in the Assessment of Cranial Bone Thickness

1997 ◽  
Vol 8 (3) ◽  
pp. 213-221 ◽  
Author(s):  
Mohammed M. Elahi ◽  
M. Lucie Lessard ◽  
Souheil Hakim ◽  
Kenneth Watkin ◽  
John Sampalis
Keyword(s):  
Cranial Bone ◽  
Bone Thickness

scholarly journals Depth Electrodes in Pediatric Epilepsy Surgery

2013 ◽  
Vol 40 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Janani Kassiri ◽  
Jeff Pugh ◽  
Sharon Carline ◽  
Laura Jurasek ◽  
Thomas Snyder ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Pediatric Epilepsy ◽  
Surgical Removal ◽  
Seizure Freedom ◽  
Sufficient Information ◽  
Epileptogenic Zone ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Intractable Seizures ◽  
Clinical Scenarios

Abstract:Background:The surgical removal of the epileptogenic zone in medically intractable seizures depends on accurate localization to minimize the neurological sequelae and prevent future seizures. To date, few studies have demonstrated the use of depth electrodes in a pediatric epilepsy population. Here, we report our study of pediatric epilepsy patients at our epilepsy center who were successfully operated for medically intractable seizures following the use of intracranial depth electrodes. In addition, we detail three individuals with distinct clinical scenarios in which depth electrodes were helpful and describe our technical approach to implantation and surgery.Methods:We retrospectively reviewed 18 pediatric epilepsy patients requiring depth electrode studies who presented at the University of Alberta Comprehensive Epilepsy Program between 1999 and 2010 with medically intractable epilepsy. Patients underwent cortical resection following depth electrode placement according to the Comprehensive Epilepsy Program surgical protocols after failure of surface electroencephalogram and magnetic resonance imaging to localize ictal onset zone.Result:The ictal onset zone was successfully identified in all 18 patients. Treatment of all surgical patients resulted in successful seizure freedom (Engel class I) without neurological complications.Conclusion:Intracranial depth electrode use is safe and able to provide sufficient information for the identification of the epileptogenic zone in pediatric epilepsy patients previously not considered for epilepsy surgery.

scholarly journals Mini-Plate and Screw Fixation Technique for Comminuted Flexor Digitorum Profundus Avulsion Fracture

2020 ◽  
Vol 25 (1) ◽  
pp. 33-38
Author(s):  
Hye Yeon Choi ◽  
Jeong Hwan Kim ◽  
Young Ju Noh
Keyword(s):  
Open Reduction ◽  
Avulsion Fracture ◽  
Screw Fixation ◽  
Flexor Digitorum Profundus ◽  
Fixation Technique ◽  
Avulsion Fractures ◽  
Pin Fixation ◽  
Flexor Digitorum ◽  
Mini Plate ◽  
Pull Out Suture

Avulsion fracture of flexor digitorum profundus (FDP) tendon is relatively rare fracture at the distal phalangeal base than avulsion fracture of terminal extensor tendon. Terminal extensor avulsion fracture, known as bony mallet finger, could be successfully treated by closed reduction and pinning, such as extension block technique. However, most of FDP avulsion fracture, known as Jersey’s finger, needed open reduction, because of the proximal migration of fracture fragment and difficulty of pin fixation. Up to date, most of FDP avulsion fractures were treated by open reduction and fixation by pull-out suture or suture anchor technique. We report a case of comminuted FDP avulsion fracture, successfully treated by open reduction and mini-plate and screw fixation technique.

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